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We all fall short in public health

In 1981, I spent part of the Christmas holidays visiting El Salvadoran refugee camps on the Honduran side of that turbulent isolated border.

For a few days I filled in for a French physician who had developed a serious eye inflammation. She refused to leave for much-needed medical attention unless someone came to relieve her.

One afternoon I was driven to a new cluster of refugees who had recently come across the border. I was not an expert in public health, but on our arrival, I saw several newly constructed outhouses, the fresh unweathered wood evidence of the newness. Wanting to put emphasis on the importance of sanitation, the first thing I asked to see was these outhouses. I grandly opened the door.

The sickening image still lingers these many decades later.

Public health success does not always come easily.

I was not raised by my father, but we sent some time together in the late 1960s when I was in Marine Corps training in southern California. During our weekend visits, he told me stories about his Army days in the 4th Armored Division, one of Patton’s units, during World War II in Europe.

The harsh winter of ’44 and his volunteering for burial details were part of the conversations, but his lifelong three-pack-a-day cigarette habit wasn’t discussed much other than him saying he liked the taste of a cigarette, one of the few pleasures during those days in Europe.

Decades later the cigarettes killed him. An esophageal cancer was successfully removed, but his lungs were so bad, he was unable to get off the ventilator and out of the hospital before he died.

Public health advice can often be easier to give than receive. Sometimes in meetings with other medical people, the topic comes up: “non-compliant patients.” It is a very necessary discussion. Why don’t people quit smoking, wear seat belts, get vaccines, eat better, move more, and drink less alcohol? What will it take to get a healthier Arkansas?

But I remind myself: We are all “non-compliant patients,” including doctors and nurses. Almost all of us lead lives with inconsistencies, and almost all of us fall short of perfection when it comes to living a healthy life.

I don’t know what the problem was with the outhouses, but I am sure the misunderstanding was cleared up after I left. And I doubt anyone would have been successful in getting my father to quit smoking. He had earned the habit the hard way.

On the other hand, after remarrying and settling into post-war American life, he only watched game shows on television. No shoot-’em-ups or violent dramas for him. He had seen enough up close. Maybe that’s not a bad health measure for the rest of us.

Some top-tier professional athletes have not yet received a vaccine for covid. Frankly, it drives me bonkers! Why can’t they all be like Arkansas’ Bobby Portis, I say to myself, and use their fame and success to advocate and educate for public health?

We might have avoided 200,000 American deaths if everyone had followed Bobby’s advice and jumped in line for a vaccine when they were first available and appropriately wore masks. But then I force myself to consider their perspective, wrong as I think they may be. Their lives have been ones of training, grit, and discipline. Their fitness is far superior to most of us, and they are too polite to comment on the lack of good health habits they see in so many of their fans.

In the last few weeks I have heard interviews of hospital medical personnel very upset they may lose their jobs over a requirement that they be vaccinated. I applaud medical facilities wanting to have a safe environment with 100 percent vaccinated staff. It’s a necessity during this scourge. And most responsible employers in all economic sectors want a safe work environment and will adopt vaccine policies to accomplish that goal.

But these medical people unsure about the vaccine are not uncaring. And if we were to do a side-by-side comparison of our health habits, I am sure that I would not look so good in some of them.

So here’s my point: This vigorous argument we are having about vaccines must be a debate, not a feud. A disagreement, not a war.

Vaccine issues are not going to go away. There will be flu shots and boosters and covid vaccines and normal kid shots and adult pneumonia vaccine and Shingrix and all the other excellent and safe vaccines available. And then we start the discussion over again when the next covid booster or flu shot comes due.

Argue firmly. Listen respectfully. Surely our Thanksgiving table is big enough for that aunt and uncle who have a different view on covid vaccines.