I think every physician is accustomed to having patients who
have misunderstandings about the risks and prevalence of certain diseases. It
is kind of built into the nature of what we do. But I nearly fell off my chair
last evening while watching a clip from cable news in which they were warning
about the risks of diseases such as tuberculosis, leprosy, and smallpox being
brought to the United States by immigrants from Central America.
Tuberculosis is a reasonable thing to at least think about.
In general, folks arriving from less developed countries are tested for TB. In
my experience, it is unusual for anyone to test positive. If they do test
positive, they are treated even if they do not yet have a contagious form of
the disease. This keeps it from progressing to an active form that is
contagious to others.
I have never seen a case of leprosy, now commonly referred
to as Hansen disease. Approximately 95% of people are genetically resistant to Hansen
disease if exposed. If one does acquire the disease, it can be cured with
antibiotics. The prevalence of Hansen disease in Central America is less than .001%.
So when factoring in all of those numbers, it seems like the risk of me catching
leprosy from someone from central America is probably significantly less than
my chance of dying in an accident on the way to work.
But the one that really made me scratch my head was the
assertion that one had to worry about smallpox. The last case of
naturally-occurring smallpox was in Somalia in 1977. There were two cases in the
UK in 1978 after someone was exposed in a lab and spread it to another person. Even
though I will be a grandfather in a few months, I am young enough that I never
received the vaccine because it was no longer considered a threat by the time I
got to the age when the vaccine was normally given. I seriously doubt that
anyone fleeing poverty and violence in Central America has been working with
smallpox virus in one of the few labs in which it still exists. Anyone who says
there is a risk of smallpox from immigrants from Central America is either
hopelessly uninformed or lying.
Meanwhile, influenza kills thousands of people every year in
the United States. So if you want to keep yourself and your family safe, do not
waste time worrying about getting smallpox from an immigrant. Get a flu
shot.
One of the satisfying things about being a pediatrician is
watching patients grow up to become adults. I have now been in pediatric
practice long enough that some of my former patients bring their children to see
me and I am becoming reacquainted with some mothers of patients from my early
days who are now grandmothers of patients.
Several days ago I walked into a room to see a child I had
not seen before. I said “Hello, I’m Dr. Sauder” and the grandmother who had
brought the child replied “I know.” She then told me about her children who I
had seen years ago. I find those interactions to be very meaningful and I think
they are one of the best parts of what I do.
It has also become more apparent to me over the years how
generational many of life’s circumstances are, both good and bad. There are
always exceptions which prove the rule. But, in general, it does seem that,
consistent with the old adage, the apple really doesn’t fall far from the tree.
However, I do know some apples from the same tree that did not land particularly
close to each other and once in a while an apple ends up in a different orchard
than the tree which produced it.
The “trees” in question help determine future socioeconomic
status and educational opportunities as well as a multitude of values about how
one lives life. It is abundantly clear that each child starts life with a different
set of advantages and disadvantages relative to his peers. People certainly
have responsibility for their own actions as they get older, but denying that
the situation they were born into plays a large role in their development is
simply not consistent with reality.
Seeing the next generation of children in a family is fun
for me. But knowing the family also helps me understand better how they see the
world, what their strengths may be, what things they may need help with, and how
I can best help them stay healthy. And it always makes me smile to hear someone
say to a child “Did you know he used to be Daddy’s doctor too?”
