Report on Resilience Session: Resilient Health through Networks

Knowledge Collection Practical Resilience
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21

A modern herbal

I keep thinking about A Modern Herbal - the author started publishing about herbs due to the great demand for such knowledge during the First World War - I guess, in part, due to increased difficulties with importing resources.  I regularly use the book as it contains all kinds of information about plants, not just their medicinal properties.

I was happy to just find that there is a hyper text version

I also regularly use the database at Plants for a Future in a similar fashion.

I work, some of the time, as a gardener and tree surgeon and find it interesting to discover the uses that can be made of plants that I encounter, be they ornimental plants, herbs, food plants, trees or weeds.

I guess access to such information would prove invaluable if supply chains begun to break down.

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herbs (some poisonous)

Hi Darren, this looks interesting.

I failed to see a listing of plants by properties, though probably using the “search” window I might be able to find some of that … yes, searching for “heart” gives some indications. Maybe if we could download the full database there could be added value in creating more useful indexes (unless they exist already).

Maybe the poisonous ones have even more promise than the “tame” ones. Actually, many farmaceuticals are just “tamed poisons”. Tamed in terms of dose/concentration, and also of presentation to the body (eating the medication, applying to the skin, injecting it, etc).

I think one way to make faster inroads in this is to look at needs and work from there. Usually, if the current system works well, our needs are invisible. So we need to look at what each piece of the system is for, if we then want to look at substitutions. Go to a pharmacy and look at their shelves. For each medication, ask “what’s this for?”. (Or, of course, look at the World Health Organisation listing somewhere else in this page.) Then, ask “how can this effect be reached by other means?”.

An example from old “wild west” movies: if you had to have a back tooth pulled out and there was no anesthetic, they apparently used whiskey. I don’t know if the “why” was “because we want to reduce the pain” or “because we want to reduce the mobility of the patient” (seriously, this would be a typical multifunctional permacultural approach).

Maybe we can use http://piratepad.net/-resilience to write a list of needs? Or just as comments here?

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Plant uses

Yes searching by uses would be most… usefull :wink: - and I guess maybe go beyond just plants?

I guess part the reason for whisky is its anti bacterial action (they use alcohol hand gel in hospitals here in the UK now rather than washing hands with soap and hot water).  I regularly use salt water on wounds - crushed garlic is good once bleeding stops.

I wonder if there is something out there that is already doing this?  There are certainly lots of good data sources available on the net - just need collating/curating

The Plants for a Future database linked in my last post does provide search by use (I just tried a search for antiseptic in their search box) Sadly you cant add new entries to that database.

Maybe a good project to start on Appropedia???

I guess Appropedia is doing this already - just for all uses - not just medical???

I leave this here for now as my head is starting to hurt…

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yeah, gets complicated fast :slight_smile:

But I think we’re doing a good job (better if others jump in, wink, wink) in looking at things qualitatively and in terms of data sources etc.

Appropedia has http://www.appropedia.org/Health -> no medication or herbs that I can find.

So … we have some questions. The meta-question would be “who knows about this”.

Slowly, slowly - health systems are among the wicked.

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Wikipedia

Or wikipedia???

this looks relative medicinaly -

I was searching Wikipedia for various herbal properties - ie. antitissive, emetic etc. hoping I’d find something.  Looks like I did. :slight_smile:

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ATC Herbal

Actaully there is a herbal ATC which is probably more relevant - couldn’t find a mention on wikipedia :frowning:

from

"A framework for ATC classification of herbal remedies was developed by Dr. Peter De Smet, The Netherlands, in 1998. The classification is structurally similar to theofficial ATC system, but the herbal classification is not adopted by WHO.

