There are basically two approaches in the treatment of an illness.

  1. There is symptomatic treatment, which as the name implies, consists of alleviating the physical discomforts associated with the problem
  2. There is the elimination of the cause which in most cases is preferable.

For example there was a time when typhoid fever was incurable and often fatal. Treatments consisted of attempts to keep the patient hydrated, control the pain and diminish bowel hyperactivity.

When it was determined that the most common source of the infection was in contaminated drinking water it was possible to eliminate the cause of epidemics of the disease. Later, effective antibiotics would be developed; however, it is obviously much preferable to avoid contracting the disease in the first place.

Although typhoid fever has been all but eliminated in our country, many throughout the world are still at risk for a variety of water borne illnesses. Water is necessary for life as we know it, and we humans cannot live longer than a few days without it. Consequently, we are forced to drink whatever is available. The most recent example is the situation in Flint Michigan where bureaucratic bungling and an apparent blatant disregard for public health and welfare has put thousands at risk for various neurological problems. In children the extent of brain damage due to lead poisoning may not be apparent for years to come.

Unfortunately, these kinds of problems are not unique to Flint, but are often accepted as a fact of life when they occur in developing nations. When masses of people live in conditions of extreme poverty, they are often eager to welcome any kind of development which could improve their lives. These are often the same places where public health facilities are either scarce or non-existent, citizens are not made aware of the health problems that can accompany resource extraction, and there is little regulation to protect the worker or his environment. A dysfunctional or corrupt government may look the other way while outside influences plunder the nation, and more powerful nations may influence public policy.
It surprised me to learn that this problem continues to exist today even though the age of imperialism is supposed to be long gone. It was brought to my attention in an unlikely place when I attended a presentation at my church by a missionary from Bolivia. She did not fit the image often times ascribed to missionaries as staid and boring, but turned out to be a vivacious and positive young lady. In a subsequent one on one conversation I found Chenoa to be also quite charming in addition to being dedicated to her cause.
Her cause was to restore the water supply in La Paz, the third largest city in Bolivia. The city’s water was supplied by a river which ran through the city, and had its origin in mountain glaciers. Consequently the water was pristine until what some have called the “resource curse” came to bare. That was when mining for minerals began upstream and the waste was dumped into the river. The water supply became polluted with a variety of contaminates which made it unfit to drink. I was pleased to learn that Chenoa and her affiliates were seeking to cure the cause rather than just the symptoms of the problem. To temporize by passing out bottled water for example would obviously do little to cure the illness, and healing could only begin if the mining company would get their act together.
In order to encourage better behavior the Presbyterian Church which sponsors Chenoa wisely teamed up with an activist group called “Joining Hands”. As its name implies this organization is non-denominational and includes not only other churches but multiple other activist groups native to Bolivia. This inclusiveness should go a long way toward reducing the perception by some that missionaries invade their land to tell them what to do. One of the focuses of this organization is on Extractive Industries and Water with the following stated goals:
“Uphold transparency and oppose corruption in countries where mineral and resource extraction create wealth for a few and rampant poverty for the vulnerable majority…Deal with the impact of the extractive industries on communities of people and the environment, advancing the right of the people to access clean water, protected from pollution.”
It was gratifying to hear that a new generation of missionaries are determined to not only talk the talk, but walk the walk. That is not to say that others have not been concerned about global issues; however they have had little power to effect change. Many missionaries have given their lives in their struggles to improve quality of life for their subjects, and indeed that persists today as we hear of clergy who are slaughtered because of their beliefs. The willingness to suffer all manner of privations, sacrifices, and dangers in order to alleviate the suffering of his fellow man requires a dedication beyond my ability to comprehend.
One such person who accepted that challenge was, Dan Reynolds, one of my classmates in medical school. He admitted that he was in medical school only because he wanted to be a medical missionary. My first thought was that this kid must be nuts. Who in the world would want to spend all those years in school just to go hang out in the jungle. Granted, most of us were motivated at some level to be able to help people, but the fact that we would be paid pretty well for doing it was icing on the cake. After twenty years in that jungle in Africa, Dan was honored by our class with a plaque for his service, and he became my dear friend.
Historians would point out that the Christian missionary movement has not always been very Christian in its implementation, but hopefully that has become a thing of the past. The most extreme of these cases was when the conquistadors were instructed to convert the populace of the southern hemisphere to Christianity. One needs only to look at the churches in South America to realize they were quite successful. Their method was very effective. It consisted of giving the prospective church member the choice between conversion or death. We now hear that same strategy is used by ISIS.
One success story in the struggle to provide safe drinking water did not involve church sponsored missionaries, but rather the dedication of one caring individual.

