Tuesday, June 10, 2014

Village Medicine

[The Four Questions have drawn an incredible number of responses, both as blog comments and as much longer emails. They are still coming in, and will take me some time to process.]

The e-book edition of Communities that Abide includes a chapter by Peter Gray, which didn't make it into the paper edition. Peter is a family physician in Canada (as is James, who contributed another chapter on medicine; it is nice that Canadian medics are stepping up to helping people deal with the medical madness that reigns south of the border). He set out to explain “how a village healer in a post-collapse community of a few hundred people, with some basic knowledge and simple tools, might make a positive difference to health, illness and suffering in that community. Peter is not any sort of alternative practitioner: “The tools and techniques described in this essay are only to be used in scenarios where conventional Western medicine is unavailable.” But unlike the vast majority of his colleagues, Peter has spent a great deal of time thinking forward to the time when the tools Western medicine takes for granted are unavailable, and finding out which alternatives are effective, which medical interventions should still be attempted, and which are pointless to try.

The topic of the future of medicine hits a nerve with a great many people. We all know people whose ability to function depends on an uninterrupted flow of “regimen” drugs. Even those who are healthy (in the sense of not having to take anything except air, water, food and a bit of sunshine) still worry about having access to medical care for emergencies, for giving birth, and for palliative care in our final months and days. It is good to know that there can be recourse (with a bit of preparation); it is also good to know what to expect and what not to expect.

Western medicine starts with the promise of eternal life but ends with hospital hallways filled with the dying while the rest of the population avoids them like the plague, for fear of getting sick. Somewhere in between, if the conditions are right, it goes through a phase of financial gluttony: how much should Americans spend on health care (whether they are healthy or not)? 20%? 30%? The sky is the limit. But the end result will be the same.

The alternative does exist. Peter picks up where James left off, responding to questions that my readers have asked me, and that we will all find ourselves trying to answer as we search for alternatives to the “radical cashectomy”—a non-elective surgery with a poor survival rate that is currently on offer at most of our contemporary medical establishments. The areas he addresses are:

  • Keeping healthy
  • Stockpiling medications
  • Insulin-dependent diabetics
  • Immunization
  • Psychological medicine
  • Herbal medicines (legal and illegal)
  • Surgery
  • Making difficult choices

At the outset, Peter debunks the thesis that regular check-ups are somehow useful or necessary: “From my personal observations as a family physician, the patients who show up at my office regularly tend to be the least healthy, while the patients who remain healthy well into their 80s and 90s are seen rarely, if at all, and are usually on minimal or no medication. ... The main problem with the ‘doctor knows best’ narrative is that it places the responsibility for staying healthy on the physician rather than the patient. This type of health care is a luxury we can barely afford even in today’s affluent, technologically advanced society, and it will not be available in a post-peak village community. Maintaining your health in the future will probably come down to just this: ‘Look in the mirror. Are you obese? Are you undernourished? Do you smoke? Do you drink to excess? Do you engage in risky behavior?’ People know these things for themselves without needing a physician or expensive tests to tell them.”

Of course, people do get sick, and if certain life-saving drugs have been stockpiled beforehand, then their chances of recovery can be much better. Peter goes into some detail about the Shelf Life Extension Program (SLEP), “a secretive US Government program which was set up to conduct research into whether pharmaceuticals which have passed their expiration date are safe and/or effective to use.” Don't ask your government, because the pharmaceutical companies have forbidden it from telling you, but the conclusion is this: “Overall, the available evidence suggests ... that most solid pharmaceuticals (capsules and tablets) are safe and effective to use long after their official expiration date provided they have been stored in cool, dark and dry conditions. The same cannot necessarily be said of liquids or of pharmaceuticals which have been stored in sub-optimal conditions. The maximum length of time for which pharmaceuticals can be kept is uncertain, but I understand that some pharmaceuticals which have been kept from the start of the SLEP program in 1986 may still be effective.” Another key point: over time, pharmaceuticals generally do not become dangerous; they just become less effective. Thus, a stockpile of the right drugs in the right form makes it much easier to handle a variety of medical emergencies, while supplies last.

