2003 News
- One thousand members!!!
- John Snow named the Greatest Doctor
- John Snow Society - Scandinavia: A movement for safer drinking water
- Public Health Study Tour to Peru, Spring 2003
One thousand members!!!
In July 2003, the John Snow Society reached 1000 members! The society was set up in the early 1990s to celebrate the life of John Snow and has attracted public health specialists (from students to experts) across the globe. Our 1000th member is Professor Michael Alpers, who is based at the Centre for International Health, Curtin University, Perth, Australia. The following piece has been written by Professor Alpers on finding out he was the society's 1000th member.
I am honoured to be accepted as a member of the John Snow Society, and proud to be its 1000th member. Little did I think when Deborah and I forced our way into Paul Fine's busy schedule during a brief visit to London what chance held in store for me. Deborah is member 1001. Alpers is alphabetically before Lehmann, but this cannot be the reason I was chosen. It must be chance. I worry, however, as all epidemiologists should, about the possibility of hidden bias: could it have been because I reached out so greedily to grab the first John Snow mug that Paul offered us?
I cannot match John Snow's royal expertise in anaesthesia, twice giving chloroform to Queen Victoria in labour, though in my early career as a junior doctor I did give open ether anaesthetics to young patients - with much trepidation but fortunately without mishap. It is also fortunate that John Snow's administrations were associated only with royal births, since otherwise the late glories of Britain's empire and the moral fibre of its superior people would today be known under a name other than Victorian.
I have been involved in cholera scares but have had no direct experience of the disease. However, field epidemiological experience with typhoid, diarrhoeal disease, filariasis, malaria and the like gives me an empathy with John Snow. My working life has been in tropical medicine, which deals with diseases which are of the tropics, of poverty and of the past. At least in the last two of these I feel close to John Snow's working environment and able to relate directly to the experiences he had in public health. Moreover, the work on pneumonia carried out by the Papua New Guinea Institute of Medical Research - with whose activities I was intimately associated for 23 years - has resonances with John Snow's frustration in having his publications damned with faint praise and initially dismissed by the medical and scientific establishment.
My own particular contribution has been to the epidemiology of kuru, a subject quite remote from John Snow but not from his country: the only two examples of a major epidemic of prion disease that we know of are kuru among the people of a remote part of the Eastern Highlands of Papua New Guinea and bovine spongiform encephalopathy among cattle in the United Kingdom. We now know that they both derive from the same practice: intraspecies recycling.
The puzzle of kuru was solved by a combination of biomedical, anthropological, experimental and epidemiological investigation: the clinical and pathological definition of the disease, the details of the mortuary practices of the Fore people and their neighbours, the transmission of kuru to chimpanzees and the changing epidemiological patterns of the disease. It was simple epidemiological evidence based on patients counted by sex, age, place and time, and creative thinking that put all the pieces of the puzzle together. There was also a pumphandle in the story: the proscribing of the mortuary practices, universal in the region, of ceremonial eating of the dead at their mourning feast. The 'act of removal' was not carried out at the instigation of the epidemiologist but as the first stroke of the newly arrived Australian administration, since the mortuary practices were deemed to be against Queensland law. The removal of this 'handle' was clearly associated with the decline of the disease and, we believe, will lead eventually to its disappearance. The Golden Square outbreak was officially declared to be over a week after the handle of the Broad Street pump was removed. The kuru epidemic has declined from 200 new cases to 1 new case a year, but that has taken 40 years, despite the total break in transmission before 1960.
I have now been working on the epidemiology of kuru for 42 years. I am still hoping that I will, within the next 10 years, diagnose the last case of kuru (which will of course be done retrospectively) and declare the epidemic to be over. I hope that the John Snow Society will wish me luck in this endeavour, as I take the opportunity, granted to me by good chance, of wishing the Society and its members, now grown to be more than 1000, all good wishes and 'bonne chance' in the future.
Dr John Snow named the "greatest doctor"
In March 2003, Dr John Snow was voted the "greatest doctor" of all time in a survey by Hospital Doctor magazine. We would like to thank those members who brought this poll to our attention and all who voted, ensuring that John Snow received this title that we believe he so rightly deserves. In second place was Hippocrates (460-370 BC) and third place went to Dame Cicely Saunders, who founded the modern hospice movement.
John Snow Society - Scandinavia: A movement for safer drinking water!
