It’s not something we worry about in the united states
Sarah M. Pearson
“It’s not something we worry about in the United States,” is a phrase said in medical school. And it is a true statement - often said following a lecture slide describing the worst parasitic or bacterial disease you’ve ever seen in your life.
Earlier this year, first-years learned that the most common human-helminthic infection is Ascaris, affecting 1 in 7 people globally. I personally hadn’t heard of it until January of this year, which made more sense after our professor mentioned that Ascaris is a non-issue in developed countries. In fact, if a country has access to clean water and sanitation, it not only rids Ascaris, but it eliminates most risk of parasitic infections altogether. (Also, if I ever did contract Ascaris, I could drive to Urgent Care for treatment because I am American, and I have pretty good health insurance in Massachusetts).
We also learned that if you get bitten by the Chrysops fly, a parasitic worm will crawl across the eyes within a few months. You might feel it move throughout your eye, too. Loa Loa is a large public health issue in other regions of the world like Cameroon or the Democratic Republic of the Congo, but for us, it's a fascinating and graphic picture - one that goes away with a click of my Anki remote.
Later on, I learned that the worldwide leading cause of death by single-infectious agent was and has been tuberculosis (TB), and I was surprised. My mind equated tuberculosis with forms to complete before orientation - I had to drive to CVS twice in one week last summer so I could submit my UMass health clearance form and start school on time. From what I can remember, the traffic in Boston was pretty inconvenient that week.
We learned about streptomycin, isoniazid, rifampin, and other tuberculosis treatment algorithms; about Directly Observed Therapy; about drug resistance. And then briefly, about how the CDC and the WHO track disease burden data. I looked up last year’s TB global prevalence map during class, noting that the US was a light shade of yellow on one graph and a deep green on the other - colors indicating a very low number of TB cases and a very high rate of TB detection. If the Mycobacterium tuberculosis bacteria is the same across the globe, then our systems simply must be stronger in the US, right?
By the end of the Blood, Infection, Immunology course, I felt conflicted with all of this new information. At times I felt amazed and thought to myself, “our American scientists have made amazing progress, I am so proud”. But my brief, almost patriotic feelings never lasted more than a few feet farther from the lecture hall or a few seconds on my phone.
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“Check the CDC website, make sure that it’s still up and running,” was another phrase said by professors this year. Along with, “unfortunately, due to a lack of funding…” and, “the status of that is uncertain nowadays”.
Around the same time as the Ascaris lecture, we learned how some vaccines prevent the accumulations of mutations, and how others can boost the immune system. And we simultaneously received an email that measles is back, for the first time in decades.
We talked about climate change, and its pernicious effects on the spread of disease. A few hours later, the President declared that our national forests are open for logging, expanding public land for drilling and rolling back regulations on greenhouse gases.
Towards the end of the semester, we learned about the MenAfriVac project - a global vaccine initiative led by the World Health Organization and PATH, where countries were able to align and collectively eliminate the meningitis A epidemic in sub-Saharan Africa, fundamentally changing the trajectory of >400 million people. Five days later, I got a Reddit notification that the US had pulled out of the WHO.
I attended lectures about epigenetics and childhood trauma - discussing how experiences can shape behavior and relationships; new data showing that trauma can have a multigenerational biological influence on risk of disease, long after initial exposure. On my walks home, I’d scroll through TikTok and see the aftermath of another bomb that was dropped on the Gaza strip - seeing thousands of kids become orphans, witnessing irreparable psychological damage compound from 6,000 miles away.
So I put my phone down. I know I should avoid distractions from my upcoming exam. Reading too many pieces of bad news can make one depressed, you know.
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This Blood, Infection, Immunology course has since passed, as time tends to do, and I’ve since continued to accumulate more knowledge about the world around me. I often think about that phrase, “It’s not something we worry about in the United States”, and I question its integrity. The saying that used to provide a sense of comfort has quite rapidly morphed into a feeling of unease. It has been difficult to not notice that the privileges we’ve had as American citizens have become much more fragile – in fact, they appear to be actively falling. Those ‘non-issues’ that felt so distant, might actually be close by.
But as I finish up my first year, I think I’m still going to hold onto my beliefs that science moves things forward, that systems can be strengthened, that the world can be coordinated again. And I hope that the research and the institutions that made all of this progress possible continue to be prominent scaffolding in society. That being said, I am also aware that the world may look very different by the time I finish my medical training - that the variables we are taught to construct and manipulate as physicians are not guaranteed to always be in our control. I suppose, in the end, time will tell.
Sarah is a first-year medical student at UMass Chan-Lahey. She majored in Nursing at the University of Pittsburgh before completing her post-baccalaureate at Harvard. She has always loved photography, reflective writing, crafting, and journalism. She joined The Interstitium to dedicate time to these passions during medical school and to also connect with the broader community.
