The Hungarian Doctor Who Pioneered Handwashing

Handwashing is easy to take for granted. It is one of the earliest and most basic forms of etiquette and hygiene we that we learn, not to mention a major pillar of our individual and collective health.

But like so many other “givens” in modern medicine and public health, hand washing was not always so accepted, even among health professionals. In fact, it practically came down to one person to discover and advocate the importance of washing one’s hands: NPR tells the story of Hungarian medical underdog Ignaz Semmelweis and his semi-successful attempts to improve the lives of millions through this deceptively simple practice.

Semmelweis was a man of his time, according to Justin Lessler, an assistant professor at Johns Hopkins School of Public Health.

It was a time Lessler describes as “the start of the golden age of the physician scientist,” when physicians were expected to have scientific training.

So doctors like Semmelweis were no longer thinking of illness as an imbalance caused by bad air or evil spirits. They looked instead to anatomy. Autopsies became more common, and doctors got interested in numbers and collecting data.

The young Dr. Semmelweis was no exception. When he showed up for his new job in the maternity clinic at the General Hospital in Vienna, he started collecting some data of his own. Semmelweis wanted to figure out why so many women in maternity wards were dying frompuerperal fever — commonly known as childbed fever.

He studied two maternity wards in the hospital. One was staffed by all male doctors and medical students, and the other was staffed by female midwives. And he counted the number of deaths on each ward.

When Semmelweis crunched the numbers, he discovered that women in the clinic staffed by doctors and medical students died at a rate nearly five times higher than women in the midwives’ clinic.

But why?

Like any rational, scientifically-minded individual, Semmelweis carefully assessed the data and sought out some empirical basis for this pattern.

“What Semmelweis had discovered is something that still holds true today: Hand-washing is one of the most important tools in public health. It can keep kids from getting the flu, prevent the spread of disease and keep infections at bay.

Semmelweis kept trying to convince doctors in other parts of Europe to wash with chlorine, but no one would listen to him.

Even today, convincing health care providers to take hand-washing seriously is a challenge. Hundreds of thousands of hospital patients get infections each year, infections that can be deadly and hard to treat. The Centers for Disease Control and Prevention says hand hygiene is one of the most important ways to prevent these infections.

Over the years, Semmelweis got angrier and eventually even strange. There’s been speculation he developed a mental condition brought on by possibly syphilis or even Alzheimer’s. And in 1865, when he was only 47 years old, Ignaz Semmelweis was committed to a mental asylum.

The sad end to the story is that Semmelweis was probably beaten in the asylum and eventually died of sepsis, a potentially fatal complication of an infection in the bloodstream — basically, it’s the same disease Semmelweis fought so hard to prevent in those women who died from childbed fever.”

An ignoble and cruelly ironic end to a man whose findings are now the bedrock of public health and sanitation worldwide. Semmelweis was ridiculed, marginalized, and ultimately forgotten because his observations conflicted with the established scientific and medical opinions of the time; indeed, many doctors took offense at the idea that they should wash their hands — at the cost of their patients’ lives.

It was only two decades after his sad death that Semmelweis’s recommendations gained widespread acceptance: Louis Pasteur’s confirmation of the germ theory of disease, followed by Joseph Lister’s use of hygienic methods during surgery both validated the Hungarian doctor, who lacked the scientific means to explain his findings.

But given his dedication to the well being of patients, I would like to imagine Semmelweis would be pleased to see his ideas become conventional wisdom. He might also be amused that his name is used for the eponymous “Semmelweis reflex” or “Semmelweis effect”, which describes a tendency for new evidence or knowledge to be viscerally rejected because it contradicts established norms, beliefs, or paradigms.