When the supplies start running out, the remaining recourse is to start using herbal medicines. Peter separates them into three groups:

1. Herbal medicines which probably work
2. Herbal medicines which probably don’t work
3. Herbal medicines which definitely work but are illegal to produce without a government license

The “probably work” list is rather long and deserves plenty of study. The “definitely work” list is quite short and, in some ways, more important: you wouldn't want to perform most kinds of surgery without having a bit of opium on hand, by which point having a government license to produce it will be rather beside the point, because, you see, government officials sometimes require surgery too.

Speaking of surgery, Peter singles out the single most common surgical procedure village practitioners will be called upon to perform: lower limb amputation: “Diabetes is the most common reason for lower limb amputation today. One third of all foot amputations are performed on diabetics with foot wounds or ulcers. The reason why so many diabetics need amputations is because high circulating blood sugar levels over many years cause damage to the interior of blood vessels, making them them narrower and less efficient at delivering blood and oxygen to where they are needed. As the condition progresses, the flow of blood and oxygen drops below critical levels, at which point the tissue dies. ...  If modern pharmaceuticals become unavailable, we will have a large number of untreated diabetics developing complications much faster than they would have previously. The numbers are difficult to estimate, but let's say that the number of amputations needed may increase five-fold. Then, instead of looking at just four amputations in a working lifetime, [a village doctor] may now be looking at 20 amputations—one every couple of years. Whatever the exact numbers may turn out to be, there will be a significant number of these procedures needed.” How will you handle these? Peter walks you through the steps. Yeah, the patient might die. But if gangrene is allowed to run its course, the patient will die. It's the patient's decision.

And this is perhaps the most important point of all: we will all be forced to make life-or-death decisions. Currently, our decisions are a matter of consumer choice—hamburger or cheeseburger? In the future, it will be “Should I allow an untrained person to amputate my gangrenous leg without a general anesthetic, or should I succumb to gangrene? ... The era we are entering into has been called “the Age of Limits.” It might as well also be called “the Age of Difficult Choices.” Good luck.

24 comments:

John in Cape Charles Va said...

There is quite a movement these days towards "ancestral health" and "ancestral diets". In fact there is an interesting symposium coming up on this at the U of Berkeley in August. So perhaps just as John Greer says "collapse now and avoid the rush", we might want to add "exit industrial and manufactured food now and restore your health while you can".

-jd

Ceworthe said...

I got the e-book version and found his assessment, as well as those of others on the same and other topics, extremely helpful

John D. Wheeler said...

As the Archdruid says, when faced with two difficult choices, look for the third alternative. In the case of gangrene, the answer is maggots. Specifically, green bottle fly larvae raised in a sterile environment. They will eat dead flesh but leave live tissue alone, cleaning out a wound with better precision than the best surgeon. It may be the most disgusting option, but even now it can have superior results.

That is just one specific example. The main point is we may have to give up our modern sensibilities to achieve desirable results.

postpeakmedicine said...

That is a good point about maggot debridement therapy: it's a potential treatment I had overlooked in the article and the Post Peak Medicine book and I shall have to remedy that. There is good scientific evidence in PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) that maggot debridement therapy works to promote ulcer healing.

The only note of caution I would sound is that it has mainly been used to promote the healing of chronic ulcers by removing the surface layer of dead tissue and allowing the underlying healthy tissue to regenerate. I'm not sure that there would be a place for it if there was no underlying healthy tissue to regenerate, e.g. where the whole foot is dead.

Terry T said...

I'm glad you brought this up. But I have the print book. I'd love to see the "probably will work" and illegal items on his list.

I'd been forced into the herbal due to pharmaceutical side effects and high costs and am so grateful I was. The pharmaceutical supply websites have wonderful libraries of active ingredients of all the herbals known. The web is filled with medical journal articles on the effects of these compounds and their host plants. I'm talking peer review stuff. It's all there. So I shopped around for the botanicals and quickly arrived at a simple regimen that has both subjective and objective effects desired. The blood work confirms it.

Frankly, the research was a revelation and showed how backwards much of our medical treatment is due to a) practice being 20 years behind research, 2) profit motive squelching the use of unpatentable botanicals until compounds can be isolated and synthesized, and c) the effective brainwashing of the public into believing that plant based and diet based medicine is quackery and nothing else.

