The Plague by Albert Camus

The Plague by Albert Camus

My rating: 4 of 5 stars


At the start of the restrictions on "social distance" intended to prevent or at least slow the spread of the corona virus, I recommended some books to read during quarantine and social isolation, and this was one of them. And since it's about 60 years since I read it, I thought I ought to take my own advice and read it again.

When I first read it as a teenager various people told me that though it was ostensibly a story about an outbreak of bubonic plague in the city of Oran in Algeria, then a French colony, which led to the whole city being placed under quarantine, it was really a kind of allegory of the Nazi plague that had devastated Europe a few years before it was published. I didn't really see it at the time. Sometimes a story is just a story, and that is what I thought this one was.

But now I am older I have read many more books and many more literary genres and have greater knowledge of history and experience of life, so perhaps I would see the allegory that had escaped me before. But I have to confess that I didn't. I thought it no more an allegory than The Lord of the Rings is an allegory.

Yes, a lifetime of experience enabled me to see things that I did not see before, so I was looking through different eyes.

One of the things I saw for the first time was that at the beginning of the book a journalist, who is trapped in the city by the quarantine, had come to write about the conditions under which the Arab population of the city were living, and that was practically the last mention of the Arab population at all. We are told nothing, absolutely nothing, about how the plague affected them. But when the Nazi plague came to France, the Jews did not cease to exist. I am sure many of them would have wished to be as invisible during the Nazi occupation as the Arabs are in Camus's book.

Camus himself was trapped in Nazi-occupied France, and when he writes of the plague as "exile", he writes from real experience. It makes little difference whether the exile is caused by political conditions, war or disease, the effects are the same. And it is not just those whose homes are outside and who are trapped in the plague-ridden city who are exiles; those who have homes in the city experience exile too, and exile, in Camus's view, is essentially separation from people you love and who love you.

Between 1966 and 1972 I experienced something like such exile four times in my life, and twice in one year. The first was when I had to skip the country to study in England in 1966. Of course I was planning to go anyway, but the haste of my sudden departure (on the road to Bulawayo within five hours of a phone call from a Security Policeman) left loose ends and unfinished business in relationships that made it feel like exile to me. Then after  my return when Bishop Inman kicked me out of the Missions to Seamen in Durban when I had only been there for six months, and I went to Namibia. After a couple of years there I was beginning to feel at home and was then deported by the South West Africa administration. I went to stay with my cousin in Pietermaritzburg and four months later was banned to Durban. But out of each of those events good things eventually came, lessons were learned, and I met people I would not otherwise have met (including my wife Val), so I would have been poorer for not having met them.

After the last of these exiles, in 1972, I read The Anatomy of Exile to help me to interpret the experience, and coming to The Plague with some experience of exile enables me to see a bit more of what Camus is getting at.

The other major difference between my first reading and now is that we are now in the middle of a "lockdown" because of an infectious disease, and it is interesting to see how what Camus describes compares. Many things he described are very similar, but in The Plague there is little social distancing. People are still allowed to walk the streets, frequent cafes and attend church services. Even when the pneumonic variety of transmission of Yersinia Pestis appears, no one seems to be required to wear face masks. Only sports fixtures are cancelled, though not so much for fear of contagion as because in Camus's book they have been requisitioned as quarantine centres for those whose family members have been hospitalised with the plague. In Camus's book there is a vaccine, though supplies are inadequate because no one had envisaged an outbreak on such a scale. And of course the plague is bacterial, not viral, so antibiotics are more effective against it nowadays.

At some points I thought I might give it five stars on GoodReads instead of my original four, but a couple of things put me off. One is the invisibility of the Arab population mentioned earlier. The second is a small boy, the son of a rather strict magistrate, who is taken ill. His name is Philippe, but later his father refers to him as Jacques. Not remembering the names of the people you love doesn't seem to be a good thing in a book about love and exile.



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World Aids Day

Today is World Aids Day, and this year is also the 30th year since Aids was discovered and named.

This map shows how it has spread around the world in the last 30 years:




For more information see World AIDS Day - Wikipedia, the free encyclopedia

Smelly socks to prevent malaria?

Malaria and Aids are probably two of the biggest killer diseases in Africa.

I wonder what the pharmaceutical industry will think about this?

Smelly socks tested in Tanzania as way to prevent malaria - The Washington Post:

In global public health, disease-fighting tools that are cheap, available and sustainable are the Holy Grail. It might be hard to top the one being tested in Tanzania as a way to prevent malaria: smelly socks.