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Khassan Baiev

d091d0b0d0b8d0b5d0b22c_d0a5d0b0d181d0b0d0bd_d096d183d0bdd0b8d0b4d0bed0b2d0b8d187Some years ago, as an  undergrad at FIU, I had chance meeting with one of the greatest heroes I’ve ever known, a man I hadn’t even heard of until that day. It has stayed with me to this day as an enduring reminder of the many unsung and unknown heroes around us who go about their lives without praise, notice, or popular knowledge.

Khassan Baiev is a Russian-born doctor, now living in the U.S., who risked his life to indiscriminately help those in need in the midst of a bloody warzone. As a sickly and frail Chechen youth growing up in the Soviet Union, he spent years building up his mind and body, eventually becoming both a pro athlete and a surgeon (at around fifty years old, I recall him looking more fit than some people my age). He held strongly to the ideals of humanism, altruism, and the Hippocratic oath. As a Muslim and non-Russian, he faced discrimination along the way, but ultimately made a promising career in Moscow.

In 1994, when Chechnya attempted to break from the Russian Federation, the response was horrific. The Russian Army leveled almost every building in the capital, Grozny, and was virtually indiscriminate about the places it bombed and shelled. Perhaps 200,000 were killed in the course of the conflict, and many more psychologically and physically disabled. Dr. Baiev left the safety of distant Russian capital and went where he was needed; he was perhaps the only surgeon in the entire region. At great risk to his life, he adhered to his duty as a doctor and treated everyone and anyone he could, including Chechen militants and Russian soldiers. He explained how his Hippocratic oath, as a doctor, adhered him to helping whoever needed it, regardless of their allegiances.

It was enough dealing with hundreds of patients in the middle of a war zone, but given the circumstances, Dr. Baiev was soon forced to make due with few resources. When his hospital in Grozny was destroyed by Russian shelling, he moved his operations to an abandoned clinic in his hometown of Alkan Kala, restoring it with the help of locals and his own funds. Anesthesia was handmade; running water, electricity, and gas were typically unavailable. Wounds had to be dressed with sour cream or egg yolks. Baiev relied on household tools for his procedures, including a power drill for brain surgery and a hacksaw for amputations; he did 67 amputations and eight brain procedures in the span of just three days. He and his nurses, some of whom were killed, even donated their own blood for patients. This went on for six years of almost constant warfare.

Given the overwhelming demand for his services, Baiev would go days without sleeping, taking in an average of 40 to 50 patients. He never asked questions of those in need — he simply did his job and moved on to the next patient. He and the village elders kept the peace between the soldiers on both sides, who were sometimes in the same hospital, giving them equal medical treatment. But his willingness to help anyone put him on bad terms with both sides of the war, each of whom regarded him as a traitor. Bounties and arrests were put on his head. He was kidnapped several times and almost killed several more. He remained to do his job anyway, and only after an official warrant for his arrest did he reluctantly leave to America for the sake of his family.

He has returned to Chechnya several times since the war, even organizing a group dedicated to providing affordable medical care and to raising awareness of the brutality of the conflict. He had all his procedures recorded as evidence of Russian atrocities, which the Russian government denied (allegedly going so far as to kill some of his patients as a cover up). I saw some of the horrific footage myself; I still can’t imagine how someone could take all that trauma daily for several years.

Unfortunately, there is still much for him to do, as rates of birth defects, psychological trauma, and cancer remain high from the effects of the war. As I speak he still goes to his native republic to help despite occasional threats on his life.

I subsequently purchased his book, The Oath: A Surgeon Under Fire, and had the honor of having him autograph it. When I saw him up close, I was struck by how large and strong he looked; the man was in damn good shape. Yet he had a really somber and weathered look to him, and I could feel that presence as well. He had a firm handshake and a force of personality, but at the same time maintained a quiet and humble demeanor, fitting for a man who risked certain death for simply doing his job without any want of attention or money. He is exactly the kind of man I hope to be, and exactly the sort of person who stays with you years later, inspiring you to be the best damn person you can be.

