“All set. Just start talking.”
Shandy settles back. After a moment, he begins.
Charles Shandy, U.K. Relief Official
My work as a public health officer has taken me to many parts of the United States, but I have spent most of my time in Texas, being attached to the United Kingdom Emergency Medical Relief Organization, Southwest Region (HQ) in Dallas, as Director of Contagious Disease Control. I have been here in an official capacity for three years. Prior to the war, my experience in America was limited to a three-week vacation in San Francisco. We exchanged our house with a couple living there, the Mannings. I remember it as being a beautiful city and formed a very favorable impression of the American people from my experiences in California. When the King and the Prime Minister described the situation in America on the telly in the winter of 1988, I was among those who volunteered for the relief effort. One cannot fail to remember the American response during and after World War II, or the close ties between the two countries. I was then assistant managing director of the Albert Doring Company. We specialized in the transport of live vaccines to tropical areas, so I knew a good deal about contagion.
At least, that was what I thought at the time.
During our prewar vacation, my wife and I traveled up and down the West Coast on a train called the
I have been once to San Francisco since the war, and found it quite a tattered and crowded version of its old self. But certainly recognizable. I went to call on the Mannings, but nobody in the road knew what had become of them. The family occupying their house would not talk to me.
My primary job is to identify outbreaks of treatable contagious disease and allocate appropriate Relief resources to them so that the problem will be minimized. It is not generally understood, but our main function is to supplement existing American services.
The ordinary citizen views the country as being without any internal authority, but this is not the case. There is still a strong federal presence. Certainly in health care. All surviving physicians have, for example, been recorded in a new central registry maintained by the Centers for Disease Control. Hospitals can, as of last year, report their supply needs to the Centers also, and get fairly rapid allocation of medicines and equipment. The loss of records and trained bureaucratic personnel that occurred when Washington was destroyed was certainly damaging to health care, but it has not proved fatal.
I work very closely with the Centers for Disease Control. My experience with the CDC has been very good. The Centers have grown tremendously since the war. There has been great advance in identifying the numerous mutant disease factors that have appeared among the American population. The progress with pseudomonas plague, which has become a significant cause of death in the Southwest since the war, has been spectacular. The death rate from this illness has been reduced to forty-five percent, primarily as a result of the development of nonantibiotic prophylaxis, which was done at CDC. We have helped in educating the population to identify and report plague cases so that isolation and treatment can be effected.
In the past year we have not had the continuous round of problems that were encountered at first. Certainly nothing on the scale of the Cincinnati Flu in ’90. Worldwide deaths from that disease are estimated at approximately two hundred and thirty million, twenty-one million of them in the United States and two million in Europe.
But the U.S. population is better fed and stronger now, so we expect the next pandemic to be less damaging here than was the last.
We anticipate another expression of this hybrid flu, and are relying heavily on CDC results in the development of a treatment regime.
Actually, one of our major projects at present is to teach CDC pneumonia prophylaxis, the construction of steam hats, the various means of assisting the breathing-impaired, control of circulation with hot and cold spots, and such things. CDC has really worked miracles with the very simplest materials and procedures.
The objective of their work is to develop effective medical treatment for serious disease, treatment that can be applied at home by family members and by the victims themselves. On another front, we are underwriting the medical faculties at the new University of Texas Medical School here in Dallas, and providing British doctor- professors so that local medical personnel can concentrate on hospital work.
Despite all this effort, we are not out of the woods. Frankly, however, the drop in U.S. as well as world population is also going to mean a long-term reduction in pandemic disease, if only because the remaining population groups are obviously going to be farther apart and have fewer contacts with one another. Despite this, it must be recalled that, worldwide, health systems remain frail. Supply lines are long and subject to extraordinary stresses. Fuel may be unavailable to move a shipment of drugs from the U.K. to America, for example. On the other hand, the lack of communications—a situation that is really improving fast, by the way—may simply mean that a disease outbreak goes unnoticed by us until it reaches an area where we have a permanent station.
This was the case with the cholera epidemic that created such suffering in South Texas last summer. We consider this to be a deeply damaged area, with the extensive residual radiation contamination from San Antonio, the uninhabitable zones, and the presence of an ill, malnourished, and restless Mexican population to the south. There was an unnoticed migration from Mexico into Texas all summer—more than three hundred thousand individuals were involved, virtually all of them starving. Many of these people moved right through the San Antonio Red Zone and began arriving in Dallas and Waco not only dying of starvation and radiation sickness, but carrying cholera. Neither of the first two problems is contagious, fortunately, but the cholera did spread to the local population. There were eight thousand deaths among registered inhabitants of the state, according to the Statistical Services Office.
Our treatment regime consisted of oral electrolyte replacement and treatment of exposed populations with tetracycline. The outbreak was quelled, but the real solution lies not in prophylaxis but in the restoration of sanitary facilities to prewar condition.
To communicate the extent of health problems in Texas, it is only necessary to talk about birth rates. The Southwest shares with the Northeast the dubious distinction of having a death rate four times in excess of its birth rate. And the number of mutations per 100,000 live births is 1,018, the highest in North America. In the Southwest we have placed birth mutations on the epidemic list and have put priority on obtaining working sonogram and amniocentesis equipment, so that parents can have some warning that their child may not be normal. In addition, the Relief has established criteria for abortion and mandatory destruction of nonassistable live births, to relieve parents of this difficult responsibility.
We encourage relocation of individuals out of the Yellow Zones south and east of San Antonio, and routinely triage those who refuse to move. The population of these counties has dropped roughly ninety-one percent since the war.
Since the beginning of my tour I have dealt with Cincinnati Flu, cholera, the first Nonspecific Sclerosing Disease panic in Dallas, a massive outbreak of brucellosis in Amarillo, apparently caused by the ingestion of contaminated milk smuggled up from Gonzales County, and numerous other smaller crises. I cannot say that my job is less than exceedingly challenging.
When my four-year tour of duty here is up, I expect to be posted back to England for six months of R-and-R and then down to the Argentine, where we have an extensive operation contending with malnutrition and its associated diseases.
You have asked me to be as personal as possible. What is the life of a Relief officer actually like? Do I meet with any hostility on the job? Of course, a certain amount. And I have emotional difficulties of my own. I must often make decisions that shorten and even take life. When I must isolate populations to prevent the spread of disease, and sometimes even withdraw medical assistance to allocate it to areas where help will still matter, I all but sweat blood.
On the other hand, I have been able to help enormous numbers of people. We have a large number of burn cases in Dallas, many of them scarred to the point of crippling: refugees from the South Texas firestorm, some of