Experiments in three villages where people get about 350 bites a year from malaria-infected mosquitoes are using dirty socks to lure the insects into traps, where they become contaminated with poisons and ultimately die.

There used to be a pop group called Toxic Socks. I wonder if they are still around? Their time may have come.

How healthy is your healthcare?

Healthcare seems to be a big issue in the American blogosphere at the moment. Normally I try to keep out of such debates, for the simple reason that I don't know enough about the issues at stake. When the debate intruded into a newsgroup discussion on another topic, I had to ask what "single payer" meant -- a term bandied about by Americans on the assumption that everyone knows what it means, but one which I had never heard of before. Don't worry, someone has explained it to me now, but I'm not really interested. The manner in which healthcare is provided in the USA is something for the citizens of that country to decide. I'm not so much a disinterested spectator of the debate as an uninterested one.

Two things happened to weaken my resolution to stay out of the debate.

The first is that the debate seems to be largely ideological, and some proponents of ideologies have been propunding slogans based on ideological principles that they regard as universally applicable. One of these was the statement that "universal healthcare is theft", which seems to me diametrically opposed to the basics of the Christian faith, and to have huge theological implications. Those who find theology too boring and abstruse will be glad to know that I'm not talking about that now, since I've blogged about that already at Health, disease, theology and politics: Khanya.

The second thing that made me think that this wasn't a purely domestic matter for the USA was a rather vicious campaign among some in the USA about the British National Health Service (NHS), full of lies and innuendo. It certainly caused a reaction in the UK Twittersphere, with lots of tweets tagged #IlovetheNHS. Bishop Alan has responded at Bishop Alan’s Blog: How healthy is your healthcare?:

Stephanie’s birth as an undiagnosed extended breach in a strange hospital (she arrived early and unexpected on Christmas night) was supervised by one of the finest obstetricians in the world, who gave Lucy the choice, then delivered her faultlessly without a C-Section, using an old midwives’ routine called the Burns-Marshall technique. Both these ace bits of effective medical care were delivered with nary a credit card or insurance policy between them, and I would take a lot of persuading that the kind of medical system we use for Max the Cat would have served us any better.

We had a similar experience with the birth of our daughter. She was born in the provincial hospital in Utrecht, Natal. Shortly before she was born the cat had kittens, and because she had previously had obstetrical problems we took her to the vet. The kittens cost us four times what our daughter's birth did.

But such anecdotes prove little or nothing. One can collect anecdotes of both good and bad treatment in any kind of hospital, whether private or public, commercial or non-profit. A lot depends on the ethics, skill and dedication of the staff, and that is often very much a matter of the luck of the draw.

I think healthcare in South Africa is something of a disaster. First because the apartheid policies of the previous government, which nationalised the non-profit church hospitals in the 1970s for ideological reasons, and there was an immediate very rapid decline in the standard of healthcare in the rural areas that had been served by those hospitals. The reasons are not hard to find. When the hospitals were run by Christian churches, they were able to recruit staff who saw healing as part of their Christian ministry. Young Christian doctors, newly qualified, saw this as an opportunity of Christian service. Highly qualified and experienced surgeons when they retired did the same. Well qualified nurses would go to serve in such hospitals with a similar motive, and try to pass on their dedication and enthusiasm to a new generation of student nurses.

When the government nationalised them, the former church hospitals were immediately taken out of the recruiting network of the international Christian conspiracy, and very often the only people the government could get to work there were medical students who had been conscripted for military service, and were sent to do their national service in rural hospitals.

Of course dedicated Christian healthcare professionals did not have to work in church hospitals, but church hospitals did have a better recruiting network for such people. Some years ago I visited the Orthodox seminary in Nairobi, Kenya, and there were two other people in the guest house. One was a young Ukrainian doctor who had come with a United Nations relief group to work in Rwanda after the genocide there. The other was a top Greek heart surgeon who had become a priest, and was spending a few weeks providing healthcare to the clergy in Kenya and their families, and helping out at clinics run by the church. The young Ukrainian had to pass exams to be licensed to practise in Kenya, and so was going through the stuff he had to learn with the priest, which shared his knowledge, and I heard the more experienced one catechising the younger one after dinner in the evenings.