Hero Highlights: Project Prakash

Of the world’s 1.3 million blind children, India is home to the world’s largest population, with estimates ranging from 200,000 to 700,000. As in many developing countries, a child born blind faces enormous social and economic hurdles: in addition to being stigmatized and marginalized in their communities, the vast majority of blind children are unable to get an education or a job. Many face physical and sexual abuses. At least half do not survive to adulthood.

In addition to regressive social attitudes, a lack of medical care access, and little to no disability-friendly institutions and infrastructure, the problem is made worse by the pervasive idea that, once a child reaches seven or eight years of age, their blindness is irreversible and untreatable. Yet the prevailing cause — congenital cataracts — is an otherwise easily treatable condition in the developed world. Imagine a lifetime of being disadvantaged and ostracized for something beyond your control and which could easily be addressed if there was the will and money. It is a disease of poverty.

Enter Project Prakash, founded in 2002 by Dr. Pawan Sinha, an Indian-born graduate of MIT. Named after the Sanskrit word for “Light”, he started the organization after a trip to rural India, where he witnessed the first hand the scale and severity of child blindness. After obtaining a grant from the U.S. National Eye Institute, he assembled team of about 20 clinicians, scientists, and outreach personnel to provide cataract surgery for as little as $300 per patient (though those too poor to pay get it for free). He tells the story in great detail Scientific American (sorry for the paywall.) Continue reading

Volunteer Rescuers of Migrants Acquitted of Criminal Charges

The sheer humanity of people in the face of suffering and injustice will never cease to captivate and inspire me. A couple of days ago, five individuals — three Spaniards and two Danes — were acquitted of charges in Greece of facilitating illegal immigration into they country when they volunteered to save migrants during the height of the crisis last year. According to the New York Times:

“This is a strong signal to other NGOs and just people working for humanity,” said one of the Danish defendants, Salam Aldeen, the founder of Team Humanity, speaking by telephone after the verdict. “Saving lives is not a crime, rescuing people is not a crime.”

Mr. Aldeen said he was now eager to return home after nearly two years in Greece — his pretrial conditions included being barred from leaving the country. He continued working as a rescuer during that time, he said.

“I lost everything but I did not lose my humanity,” he said.

Along with Mr. Aldeen and another Dane, Mohammed el-Abassi, who also worked for Team Humanity, three Spanish firefighters who volunteered for the Spanish group Proem-Aid faced as many as 15 years in prison.

The five were arrested on Jan. 14, 2016, just a few hours after successfully rescuing 51 migrants, according to Mr. Aldeen, the owner of the boat on which the five were working.

Not long after their operation, the men said, they had alerted the Greek authorities to another migrant boat in trouble, without approaching it. They were arrested soon after. “We didn’t even see the boat,” Mr. Aldeen had contended.

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The U.N. Official Who Quietly Saved the World From Nuclear Annihilation

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Though they are in charge of an organization that represents virtually all of humanity, Secretary-Generals of the United Nations — described variably as the “world’s moderators” and the “chief administrative officers” of the U.N. — have never been household names. Not many could name or recognize the current officeholder, António Guterres, the former prime minister of Portugal, let alone any of his eight predecessors.

Yet one of these men, a self effacing and bespectacled diplomat from Burma named U Thant* not only served with distinction as a capable administrator — of what was then a young, bold, and largely untested institution — but true to his role as the “world’s mediator”, he saved humanity from one of its closest calls with armageddon: the Cuban Missile Crisis.  Continue reading

Lessons from Bangladesh in Reducing Child Mortality

Bangladesh — the world’s eighth most populous country with 162 million inhabitants — has made tremendous and inspiring strides in reducing child mortality. This is despite the fact that it is a very poor country, with half the GDP per capita of not-particularly-rich neighbors India and Pakistan.