TheUppsala Monitoring Centre is responsible for the ATC herbal classification, and itis used in their Drug Dictionary.The Uppsala Monitoring Centre has published Guidelines for Herbal ATC (HATC)classification and a Herbal ATC Index. The Herbal ATC Index includes a list of accepted scientific names with HATC codes, while the guideline is intended to helpin assigning HATC codes to herbal remedies.Further information about the Herbal ATC classification can be obtained from Dr Mohamed Farah [address: The Uppsala Monitoring Centre (WHO CollaboratingCentre for International Drug Monitoring), Box 1051,S-751 40 Uppsala, Sweden, E-mail: Mohamed.farah@who-umc.org]"

27

WHO * herbs & stats

One way around it would be to look at the World Health Organisation’s list of essential medicines, and then look for alternatives in Nature (herbs etc). Or for molecules that are known by botanists and can be extracted by chemists.

Ah, if we could hire!  … This is obviously a “provocation”. I know we can’t hire. So …

I think we can just look at some examples. Leading causes of death worldwide. Another page about the same. Some graphical details - this page is good.

Statistics by age would be even better, if say untreated “juvenile diabetes” kills the very young (“elderly diabetes” - the other kind of diabetes - is not as deadly) means more “life years lost” than causes of death that affect older people.

All of this starts to sound better: just a handful of meds to serve as examples for our exploration, then dig as deep as we can with some of them.

Note: some causes of death can be prevented. Who wants to look at those and see how “networks” could help specifically?

28

Insulin

Apparently the pancreas of a fetal calf is a good insulin production unit!!! You need to get the purification right - If the supplies stop coming in from Germany could this be an emergancy alternative for the Canaries???

I’m not quite sure where to go from here.  I’m presently spread very thin and not sure I can really contribute much more right now.

I think a database of plants with uses (not just medicinal) would be a most usefull thing to have. Plants for a Future does have this.  Pity its not set up for open editing with revertable history, wiki style.

There is  however a good search tool -

http://pfaf.org/User/plantsearch.aspx

(you can aso download the whole database if you follow link to the shop from this page costs a little £)

Also http://pfaf.org/User/Medicinaluses.aspx will help for medicinal usage - demystifies the medical terms which are more than a bit alien to most I suspect.

The PFAF database is most of what we are looking for I think.  I guess more data would always be good (more on processing and dosage would be useful for medicinal uses).  As would wiki style editing - although I note they are trying to recruit volunteer editors, moderators, contributers - How You Can Support Plants For A Future - still I prefer open.

I wonder if they would be interested in opening up?  One of the trustees is into novel databases…

Alternatively I note that the database is CC licenced BY-NC-SA so I guess another instance could be set up and worked upon?

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Wikified Plants for a future database

Happy to just find that someone has very recently done just this :slight_smile:

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Encyclopedia of Life

Another massive (and) useful resource

Encyclopedia of Life http://eol.org/

Can search by use I tried ‘diabetes’ and ‘diabetics’ and got lots of results.

31

I also stumbled upon this at the P2P Foundation wiki

http://p2pfoundation.net/Open_Source_Herbalism

(the source article is great - and lead me to this database of plants, chemicals in plants and plant chemical uses + combined chemical uses!! http://www.ars-grin.gov/duke/ )

I was visiting a friend last week who is in the last year of her studies as a herbalist - she was complaining about the combined effects of Codex Alimentarius - Wikipedia and European Directive on Traditional Herbal Medicinal Products - Wikipedia which prevents her from being able to prepare herbal tinctures for sale unless she pays out tens of thousands of Euros for a licence.  She can prepare them for her patients but the shelf life and amount she will get through make this undesirable (the effort to produce very small batches makes it unattractive).

Is this another kind of commons enclosure?  Big comapnies can afford to pay the licence fees and turn a nice profit- smaller operators are pushed out of the market.

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and this looks good too Problems | Henriette's Herbal Homepage

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moving on

This “health resilience” issue is proving hard-ish to nail. I’ll have a go at writing the 3-page report, which would basically be an expansion of what we wrote, but with more details for those who don’t know about the subject.

Given that the devil is in the details, I expect it to be hard-ish to write.

