Inflammatory Language: The Rain in Spain...

Sanidad publica
Illustration by Monica Lalanda 2012

...austerity, that is...falls on many of us (in the UK, Ireland, Greece and many other European Union countries including the Baltic States, and also the US). Austerity has finally pushed Spanish doctors into working together (a historically rare occurrence) to fight the break-up of their national health system. The UK is at risk as well.

In February, The Febrile Muse asked readers to submit to Inflammatory Language either a 300-500 word article and/or illustration that conveys inflammation. It could have been humorous, political, or encompassed pop culture or current events. The overall goal was to accurately inform readers. 

Dr. Monica Lalanda was the first to submit her work. She submitted three illustrations from her blog:  Medicoacuadros. Dr. Lalanda is a Spanish Emergency Medicine doctor who trained and worked in the UK before going back home. She fights for a better world with her stethoscope, her words, and her drawings, and strongly believes in a good public health service. She is married to a surgeon and has two kids. Please read her blog. It is passionate, and places her patients and vocation at the center of healthcare. I'm sure doctors, pharmacists and other health care professionals will be able to identify with her illustrations, such as this one: 

A punto de estellar (to burst)
llustration by Monica Lalanda 2012

Now, how does this relate to Inflammatory Language? Well, obviously financial tensions are inflammatory. Yet, my original intention was to focus on the science of inflammation and infection. After reading more submissions, and reading about the sequester (not to be confused with quarantine or isolation here), it hit me how healthcare systems and cuts to resources--to detect, research, control and treat infections was inflaming passions.

We all know that good accessible healthcare leads to the control and treatment of infectious disease. I will go a step further to say that we (physicians, pharmacists, nurses, scientists, and science writers) have an ethical obligation to worry and work against the unintended effects of austerity, sequester, and challenges to our health systems--on many levels, but for our sake here, on the prevention and treatment of infectious disease. 

What evidence do we have that austerity measures have already affected infectious disease? These four things are just the tip of the iceberg..... Feel free to add to the list in the comment section--a later post can expand upon the evidence.

• In Greece, drastic cuts to condom and needle exchange programs has lead to more HIV infections
• Also in Greece, overall infectious diseases morbidity/mortality in men has increased.
• No statistics done to find an association, but look at resistance pattern for Klebsiella pneumonia--appears to be higher in countries that have made drastic cuts to healthcare (austerity measures)
• Disease-carrying insect control has been drastically cut in Florida, where an uptick in home-grown Dengue fever seen in 2009 (before Mr. Scott took office) and 2010; Globally, dengue fever cases are up (in non-tropical areas too) and severely underestimated.

Angry Doctor
Illustration by Monica Lalanda 2012

Infectious diseases can spread globally, and a great deal of resources need to be in place (in all countries) to prevent widespread disease. An outbreak, if not contained, can spread to other countries, undetected until it is too late. And in the case of resistance, inadequate containment/treatment in one country may lead to inadequate treatment in others.


It will take global resources to prevent a backslide in protecting our people from infectious disease. It is imperative that we consider:

• The Healthcare labor-force
• Nursing shortages have been associated with increased mortality in patients due to urinary tract infections and pneumonia
• Number of clinical pharmacists in hospitals inversely related to medication errors
• Access to healthcare and nutrition
• When patients have limited access to healthcare, emergency rooms become overburdened. 
• Limited access either results in inappropriate use of ER departments and/or delayed treatment (if patient goes nowhere).
• Sequestration will lead to cuts in public health (the extent of cuts has been debated)
• Decreased funds to multiple programs to aid the poor
• Infant mortality is already high in poorer cities and states
• Decreased meals for seniors, due to sequestration
• Vaccinations
• Global vaccination programs require resources
• Lack of adequate vaccination coverage leads to more infection
• Sexually transmitted diseases and HIV/AIDS testing/treatment services
• Decreased HIV testing and for other STDs
• Decreased treatment programs
• Infection control and antimicrobial stewardship  
• Surveillance agencies need resources (sequestration has led to cuts at the Centers for Disease Control, CDC)
• Resistance
• Multidrug resistance among Gram negative infections, HIV, and TB are increasing (a recent example of carbapenem resistance)
• Treatment of resistant organisms is more expensive than prevention of or treatment of susceptible infections
• If resistance reaches the point where many infections are not treatable, routine surgeries such as cardiovascular procedures and joint replacement become more risky
• Research organizations need resources to develop new vaccines and antimicrobials and other methods to prevent and fight infection (sequestration has led to cuts to the National Institute of Health, the NIH) 
• Pharmaceutical companies have little financial incentive to develop new treatments
• Food and water inspection
• less inspection of food, water, and more antibiotic use in animals may lead to more food and waterborne illness.

Dr. Lalanda won this book!
Thank you for your submission.
Photograph by Monica Lalanda 2013

By working together, as healthcare professionals, as scientists, as writers and illustrators, we should fight for the resources to do what is right and just (because we have the information)...for humanity, not our individual pockets.

I realize that there is only so much money to go around, but we have made tremendous gains in the prevention and treatment of infectious diseases. When you only look at infectious diseases and what needs to be done to take care of our people in the best way possible, I see the Tea party as immoral...at least real tea has antimicrobial properties.