Dr. David Katz: Yale Ebola Scare a Reminder of Case for Holism

New Haven Register (New Haven, CT), October 20, 2014 | Go to article overview

Dr. David Katz: Yale Ebola Scare a Reminder of Case for Holism


Those of us here in Connecticut are relieved to learn that after a considerable dose of local drama, a Yale public health student just back from Liberia who might have had Ebola probably has a cold. I wish the student a speedy recovery. For the rest of us, this was a practice run -- and a reminder of the case for holism.

The management of this one, possible case of Ebola apparently involved the choreography of city government, state government, Yale- New Haven Hospital, Yale Health Services, first responders, the university, and both local and state departments of public health. That was only overkill in hindsight. If we really did wind up with Ebola here, it's good to know our system can function with such apparent, holistic integration.

Holism may evoke butterflies and wildflowers, as the term has taken on a New-Age, touchy-feely kind of glow. Holism suggests not so much the rigorous analytics of applied epidemiology, as the soft touch of doting humanism. But if holism is indeed "soft," then the softest of care may best suit the hardest of cases.

Consider that the origins of the Ebola crisis relate not directly to public health, but to ecosystems, native diets, and biodiversity. We have known for a long time that bats and primates -- eaten as bushmeat -- were prone to harbor viruses that could infect humans, Ebola included. A failure to think holistically, however, precluded culturally tailored approaches to modifying traditional diets, providing for ample alternatives, and sparing the world its current catastrophe. It's not too late, however, to prevent the next one.

As for Ebola containment, holistic thinking is clearly essential. Control of an outbreak is not limited to treating the sick, but managing the social network of every index case. Hospital care becomes the workings of a village, with the comings, goings, tasks, and interactions of providers inextricably tangled up with the patient's requirements, and the vulnerabilities of us all. The social contacts of a hands-on caregiver, both in the hospital and beyond, suddenly have clinical relevance.

The lesson here is that they always do. The nature of care and social interactions influence the propagation of heart disease, too. That some populations are so much more prone to diabetes than others isn't about biological distinctions, but social ones. …

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