Public Health Events

In December 2017, I applied for a job as the Executive Director of the local Main Street program in a small town with a big homeless population. In 2019, locals were still stringing me along with talk that I might yet get that job and that year I got an email indicating the quiet little Hepatitis A epidemic in the US had reached my state.

So I began mentally planning a public health event. Had they ever hired me, a public health event would have been one of my first projects. This piece grows out of that, with a dash of concern for Central and South America due to recent political events (see the footnote).

Free or Cheap Haircuts
I spent several years homeless and I kept my hair short for hygiene reasons. In the US, it can easily cost a homeless man forty or fifty dollars to simply get his head and beard shaved and this takes almost no skill. 

Most events offering free haircuts to homeless people are framed as trying to pretty them up for self esteem issues. I would not do that.

Find a way to estimate demand, see if you can get students from a beauty college to volunteer as extra practice and ask if their school will give them credit for it. Offer SIMPLE hair cuts for hygiene reasons.

Offer men a free or cheap shave for their face alone or face and head if they are willing. Offer women a simple shorter cut. Make sure they understand your goal is making it easier to stay CLEAN while homeless, not beautification per se -- though I did find I looked better with short hair because it was cleaner and less messy.

Vaccines, Tests and Medical Treatment 
I was planning this event because I knew the town had a high homeless population, there was a quiet Hepatitis A epidemic in my country that started in the homeless population in San Diego, California and had finally reached my area. At risk individuals included not only homeless people but others interacting with them, including homeless services, police and even cashiers.

So step one is identify large scale health issues for YOUR people. Then plan appropriately.

I wanted to arrange free or cheap Hepatitis A vaccines but before vaccinating, people should be tested and if necessary treated. So I would have needed to talk to a physician and find out some reasonable means to test, treat and vaccinate.

I never got to that step because I was never hired. But ideally you would want a quick test if possible followed by appropriate action (vaccinations for uninfected, treatment for infected individuals).

Trying to plan a public health event means you need to figure out ways to do this in one day if possible. 

I do know of a one day course of antibiotics, and that is to have a patient take an entire course of azithromycin in one sitting while a nurse watches, but it happens to be contraindicated for hepatitis because it's hard on the liver.

This works because azithromycin has a long half life and stays in the system ten days. Most antibiotics are prescribed for seven to ten days.

Years ago, I read an article about an STD clinic someplace with low average education levels and people were not finishing their antibiotics, so they had a high percentage of repeat visitors. So they switched to giving an entire course of azithromycin in one sitting while a nurse watched and their repeat visitors dropped by a crazy high percentage, like eighty percent.

It's reasonable to want to use this method for ANY distressed population that may have challenges staying organized enough to finish a course of antibiotics the usual way because failure to finish your antibiotics not only fails to be effective treatment, it actively promotes antibiotic resistance. This is an ongoing major world health issue.

Some provisos: 
1. Azithromycin has to be given with food. It is very hard on the stomach and I would want to give people a meal, not just a snack.
2. Azithromycin works best when consumed with something acidic and is undermined by consuming it with something alkaline. 

If you are treating STDs, try to treat their partners as well. I readily found this study from 2005 supporting that conclusion but I'm old enough to remember that before the AIDS epidemic in the US in the 1980s, having a social worker track down all your sexual contacts and testing and treating them was standard practice and it worked extremely well to stop the spread of STDs.

Bread and Circus 
From what I have read, people are very critical of the Roman practice of bread and circus -- feed people and entertain them -- but ironically at the same time they laud the Christian religion for feeding people as a means to promote peace.

I took a college class in Social Psychology and for that class wrote a paper on the power of feeding people as a means to promote the peace. We have studies that agree that the best way to promote peace and prevent riots etc. is to FEED people.

Feeding people is also extremely cheap, very basic health care. That's the entire reason the US food stamp program exists: It's cheaper and more effective to feed poor people than let them go hungry and then provide medical care.

If you can provide a bit of entertainment to help distract people while waiting, that's also good. I have firsthand experience with eating at the mall on their free entertainment night as an exhausted mom whose military husband was frequently elsewhere. It's nice if the kids are eating and watching something on stage for an hour.

If you can count on nice weather, it's fine to do this outdoors. If the weather is not conducive to that, find a mall or other indoor space to feed people, entertain people and start providing medical care for local health threats for the demographic in question.

Make culturally appropriate healthy foods AVAILABLE. Let people choose what they want to some degree if possible.

If you want to do cold prep ramen: Have a few different flavors of ramen soup in a cup, Ziploc bags with different vegetable mixes and Ziploc bags with jerky or cheese or other protein. Let people pick a soup flavor, pick a vegetable bag and pick a protein.

Provide a plastic spoon and either hot tap water or bottled water. Ramen does not need to be cooked, so you can just add cold bottled water if the setting in question does not have hot tap water available.

Footnote 
Trypanosoma (aka Chagas Disease, African Sleeping Sickness) is rampant in some parts of Central and South America. 

I most likely have a trypanosoma infection brought back from Saudi Arabia by my military husband and my condition stabilized after talking to a physician I was friends with and thereafter insisting on condoms with my husband and coincidentally getting prescribed two weeks of azithromycin with two refills, which effectively allowed me to have azithromycin in my system for roughly three months total, followed by two rounds of levaquin.

That's a LOT of drugs but I have a genetic disorder so it's probably more than most people need. Azithromycin is likely less toxic and possibly less expensive than most of the antiparasitic drugs used to treat trypanosoma.

I'm a private individual who was just trying to deal with my health. A quick google turns up a couple of studies on mice suggesting azithromycin is likely effective for treating trypanosoma, but nothing definitive for people.

So this is my suggestion if you have a huge trypanosoma problem:

1. Make a list of diseases normally treated with azithromycin (including STDs like chlamydia and gonorrhea) and treat patients for THOSE conditions.
2. Use the above described method of giving the entire course in one sitting.
3. Try to get DATA on how many of those patients ALSO have trypanosoma and try to document if their trypanosoma infection improved as a result of giving azithromycin for some other infection typically treated with azithromycin.
4. Run your plan past both a licensed physician and lawyer to make sure they agree with a BLOGGER who has neither legal nor medical licensing (though I did work in health insurance for several years and have pertinent training a la HIPPA and Gramm Leech Bliley, among other things).

There is a drug prescribed for depression that as a side effect caused so many people to stop smoking we now prescribe it to help people stop smoking. IF you are using azithromycin to treat an infection it is already approved for and merely DOCUMENT its impact on people who also have trypanosoma, you should be in the clear legally and morally.

And then maybe someday there will be sufficient documentation to start prescribing it for trypanosoma. 

I also recommend you work on housing issues if your country has a known serious trypanosoma problem because it's strongly associated with poverty housing and transmitted by bugs typically found in poverty housing. I have an entire website devoted to my ideas about improving affordable housing: Project SRO.

Central and South America could start a project to SHARE data on what works to combat the trypanosoma epidemic. You could also potentially look for non-English sources of verification that azithromycin is effective medical treatment for trypanosoma.

This would also be relevant for Africa due to African Sleeping Sickness and presumably the Middle East, given that's where my trypanosoma infection came from. Adding those as tags to this piece.

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