150803-jimmy-carter-file-jsw-158p_5e66b4113f7db8e269482f0f50105c95-nbcnews-fp-1200-800In 1986 Jimmy Carter with the encouragement of the World Health organization set out to eradicate the guinea worm. His success may well represent the most monumental and least noted medical achievement of the century. In the nineteen eighties there were an estimated 3.5 million cases of guinea worm infection world-wide. In 2015 there were 22 cases reported. In the poignant announcement of his affliction with a malignant brain tumor, Mr. Carter announced that he only hoped he would be able to outlive the last guinea worm on earth. The significance of this event cannot be overemphasized as it would be only the second disease (after smallpox) to be totally eradicated.
Guinea worm infection or dracunculiasis as it is called is a horrible disease. It is passed to humans by drinking water containing water fleas infected with the guinea worm larvae. The fleas die, but the larvae persist and penetrate the intestinal wall. They migrate through the body growing to as much as forty inches in length over a period of from 10 to 14 months at which time they exit the body through the foot. This results in an intense burning sensation leading to an impulse to put the foot in water into which the worm discharges thousands of larvae. Since surface water is all that is available, the contaminated water is drunk and the cycle is repeated.
The only treatment available is to entwine the worm around a twig as its head exits the body and to very slowly twist the twig in hopes of removing the worm in toto. This must be done very slowly over a period of several days in order to avoid pulling the worm apart and leaving a portion inside the body. There can be many complications from the infection including amputation.
Since there is no treatment for this disease, prevention is the only option. Of course the ideal solution would be to provide clean drinking water for all. Unfortunately this goal is often not achievable in some parts of the world. It was discovered that the larvae would not pass through a simple cloth filter which could be made inexpensively. When people were made aware of the cause of the infection, they readily complied with use of the filters, and even improved upon them by developing a simpler and more portable version. The success of the eradication venture depended on an intense educational program to some of the most remote areas of the world. The results of that effort demonstrate clearly that ignorance is not synonymous with stupidity.
The problems associated with maintaining potable drinking water are not limited to less developed parts of the world. Mountain top mining is said to pollute otherwise pristine mountain streams in West Virginia, and some insist that fracking has affected their sources of water. The great lakes, a source of drinking water for millions, have been affected by the runoff of fertilizers. Since the Flint Michigan fiasco we have learned that the incidence of lead and other toxic materials in water all across the country have been vastly under-reported. When I was a kid, I was taught that water which came from the side of a hill was always safe to drink, and indeed many farm families relied on springs from those hills for their drinking water. We certainly could no longer rely on the earth to filter out all the poisons from the water we dump on it, and “spring water” could no longer considered to be safe to drink.
It seems to me that governments are very good at proposing solutions to problems but not so good at implementing them, and that is the reason we need people like Jimmy Carter and Chenoa. They deserve our unconditional support support and extreme gratitude.
In this paper I have only addressed concerns about the quality of water, while an even more pressing problem may turn out to be the quantity needed for our species to survive. Some futurists have predicted that competition for diminishing supplies of water may result in more world-wide conflict than that to which we are already accustomed. The squabbles over water currently taking place in California may be a harbinger of worse conflicts to come. For this and other more pressing reasons we can no longer assume that there will always be an inexhaustible supply of life’s most vital substance.

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