If one accepts that a) evolution is real and b) we are a product of our hereditary biosphere and c) our ancestors didn't have the option of opening the fridge and pulling out the mac and cheese but instead ate anything and everything that was edible, some perhaps only circumstantially as needed for medicinal purposes, then it is not hard to see that our grotesquely oversimplified diet of a dozen nutrients as provided by our monoculture mindset is missing enough to explain a good proportion of modern illnesses, including mental illness.

JiCCVa brings up "ancestral health" above. I have long contended that DNA testing can place an individuals genome in a handful of regions, about which all botany has been known. An individualized cocktail developed and utilized would, I estimate, solve the vast majority of intractable illnesses found in modern society, including most cancer. Just look at the journal articles. Effective treatments are well documented.

Now, the trick is to do this pre-collapse and get the stuff growing NOW, so long supply chains won't cut us off.

A few of the most effective herbs are hard to come by in the U.S. as it is, and I fear will probably become "controlled" --illegal-- not because they are hallucinogenic or dangerous (they aren't), but because they work too well!

Eddie Tennison said...

For a lot of Type 1 diabetics, fast collapse is likely to be a death sentence. In fact most of the diseases we handle easily, like childhood diarrhea, bacterial pneumonia, and influenza, will kill people right and left if we lose access to modern drugs. Sorry if I don't put too much faith in folk remedies, although some of them no doubt have some benefit.

I'm not a physician but I'm a dental GP, and I'm worried about losing the very basics, like local anesthetics, that are supplied these days by the JIT delivery system. I've taken the precaution of starting to stockpile powdered lidocaine, which is available online (apparently for use mostly by drug dealers, from what I gather.)

As they are supplied ordinarily, local anesthetics have a claimed shelf life of one year. From time to time, some of them seem to fall into short supply now, due to bad planning by our friends at Big Pharma.

I'd welcome information regarding sources for storage friendly forms of basics like epinephrine. As doctors, we can only buy drugs from those who legally sell them, and nowadays the whole supply chain is corporatized, and tightly controlled.

Taraxacum said...

I have been studying herbal medicine for about 8 years now, and I have to say that a lot of it works quite well, albeit by slightly different rules of practice than modern medicine. Herbal protocols have to be quite a bit more intensive in some cases, and more personalized in others. It is easy to understand why so many are skeptical. There are a lot of charlatans out there, and more critically, there is an extremely large amount of bad information floating around the internet. The information you can get from a random web search, or a site like Livestrong.com, or even worse, blatant profiteers and fearmongers like Mercola or NaturalNews.com, is as likely as not to be unhelpful, to be generous about it. If you want a taste of true scientific herbalism take a look at The Journal of Medical Herbalism at
http://medherb.com/MHHOME.SHTML, or James Duke's database of phytochemicals at http://www.ars-grin.gov/duke/,
or the Southwest School of Botanical Medicine at http://www.swsbm.com, where you can find extensive databases of all sorts of data, including old texts containing the accumulated wisdom of the Eclectic and Physiomedicalist practitioners.

A lot of the best knowledge is contained in the heads of the best modern practitioners, many of whom have published books or websites with blogs. Stephen Harrod Buhner is an essential author who has done extensive research into herbs effective for antibiotic resistant infections. Also, for those who are interested, to get started, look at

http://www.herbcraft.org/seedsandstems.html,

http://www.herbcraft.org/links.html

http://www.matthewwoodherbs.com/Mattwood.html

and

http://bearmedicineherbals.com/

to get an idea of how genuine, effective practitioners approach the art.

Joseph said...

I bought the ebook and enjoyed Peter Gray's essay. I am also a family physician. Well done Peter!.

However, I disagree that amputations due to diabetic complications will be the most common reason for limb amputations post-collapse. Currently, the vast majority of diabetics are Type 2 diabetics (usually adult onset, non insulin dependent). Juvenile onset or Type 1 (insulin dependent) diabetes is a relatively rare disease.

Type 2 diabetes is a disease of our cheap calorie, carbohydrate rich modern world diet. It is not something common in the developing world. Based on a stint working in Kenya, I can say that type 2 diabetes and other common 1st world diseases (such and coronary artery disease) are rare there. It is infectious disease that predominates the medical problems in the developing world and so it will be world wide post-collapse. Above all I think it will be the unavailability of antibiotics that will lead to otherwise avoidable death in a post-collapse world. And that includes causing death of many who undergo crude (mostly post traumatic) amputations.