JSS-Scandinavia was established in Kristiansund in Norway in 1998. Closely linked to the annual Scandinavian or Norwegian Drinking Water Conferences, the Scandinavian branch of JSS focuses on drinking water safety and risk communication in connection to drinking water quality.
The "movement" now has 112 Scandinavian members: 78 from Norway, 12 from Sweden, 9 from Denmark, 4 from Iceland, 2 from Greenland, 1 from the Faroe Islands and not to forget: 6 from Bergen !
Every year the Pump Handle Award is awarded to a person who has contributed to the safety of drinking water. On May 20th 2003, the Pump Handle was awarded to Toril Hofshagen during the Norwegian Drinking Water conference in Tromsoe, north of the Arctic Circle. As assistance director of The Norwegian Water and Waste Water Association (NORVAR), Toril Hofshagen has been very clever and very successful in getting safe drinking water on the agenda of different state authorities and in builing and strengthening networks between drinking water professionals in Norway and the rest of the Nordic countries.
JSS Scandinavia also handed out a "scholarship" to historian Tor Are Johansen for his work in writing the history of Norwegian Water and Waste water development from 1800 up to today. The scholarship is linked to development of a TV programme or a TV series on water history in Norway. Tor Are also gave an excellent lecture on "Cholera in Norway 1832 - 1890".
As a follow up of the last national conference in Haugesund in 2001 we also had a flower ceremony at the Valevåg Churchyard, a graveyard exclusiovely for cholera victims on the west coast of Norway. The ceremony of course was on Pump Handle Day, Sepetmber 8, and got very good press coverage. There is a music piece by the Norwegian composer (Fartein Valen) entitled "The Graveyard by the coast"; a classical composition in honour of the cholera graveyard.
We are interested in possible cooperation with other JSS members on the topic of risk communication, as this unfortunately seems to be a more and more relevant topic these days.
Public Health Study Tour to Peru, Spring 2003
David Clapham, Principal Environmental Health Manager for Bradford MBC, a consultant to the Royal Institute, and formerly founder and director of the charity Water for Kids, is organising a 2-week field trip to Peru in Spring 2003. He warmly invites RIPH members to participate.
The trip will combine some development work, and learning about life and health conditions in the poorest communities in Peru, with an exciting visit to a fascinating region of South America. David has organised two similar trips before and this time he would like to widen the potential benefits to the Peruvians by utilising the experience and expertise of RIPH members.
The main purpose of the last trip was to help tackle some of the problems facing the communities identified as being most in need of help. Participants were sent on placements and worked on an environmental health action plan for the province of Huancayo, where the life expectancy is 40 - 50 years. Problems identified ranged from a school's "absolutely foul toilets and the roof falling in" to badly run rubbish dumps with pigs (and their tapeworms) and children wandering all over them. Polluted rivers where children played were another problem, and there were districts where gastro-intestinal disease was a major killer because of lack of education in health and hygiene, so some participants gave lessons to school children about hygiene and environmental awareness. Highlights of the trip included visiting a shanty village outside Lima where Water for Kids had installed safe drinking water for its 1,000 inhabitants; living in a mountain village for two days; and visiting an organic guinea pig farm! They also visited a school where David helped to raise money to provide a simple bread oven which now enables the school to provide malnourished local children with breakfast before they start lessons. As well as working, the group explored parts of the Andes, flew over the Atacama Desert and saw a wide variety of wildlife. Some stayed on to visit Machu Pichu and Lake Titicaca.
David is now planning the details of next year's trip with a Limean NGO, which will include working in the town of Ariquipa on developing an environmental health action plan, the idea being to leave behind something of lasting public health benefit.
Answers to likely questions are:
| When? | March or April 2003 |
| For how long? | 2 weeks are organised, but most people like to stay 3 weeks to visit Machu Pichu, the Amazonian rainforest etc |
| How much? | About £1,500 |
| Expertise needed? | An ability to solve problems and a willingness to help, learn and contribute are more important than traditional UK skills (but they help as well). |
| What do I need to take? | A sense of humour, enthusiasm, and crayons, pencils, chalk etc for the school children. |
Anyone interested in next year's visit is invited to contact David direct on tel. 01274 754381 or by email david.clapham@bradford.gov.uk
He will be delighted to give you more details and fire you with enthusiasm!