But whether in Kenya or South Africa, very few commercial healthcare providers are going to establish a practice in the poorest rural areas. Anyone who puts the commercial model forward as the ideal and universal one might be following the best free-market economic principles, but for Christians that comes up against the parable of the rich man and Lazarus.

Update
There is now a stnchroblog on this topic, with various Christians writing on it: Square No More: Synchroblog on a Christian Response to Healthcare

Circumcision of HIV+ males increases risk to women

For quite a long time now there have been reports of studies that purport to show that male circumcision reduces transmission of HIV and Aids, leading some people to advocate universal male circumcision as a means of combating the pandemic.

There is a study that implies that this approach could be counterproductive. Circumcision of HIV men INCREASES risk to women. | ICGI - Genital Integrity:

A new study published in Lancet shows that women are 50% more likely to contract HIV if they are having sex with circumcised men. Most of the infections were from the time period when the couples began having sex before the wound healed, but the effect continued past that period, indicating that there is no benefit to women from male circumcision. Proponents of mass circumcision plans have long argued that women are protected when men are circumcised, but this study indicates the opposite. The study, like its predecessors, was stopped early.

Medical statisticians may believe that universal male circumcision will statistically reduce the rate of transmission of HIV, but one is dealing with people, not statitstics. The web site in the link is an advocacy site, and not disinterested in this matter, but The Lancet is a reputable medical journal.

The study referred to above shows what simple logic should have shown anyway -- that while circumcision may reduce a male's chance of being infected with HIV, one that male is infected, it does nothing to reduce the chance of his passing on the virus to women.

And the propaganda for universal male circumcision may be counterproductive, in that, human nature being what it is, it could lead circumcised males to believe that they are immune to infection (yes, weirder things have happened -- people are not statistics) and thus become more promiscuous.

Health hazard in flu vaccine?

It has been reported that some batches of flu vaccine have been contaminated by live avian flu virus (H5N1):

The Czech company Biotest near from Prague got from Austria a testing batch of the new flu vaccine for 2009 from the american company Baxter. In february they have found that the vaccine was contaminated by the H5N1 - Avian flu virus, which is on the list of the possible biological weapons and is one of the most dangerous biological agents on the Earth - with more than 60% death rate [4]. All the testing animals in Biotest were subsequently destroyed and all the workers in the company were put in quarantine. Luckily nobody contracted the disease. Subsequently the same problem of the Baxter vaccines contamination with H5N1 was found in the laboratories in Slovenia, Austria and Germany, which confirms that the source of the contagion was in fact the Baxter vaccine, which could be very probable, because Baxter is one of the companies, which are developing the vaccines against H5N1.

This has led some to suggest that it is a deliberate attempt to create a pandemic. That sounds more like a conspiracy theory, and most of these reports, except possiblt the original Czech ones, seem to emanate from conspiracy theory factories.

But I've managed to survive every winter of my life so far without resorting to flu vaccines, in spite of my Medical Aid sending out letters recommending them, and I think this year will be no exception.

Cholera stretches Limpopo resources

The Times - Cholera stretching SA to breaking point:

MORE than 40 new cholera infections — half of them further than 100km from the disease’s South African epicentre, Musina — have prompted Limpopo health authorities to ask that outbreak sites be declared emergency areas.

The new cases of the water- borne disease were reported at the weekend. Twenty-one new cases were reported in remote areas along the Limpopo River, where thousands of Zimbabweans illegally cross into South Africa. Officials fear the outbreak will become unmanageable if there is no emergency intervention.

It has taken a long time for Zimbabwe's infrastructure to collapse to this extent. The collapse has now reached, or passed, the point that Albania had reached ten years ago. And the South African government continues prop up the mad dictator who is destroying his country and his people.

Five years ago a group of Johannesburg church leaders criticised the state of human rights in Zimbabwe after hearing stories from Zimbabwean refugees, and were castigated by Frank Chikane and Cedric Mayson (two clergy advisers of the ANC government), for doing so, and likened to George Bush. At the same time Bishop Desmond Tutu made a much stronger statement, which was reported in the newspapers, but did not have much effect, since he was retired. But it was the kind of statement that the South African government could have made, but did not. The ANC could see through Ronald Reagan's "constructive engagement" approach to P.W. Botha's human rights abuses in South Africa in the 1980s, but 20 years later it had fallen into the same trap in the way it approached Mugabe's human rights abuses in Zimbabwe.