I hope the issue has been in other people’s back-burner. It certainly has been in mine, and I have some minor facts to report on:

I started drafting what would be a specific proposal about medication. The general idea is clear: after the medication is produced at the “factory” (F), it goes through a series of stocks (S) and transports (T) until it reaches the user (U) at home or hospital. So it’s F-T-S-T-S-T-S-T-U. If there’s reason to believe production or transport (or maybe one of the stocks, if a freezer breaks somewhere) might be compromised, then you want larger stocks closer to home, period. (We’re asuming there are no alternative suppliers.)

I don’t have the data to actually sort the medications acording to impact (deadlyness of the medication’s abscense, multiplied by number of people affected). That stuff requires a small network of people in the know, I guess.

So, I decided to do “insulin” first. If it’s 7000 insulin-dependent people in my (“my”) territory, so many “units” (that’s dose) per day per person, and you want say one month, then … you need a freezer and so many euros. Quite a quantity if you ask an individual, but not that much for a whole health system. And that insulin is going to be used anyway, so we’re talking about keeping a stock. The real price is the freezer (for visualisation purposes, my numbers gave me a freezer about 2m³ in size) and it’s electricity.

If we add 20 medications, not all taken as frequently, we might end up with, vague estimate here, “a room per million”. Not all freezer (injection stuff, some medications).

I went with those numbers and asked a pharmacist friend. “Yes, but the prices are slowly falling, so the incentive is against building a stock right now.”

Ah, incentives. In general, they are upside down before a crisis, or there wouldn’t be a crisis. It looks like resilience needs minor crises to earn its place at the table. :-/ Anyone here knows a way out?

34

Covered, Gaps, Next steps

Ok, so.

We’ve thought a bit about pharmaceutical products. Building self-sufficiency is hard, so prioritisation, other ways, and prevention - all may play a role for some diseases.

I think we need to look at networks of people as a source of solutions. Specific examples anyone? Specifics now will mean we can look at patterns and build on that later.

We may also want to think of some questions that might be answered soon - about the countries that are already into a situation of financial unease, or might be soon. What do you need to know when you want to look at the specifics of solutions?

35

busy > skype

Hi Lucas,

I’m really busy at the moment, but I’d like to get my head round all this and try to help somewhere. For me I feel it might help me get reanquainted with the progress and figure out how I can best help if we could chat about it - on skype? Perhaps a group call would even be useful?

Find me as @peterpannier if you like…

James

36

Networks of people from different generations

Hi Lucas, this is probably the most challenging topic for me to fully understand, so thanks for constantly pushing it on twitter, makes one really think about it :slight_smile:

but I was thinking whether we could - under this framework - develop a bit the idea of networks from the perspective of mixed generations: cooperation between young people and elders. The former we know are full of energy and creative solutions, whereas the latter are full of resources, mostly time and know how (bigger medical history, probably more knowleadgeble of medication and herbs too)… although are also more vulnerable.

You mentioned somewhere below neighborhoods for mutual care… could we envision such networks with a focus on age diversity?

One thing that makes me doubt is whether in crisis situations medication administration is or would be prioritized according to age or health status or whatever… that would be a turnoff in terms of real cooperation…

The reason I mention generations is because pretty soon will launch a discussion here at Edgeryders about intergenerational solidarity, and would like to introduce the resilience framework in the startup of discussions…

37

slow thinking

Yes, some issues take lots of slow thinking. Looks easier in retrospect!

Intergenerational networks, & medication …

I heard long ago about some scheme in Japan where students at one university would shop for groceries for the elderly, in (networked) exchange for others doing the same for their parents (at their home town).

Maybe the same could be done for healthy life: taking each other for a walk and cooking healthy food. (I’m not sure who would take who out for a walk, in certain cases I know of. ;-))

There was this story in Cuba (could have been anywhere else) where kids would be taken to vaccination by the elderly, missing school that morning, while parents would go to work.

Several issues come to mind:

  • These things need to be facilitated. They happen spontaneously, but facilitation can go a long way in making them more frequent, easier, maybe even more fun, and correlated to other needs. (Students in Japan without parents to be taken care of would have their “currency” converted to say books.)

  • There are priorities, and some kind of “population view” might be useful, so that important things are taken care of first or at least most. Just as an example, we don’t want vital diseases in the young to fall through the gaps.