Less than two decades ago, the rate of death for children under five was 54% higher than the global average — now, it is 16% lower than the world average, and less than even its comparatively wealthier neighbors. Child deaths from diarrhea and other enteric diseases (e.g. those from bacterial contamination of food and drink) have declined a whopping 90%; whereas in 1994, 14% of Bangladesh children in surveyed households had suffered some sort of serious enteric illness, by 2014 that number halved to 7%.

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The Swiss Diplomat Who Saved Half of Budapest’s Jews

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Photo: Yad Vashem

Carl Lutz was a Swiss diplomat who, as Vice Consul in Budapest, Hungary, saved over 62,000 Jews – nearly half the Jewish population of the city – in one of the largest rescue operations of Jews in the Second World War.
Shortly after being appointed Vice Consul in the Hungarian capital in 1942, Lutz wasted no time in trying to save as many Jews as he could. Taking full advantage of his country’s famously neutral diplomatic status, he issued safe-conduct documents that allowed nearly 10,000 Jewish children to leave Axis-aligned Hungary.

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The Former Italian Fascist Who Teamed Up With a Franco-Era Spanish Diplomat to Save Thousands of Jews During WWII

Giorgio Perlasca (pictured left, some time before his death in 1992) was an Italian businessman and ex-fascist who cleverly used international law and bold impersonations to save thousands of Hungarian Jews during the Holocaust.

Perlasca was once a committed fascist who had fought for Italy in its brutal war against Ethiopia, as well as for the Nationalists in the Spanish Civil War. By the start of the Second World War, however, he had grown disillusioned with fascism, especially following Italy’s alliance with Nazi Germany and the implementation of Italian racial laws in 1938.

While serving as an Italian delegate in Hungary (another Nazi ally), his country had surrendered to the Allies, forcing citizens to choose between remaining loyal to the fascists or joining the Allied cause; at great personal risk, Perlasca chose the latter, and he was subsequently arrested by Hungarian authorities.

Using a medical pass that allowed him to travel in the country, he fled to the Spanish Embassy in Budapest, where he requested political status. Fortunately, his service to the victorious Spanish Nationalists endeared them to his request, and he was subsequently given protection, since Spain was neutral. Perlasca then took full advantage of his diplomatic cover to save people of a completely different faith and nationality.

Lucky for him, Angel Sanz Briz (pictured right, in 1969) was stationed there with the same idea in mind.

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The End of Smallpox

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Yesterday, December 9th, came and went like any other day. But on that day in 1979, one of the most groundbreaking endeavors in human history was accomplished: a group of eminent scientists commissioned by the United Nations World Health Organization (WHO) certified the global eradication of smallpox, the only human disease thus far to have been completely eliminated from nature. The WHO officially confirmed and announced this momentous achievement a few moments later:

Having considered the development and results of the global program on smallpox eradication initiated by WHO in 1958 and intensified since 1967 … Declares solemnly that the world and its peoples have won freedom from smallpox, which was a most devastating disease sweeping in epidemic form through many countries since earliest time, leaving death, blindness and disfigurement in its wake and which only a decade ago was rampant in Africa, Asia and South America.

Less than a decade before, the end of smallpox would have seemed the remotest possibility. As recently as 1967, the WHO had estimated that 15 million people contracted the disease, and that two million had died that year alone — the average number of annual deaths since the turn of the century. Continue reading

The Cop Who Threw Himself at a Suicide Bomber

Afghanistan’s reputation as a lawless, war-torn place is perhaps surpassed only by its reputation for rampant corruption (which doubtless accounts for the intractability of many of its other problems). Yet millions of Afghans risk their lives everyday in the hopes of creating a better society for themselves and their children, and tens of thousands more have died toward that noble and seemingly distant end.

One of them was 25-year-old Afghan Police Lieutenant Sayed Basam Pacha. He was a hardworking and ambitious cop who despised corruption and the widespread distrust of the country’s security services. He even dreamed of being a high ranking police officer or government minister so as to do more good for his country. He ultimately gave his life in accordance with his noble and virtuous goals.  Continue reading