Whether speaking out more strongly against Mugabe's human rights abuses would have made a concrete difference is a moot point, but the "constructive engagement" policy certainly achieved nothing, and the cholera epidemic is just one consequence of that.

The Times - Few will turn 50 in SA

According to this report, South Africa's life expectancy has dropped drastically in the last 10 years.

The Times - Few will turn 50 in SA:

MOST South Africans will not live to celebrate their 50th birthday, just like people living in strife-torn Somalia and impoverished Ethiopia.

A UN Population Fund report puts the life expectancy of the typical South African man at only 48.8 years; women are not expected to live longer than 49.6 years.

This is drastically lower than a decade ago, when the US Census Bureau’s international database put life expectancy at 55.5 years for South Africans.
---
The most recent estimate of South African life expectancies was less than for people living in Brazil, the murder capital of the world, or for people in war-torn Iraq.

The report, UNFPA State of World Population 2008, states that South Africa has one of the highest HIV prevalence rates in the world, with 21.8 percent of all women aged between 15 and 49 being HIV-positive — the fourth-highest rate globally. Only South Africa’s less populous neighbours — Swaziland (32 percent), Botswana (28.9 percent) and Lesotho (27.1 percent) — have worse prevalence figures.

So Southern Africa generally is the region suffering most from HIV/Aids.

In view of this, one wonders why South Africa seems to attract so many immigrants, legal and illegal.

Health and healing - private profit from public misery

Pickled Bushman reviews Michael Moore's latest documentary: Sicko (or American refugees in Cuba) showing the ravages wrought by the privatisation mania on the American health-care system, which has slipped from being among the best in the world to 32nd place, just above Slovenia.

The same thing has struck South Africa, since neoliberalism took off in the Reagan/Thatcher years.

Actually the problem is not so much privatisation as commercialisation. One of the things that caused a huge slide in South African health-care services was the nationalisation of all church hospitals in the "homelands" in 1973. This has been documented by Dr Darryl Hackland, who had been Medical Superintendent of Bethesda Hospital (Methodist) in Zululand, and after it was nationalised became a senior official in the KwaZulu Department of Health. The church hospitals were run by "private enterprise", but the difference was that they were not run for profit.

In the 1980s there was a reprivatisation of health services, but this did not take place in the poorer areas of the country, but in the rich ones. The government at the time (under PW Botha) followed the Reagan/Thatcher ideology, and encouraged the formation of commercial clinics, in which doctors owned shares. It was privatisation for profit.

Medical Aid schemes have been infected as well. They were formerly socialist bodies, owned and run by their members, as a form of mutual aid. Now many of them are owned by outside shareholders. They no longer speak of members, but "customers". They no longer provide health care, but "products". They advertise, and refer to themselves as "financial services providers". Beware of any "financial services provider" that tries to sell you a "product". Whenever anyone uses the term "product" for a service, financial or otherwise, it is a pretty sure indication that they are simply out to rip you off. They offer "rewards", like club memberships, and cards that give you discounts in stores -- but be sure of one thing, you are paying for these things, even if you don't use them, and what these frivolities mean is that you get less health care for your money, because your money is being wasted on advertising and promotion and putting money into the pockets of shareholders.

The ANC when it came to power in 1994 has basically continued the policies of the National Party under PW Botha. There have been ritual pronouncements to placate their alliance partners, like Cosatu, but basically nothing has changed.

One thing they could do, for a start, would be to set up a tax structure so that not-for-profit mutual Medical Aid schemes are not taxed, and that commercial ones, making profits for outside shareholders, and ones that run superfluous "incentive" schemes not related to their core business are also taxed. (The same should be done for mutual building societies and life assurance providers.)

Also, "faith-based" and other non-profit private health service providers should be encouraged in a similar way.

I can't speak for other faiths, but from a Christian point of view, Jesus sent out his disciples to preach and to heal, and said "Freely ye have received, freely give." Before 1973, when the provincial governments subsidised church hopspitals, they got a better service for their money than they did when the central government nationalised the services, and then later devolved them to the "homeland" governments. Why? Because Christian doctors and nurses went to work in those hospitals, not for the sake of financial gain, but because of a desire to obey the command of Jesus to "heal the sick". When the government took them over, they found it difficult to get staff willing to work in the mainly rural areas where the church hospitals were to be found, and resorted to using army conscript medical students. Secular doctors were out for money, and only wanted to work in the big cities, where they could specialise in the diseases of the rich.