Samantha said...

Local anesthetic is always within easy reach, for those with a little skill in hypnosis. The In the 19th century, the surgeon James Esdaile performed hundreds of surgical procedures with use of hypnosis for anesthesia and with extremely low morbidity rates for the times. google him and learn. Almost simultaneously with the reports of many surgical successes with hypnosis, ether and chloroform became popular and displaced the use of hypnosis for anesthesia in surgery.
Modern consulting hypnotists can induce local analgesia or anesthesia in less than a minute, with no side-effects or risk of overdose.
The future of healthcare in a post collapse world was one of the main reasons I became a hypnotist back in 2005.

salza said...

The medical info seems to be accurate and practical, but what about dental health, I'd love to find some DIY dental info. Any ideas? Anybody?

postpeakmedicine said...

Where there Is No Dentist"
http://modernsurvivalonline.com/Files/medical/wtndentist_2010_Web_Full_Book.pdf

Eddie Tennison said...

Not to hog the thread, but I'd like to respond again.

@Taraxacum

Thank you for the links. I intend to educate myself better in this area. Is there anyone who teaches workshops or CE for healthcare pros that you'd recommend?

@postpeakmedicine and salsa

Thanks for what you're doing. I agree that" Where There is no Dentist" is an excellent book. It is available widely for free download. Everyone should print a copy and read it. Much of the first part is aimed at teaching prevention to 3rd world populations, but it is completely applicable to a post collapse world. The diagnosis portion is also excellent. It's the treatment portion of the book where it might fall a little short. I am currently writing an article of my own about dental preps and I'll share it when I'm done. I hope it will add a little useful knowledge.

@Samantha

I love hypnosis, and I have more than a passing knowledge there, having studied the subject with an acknowledged master for two years. I take issue with your statement " Modern consulting hypnotists can induce local analgesia or anesthesia in less than a minute."

You left out the part about the repeated half-hour sessions to create triggers that would make that possible. No hypnotist I've met can induce sufficient analgesia or anesthesia on a brand new patient in the way you describe. Perhaps you can. Maybe Milton Erickson could have in his day. The average consulting hypnotist cannot.

BrianZ said...

A senior nurse I know here in Canada works in the local big research hospital.
She says they use leaches to reduce swelling. It is apparently quite effective for chronic or other conditions where modern medicine isn’t quite effective.
I guess you get assigned a particular leach and you get to name it.
Apparently outcomes are better, less disgust and fear, this way.

Taraxacum said...

@ Eddie:

I don't know anyone offhand exactly, though there is a chance I could turn someone up through my networks. You might try reaching out through the following links to see if anyone knows anything:

http://www.ithacahealth.org/freeclinic.html The Ithaca NY free clinic, where physicians and alternative practitioners work in concert to provide free healthcare to all comers.

http://thehumanpath.com/index.htm
A wilderness survival school started by a former special forces agent.

http://www.muih.edu/
Maryland University of Integrative Health, offering accredited graduate degrees.

http://www.americanherbalistsguild.com/

ccwaters said...

Thanks for the information. A brilliant thread.

Kaela van Breevoort Reed said...

@ Eddie

I've been studying herbalism for about 5 years, and I just went to a wonderful conference in North Carolina that has CE's for MD's, ND's, RN's & Acupuncturists. The conference is called Medicines from the Earth and is held yearly. There are a few other conferences like the International Herb Symposium and the same people that run Med from the Earth also organize another conference in the South East.
Hopefully that's helpful!

Samantha said...

@ Eddie
One 'acknowledged master' is not necessarily as good as another.
Two weekends with a good instructor can have you up to speed. Hypnosis is not rocket science.

In the future, when a person has the choice of hypnotic anesthesia or nothing, motivation to follow the hypnotist's instructions quickly and carefully will make the job even easier.

You are probably correct that 'The average consulting hypnotist cannot,' but I didn't say 'average', I said modern. Which, to me, means someone who has learned the latest techniques and uses them.