  • We still need to take care of those who are not taken care of by the social network around them. So there would be need for some kind of, what’s the name, broom lorry?, you know, the car that picks up cyclists who are too tired to go on with the bike race.

  • Instant communities would work across generations. The idea would be to make a rough local census of haves and needs. A building with 10 families, 40 people in all, might have different ages and situations. If one of the more abled elders mantains a list of diseases and medications, she or he can be contacted by the young ones and distribute the jobs. Or maybe they can just have a party from time to time!

Now, medication, shortage and cooperation-vs-competition …

If there’s a shortage, the general fear is the powerful ones (or their close ones in need) will get the first and best. So the dis-networked elderly will more easily be left without.

For some medications, some elderly people are even willing to do without if that benefits their young. When asked about a vaccine for a formidable killer like the avian flu virus (if it caused a pandemic with a high mortality), many grandparents would prioritise their own grandchildren. (Not sure if they would prioritise other people’s grandchildren.)

Those decisions are always difficult, messy, and - erm - not always sanitised by sunlight. So, no easy way out. Having enough for everyone, good shared open criteria for what level of disease needs what level of treatment, alternatives so that pain is always treated, etc - harder than it looks.

Can a shortage reduce cooperation? Sure, at least among layers. Within layers there could be more cooperation. A tough one and I don’t have shiny advice for that at all. :-/ (Slow thinking …)

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Noted and thinking about this…

Why do we name those “instant communities”: is it because they’re fabricated with a clear purpose?

thanks so much, Lucas!

PS just thinking that older people is too vague. in policy reports you have the “50-64” and “65-79”, “>80”, and occupational status, probably medical status differ greatly, so facilitation and mapping would need to consider this difference (incomplete measurement anyway but…).

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instant communities, ages & health, and help needed w/ examples

The name “instant communities” emerged at the meeting, after networks were reviewed.

I’ve been thinking about bad pandemic flu for several years, and in that kind of scenario profesional help (where available) would become scarce soon. (Too many patients, while health-care workers are ill themselves.) So that’s my bias, and the reason why the idea of “helping neighbours help each other” was at the back of my mind.

Looking at it from the point of view of human networks enriched the idea and made it plausible.

The general vague idea is there would be some kind of booklet & fill-in-the-blanks documents. If you live in a flat with 2.5 other people (where I live, if I recall correctly, family groups here are 3.5 people on average), and there are maybe 7 other flats in the same building, you may know some of the other 24-ish people by name. do you know their medication, risk factors like smoking or exercise, etc? So, if 2-3 people in that group write down the data, and somehow check that everyone’s ok say 2-3 times a day, that would mean the elderly, those who live alone, families with several kids, etc, all would have “multiple eyes” checking on them frequently enough.

Not exactly an instant community, but a few weeks into the pandemic people might know more about each other.

Maybe.

And yes, ages are varied, not just 3 categories. Some older folks are healthier than the young. Some have more time, or more inclination towards taking care of others, etc.

Plus, there could be connections between instant-communities - perhaps 2-3 people in a building could have contact with others in other buildings. (I insist on 2-3 for redundancy, as 1 people might fall ill, but 2-3 simultaneously is less likely.)

I’m looking at the big picture, and to be honest I’m a bit lost. Maybe we should start from the few simple ideas? Instant communities is a big one. Stocking up on insulin (as an example for other medications) is another one. Doctor-community networks need to be fleshed out. What else?

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I don’t think you’re lost at all!

…coming from someone totally ignorant of the subject…!

Wasn’t expecting so many details… it seems to me you do have a model in mind. hard to imagine it in practice since people have a hard time thinking about worst case scenarios… But then older people are wiser and again, makes sense to put their time into this, plus they’ve been around and most definitely know people around their blocks/ strangely even neighborhoods…

I think starting simpler depends on what people in here are knowledgeable about… for example for me it;s simpler to think about modeling and mechanisms behind attitudes towards resilience than calculations about insulin stocks… or about medicine in general. although I’m eager to learn not sure how much I can contribute. I guess we would need more input…