Doctors in private practice did, of course, have to charge fees in order to make a living. Even healers have to eat. But when they worked on their own, or in small partnerships, they could treat the poor and needy for reduced fees, or even, in hard cases, waive the fees altogether. Where, however, they work for clinics run as for-profit companies, this is much more difficult when the fees are paid to the company, and every reduction of fees for poor patient means a reduced profit for the shareholders.

The Orthodox Church has several saints who were medical doctors, and known as "anargyri" (silverless ones), usually translated into English as "unmercentary doctors". Among them are three pairs of brothers called Cosmas and Damian, perhaps because the later ones consciously followed the example of the earlier ones.

Until now the ANC government has done little more than try to force mercenary doctors, clinics and medical aid scemes to serve the poor. But it might do better to encourage the unmercenary ones, for example by differential taxes, as suggested above.

HIV, Aids etc

Yesterday I went to a day-long seminar on HIV and Aids.

It was organised by the HIV Clinicians Society, and it was intended for HIV clinicans and religious leaders, and there were a couple of hundred people there. I won't try to summarise the proceedings, but a few points might be worth mentioning.

The first speaker was Clem Sunter, who is a motivational goal-setting bloke, and had just returned from helping the Chinese to beef up their economy. So he was dealing with the question of why it was necessary to have such a seminar. One of the questions he asks in these exercises is "What has changed in the last 5-10 years, and what hasn't changed?" And in this case he noted the following:

• People are dying. The death rate, especially among people aged 25-35, has risen dramatically.
  
• More people are infected
  
• There are more players in the game, including the government
  
• There have been advances in drugs, including triple-drug therapy
  
• There is little change in prevention
  

Professor Des Martin spoke on transmission and testing, from the clinical point of view -- what is known about how HIV is transmitted, the progression of the disease, and advances in testing. Professor Rachel Jewkes spoke on transmission from an epidemiological point of view. Zackie Achmat, the flamboyant Aids activist, gave another motivational presentation from a somewhat different point of view. And so it went.

Speaking for myself, I found it useful to catch up. Some things had not changed -- there seems to be little known about transmission that was not known 5-10 years ago. What has changed quite dramatically is methods of treatment. Dr Leon Levin, a paediatrician, spoke on treatment of children with HIV/Aids. Most of the children with HIV infection would die in 4-8 years if untreated. Many people asked if there was therefore any point in treating such children, if they were going to die anyway. He said that in his clinical practice he had seen dramatic improvement in the health and quality of life of children after treatment.

All the medical speakers emphasised this point. There is no cure for Aids, just as there is no cure for diabetes, or high blood pressure or heart disease. Those who have the disease will have to continue treatment for life. If they stop their medication, the disease will return, and they will die. But the record of treatment for HIV/Aids is much better than that for other chronic diseases. It is more effective than the drugs used for treating heart disease, blood pressure etc.

I found the most useful part of the seminar the factual and scientific information given. When it got on to the role of religious groups, it tended to get fuzzy. Trying to say things that are acceptable or applicable or all religious groups tends to make those things vague and ineffectual. It might be better to disseminate the facts, and then let each religious group to work out for itself how it will interpret and apply the facts.

But there are some questions that one can ask about Aids and its social impact.

One was highlighted the very next day, when there was a news report about a doctor who was facing disciplinary action from a medical body for listing Aids as a cause of death on a death certificate, on the grounds that this was an invasion of the privacy of the patients, and threatened the confidentiality of the doctor-patient relationship.

That seems a strange kind of reasoning, as surely the same would apply to any other cause of death. If it is such a threat to privacy and patient confidentiality, then surely no causes of death should be recorded on any death certificates at all.

There are several good reasons for recording the cause of death on death certificates: to see if death was caused by foul play, to see what is statistically responsible for most deaths, which can guide efforts aimed at prevention or cure -- should we concentrate our efforts on reducing deaths from road accidents, or snake bites, for example. Which kills more people -- shark bites or mosquito bites?

The other thing is that at this Aids seminar, and in many other similar seminars, people have urged that the stigma must be removed from Aids. But surely keeping it off death certificates is one thing that perpetuates the stigma. When medical people speak with two voices, one urging the removal of the stigma, and the other urging its retention, to the extent of prosecuting those who list it as a cause of death, there will never be concerted action against this epidemic.