Mr. Moai said...

As far as diabetes goes, I think starvation might surpass it in the short term, by those who do not see the food all around them. A hunting, wild harvesting and cultivation system (once developed) is capable of providing 20,000X the FDA nutrition requirements and results in drastic weight loss and balancing of insulin levels. What we eat today is starvation food. It starves us of nutrition so we keep eating more as our body grasps for nutrients. What an excellent marketing gimmick, the food that makes you hungry yet fat. Grains, starches, and tubers were often food only eaten in lean times by our hunter gatherer ancestors. Our saliva is adapted to process starches and process them into sugar to keep us from starving when surviving off our environment living off edible roots and bark (not glamorous, but it works) with some dried herbs and maybe some dried fruit or meat.

It is all about understanding and adapting to your environment. Herbalism, a knowledge of wild foods in your area, and seasonal collection techniques are a start. Many people may see collapse coming and think we are screwed. It may apply in their case, but there are those who have been preparing for years who have the knowledge to make it through. It is not enough to simply recognize the problem and stockpile. It helps as a buffer. But as we should have learned by now (considering this is a blog about peak oil) sustainability > supplies. Starting with a sustainable mindset will vastly improve your chances of living longer than X months.

For practical knowledge about improvised medicine the tome Wilderness Medicine by Paul Auerbach is PHD-grade stuff.

I also second the Southwest School of Botanical Medicine.

There are spiritual/mind/psychic healing methods which while scoffed at today will be in resurgence. The time will soon come when the spiritual part of our existence will again reassert itself. Power outages will collapse the etheric net which surrounds the earth due to our poor application of Maxwell's equations, ignoring the inverse wave. Implosive energy will power the future as an implosion of the ether due to magneto-electric or mass implosion is capable of releasing unfathomable amounts of energy. The use of implosion energy can heal the planet by stimulating growth. I think the future is a bit brighter than people think in the long run, but we have to either surpass our current culture and technology or reinvent a new post-collapse culture to create one that is beyond it's mental infancy and which is adapted to our environment with a richer, more complex view of the world. Follow your heart, trust your intuition, and live to bring a better future to mankind. It's actually uphill from here in my opinion as people begin to leave behind the madness of modernity steeped in Logical Positivism and the earth begins to heal itself, which will heal us.

Ien in the Kootenays said...

I did not even finish reading the post. Hopped over to Amazon and got the book. Must get the herb garden refreshed, new bed of echinacea is in order....

Cathode Ray said...

Here in Australia medical cannabis is illegal. However is is supplied by some determined and caring people who run the risk of court and gaol. See http://www.thesaturdaypaper.com.au/news/health/2014/05/31/should-medical-cannabis-be-legal/1401458400#.U4rqWRy1leU

onething said...

Samantha,

I sure would like to meet the hypnotist who can put me out. I've tried about three times to be hypnotized and while I got relaxed and a bit dreamy, I didn't get what I came for.

Eddie Tennison said...

@samantha

Shoot me a link. I'm all about training. Or if you'd prefer, send the info to Dmitry and perhaps he can forward it to me.

@onething

Hypnosis does not generally put people "out". This is a misunderstanding about what hypnosis really is (which is a way to communicate directly with the subconscious).

Stage hypnotists practice certain techniques that work well with certain particularly suggestible people. They cherry pick their subjects and impress people with their rapid induction techniques. While it makes a good show, it has little to do with the kind of therapeutic hypnosis that actually helps people.

Relaxed and dreamy = being in a suggestible alpha brainwave pattern=hypnosis. This is why TV advertising works so well.

onething said...

Eddie and/or Samantha:

My use of the phrase "put me out" was ill chosen, probably due to Samantha saying you could perform surgery with it. Relaxed and dreamy does not cut it! That might be alpha brain wave, but you could have pinched me and I'd feel it.
I was trying to get to the spirit world, past lives. Didn't get very far.

Samantha said...

onething and Eddie,
There are hundreds of websites that debunk the myths of hypnosis (what if I get stuck in trance!?) and explain how surgery can be performed using only hypnotic anesthesia.
Hypnosis IS a fascinating topic, full of wonder and promise. Click on my avatar and follow the links to contact me if you like.