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A World in Shadow I

The New York Times recently ran a series, titled "Diseases on the Brink", that surveyed five diseases - polio, measles, dracunculiasis (also known as guinea worm), blinding trachoma and lymphatic filariasis - that it may be possible to eradicate, if the political will of the world community is up to the task. All these diseases can be treated with relatively simple measures, and have been wiped out or nearly so in industrialized nations thanks to improved sanitation and vaccination, but remain endemic in the Third World. All of them are also notable for their effects, which can include lifelong debility, disfigurement, or both.

While polio and measles will likely be familiar to readers, the other three may not be. Guinea worm was discussed in the Ebon Musings essay "All Possible Worlds", to which I direct interested readers (although a strong stomach is advisable).

The other two are equally revolting in their effects. Blinding trachoma is an eye infection caused by the same microorganism that causes chlamydia, Chlamydia trachomatis. Spread from person to person by flies or by contact with infected individuals, the disease causes the sufferer's eyelid to turn inwards, painfully scraping the eyelashes over the surface of the eyeball with each blink. If not treated, the corneal scarring this causes eventually leads to total blindness. The World Health Organization estimates that 70 million people worldwide are infected with trachoma, with infection rates as high as 86% in countries such as Ethiopia, and as many as 5 million suffer from the late-stage trachoma that ultimately causes blindness.

The Times' description of how the disease is spread:

Swarming Musca sorbens flies play an ignominious role in spreading the disease. They crave eye discharge and pick up chlamydia as they burrow greedily, maddeningly into infected eyes.

recalls Mark Twain's description in the essay Thoughts of God, where he imagines God giving the fly its marching orders:


"Depart into the uttermost corners of the earth, and diligently do your appointed work. Persecute the sick child; settle upon its eyes, its face, its hands, and gnaw and pester and sting; worry and fret and madden the worn and tired mother who watches by the child, and who humbly prays for mercy and relief with the pathetic faith of the deceived and the unteachable. Settle upon the soldier's festering wounds in field and hospital and drive him frantic while he also prays, and betweentimes curses, with none to listen but you, Fly... Harry and persecute the forlorn and forsaken wretch who is perishing of the plague, and in his terror and despair praying; bite, sting, feed upon his ulcers, dabble your feet in his rotten blood, gum them thick with plague-germs... carry this freight to a hundred tables, among the just and the unjust, the high and the low, and walk over the food and gaum it with filth and death. Visit all; allow no man peace till he get it in the grave; visit and afflict the hard-worked and unoffending horse, mule, ox, ass, pester the patient cow, and all the kindly animals that labor without fair reward here and perish without hope of it hereafter; spare no creature, wild or tame; but wheresoever you find one, make his life a misery, treat him as the innocent deserve; and so please Me and increase My glory Who made the fly."

Filariasis, by contrast, is caused by parasitic worms whose larvae are spread by mosquito bites. Inside the body, the worms grow to adult form, up to four inches long and as thin as hairs, and take up residence in the lymph nodes. They obstruct the vessels that allow lymphatic fluid to flow properly, causing it to pool in the body's lower extremities - the legs, feet, and for men, the scrotum - and producing a grotesque swelling called elephantiasis. (The scrotum of an infected man can swell to the size of a basketball.) Even besides the pain and humiliation this condition causes all by itself, it can lead to fevers, sores and infected ulcers of the skin. Victims can be left literally unable to walk. The worst part is that, even if the parasite is killed by anti-worm medications, the swelling is permanent, because the overstretched lymph nodes do not shrink to their former size.

The suffering caused by these diseases is beyond description. Why, then, do theists praise the goodness of the God whom they believe created them? If a human had created one of these pathogens and released it into the wild, he would be reviled as one of history's greatest villains. But when God is held to be the cause, believers sing hymns of praise to his name and proclaim his infinite goodness. Few of them even seem aware of the discrepancy, and those that are aware typically appeal to patently unsatisfactory evasions such as proclaiming it a "mystery".

An atheist, on the other hand, faces no difficulty in explaining these pathogens. As with every other species, they came about through evolution, which like all natural processes is neither morally good nor morally bad and does not take human needs into account. These species have adapted to prey on human beings, and so long as they continue to gain reproductive advantage by doing so, they will continue to torment us. If we ever want to eradicate them, we must use our faculties of reasoning, themselves the product of evolution, to better understand how nature works so that we may control it to our benefit.

But more than that, we must come together and work for the outcome we desire to see. The most effective cure in the world is nothing if there are not people willing to distribute it. Prayer and other appeals to the supernatural are worse than useless, in that not only do they achieve nothing in and of themselves, they draw time, effort and attention that could otherwise have been spent on useful tasks such as vaccinating another child or treating another contaminated pond. Witness the abject and pitiful superstition some families turn to in lieu of effective treatment, quoted from the measles article:

The swami, Grishm Giri, 82, his long white beard hanging halfway down his stained tunic, explained that last year had brought twice the usual number of measles cases. He waved a staff of peacock feathers over each child and chanted prayers, collecting about 12 cents from each family.

His assistant, Niraj Giri, a middle-aged man in a saffron-colored shirt, measured the distance from the children's navels to their nipples with a string. "We try to find out if the center of the navel is in the right place," the assistant said. "If it is not, we correct it." He explained that this displacement of the center is the real cause of disease, a problem that can be fixed through the nerves by hitting the bottoms of a person's feet.

Among those waiting for help was Ram Pukar, a rickshaw driver, holding his 6-year-old daughter, Sujita, who was so sick her head lolled from side to side. Her long black hair hung like a matted screen across her face.

(Note that 12 cents is almost exactly the cost of the measles vaccine. What good could that money have done for this poor family, rather than being wasted on the ignorant posturings of a charlatan?)

Worse, sometimes superstition directly interferes with the genuinely effective efforts. The article on guinea worm discusses a rural village that refused to let international workers treat its contaminated pond with a mild pesticide that kills the worm's larvae, because the pond is "sacred" to them. Similarly, the polio vaccination program has run into intense difficulties because some Muslims believe the vaccine is part of a Western plot to sterilize them, or because Muslim families refuse to let male strangers enter the household if the husband is away.

If we are ever to wipe out these scourges, we need to overcome the distracting and stubborn superstitions that stand in the way of true cooperation. It can be tempting to let people who refuse effective help in favor of superstition suffer the consequences of their folly, but compassion demands a higher standard - if for no other reason, then for the sake of the children and other innocents who do not deserve to suffer for the irrational beliefs of others, and who have a chance to grow up into a future free of diseases both of the body and of the mind. For the time being, this is still a world very much in shadow, but if the human community can truly come together to work for what is good, then we have a chance at inheriting a future full of happiness and light.

Other posts in this series:

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