Archive for January 21st, 2010

Money is better disaster aid than homeopathy

January 21, 2010

In which Dr Aust suggests that while sending money for disaster relief may not feel like enough, it it better than sending nothing. Even magic nothing.

Earlier this week Dr Aust wrote out a cheque to the Disasters Emergency Committee.

At times of disasters with tragic costs in human lives, people are naturally moved to think about what they can do to help. Money seems a feeble response, in a way – but here in rich countries, money is what we have to contribute. It is also something that is needed urgently, and will continue to be for many years to come.

Beyond that, though – and perhaps other slightly more “political” measures like campaigning for cancelling of Haiti’s debt – there is little concrete you can do.

And anyway, it would be rather arrogant to think you could do anything on the ground. Or even that you know what needs doing. Though certain things are fairly obvious, like medical supplies for overstretched hospitals, or – possibly most urgent of all – getting enough clean water to people to try and head off deadly outbreaks of water-borne infectious diseases.

It would certainly be arrogant, though, to think one knows exactly and precisely what kind of medical treatments are required to deliver the necessary care. How could one know from here?

Some people do seem to think they do know quite precisely, though. You can find a few of them here, or here. Some of these folk seem to think that homeopathic first aid (sic) would be just the thing for the people of Haiti.

It strikes Dr Aust that this is a touch self-centred.

If the homeopaths want to help, they should do what everyone else does and donate their pounds, or dollars, or whatever, through some non-profit NGO (non-governmental organisation) with an existing local presence – like Oxfam, or Unicef, or Save the Children. That would be my first thought, and indeed it seems to be what real aid workers tell you to do too.

To be fair, there are some people on the homeopathy blogs and forums saying this. But there are also some commenters who seem as interested, or more interested, in promoting homeopathy. Or telling you the established NGOs are (to paraphrase)  “just going to spend all your donation on administration and jobs for fat cat managers”

[PS – even if some aid organisations do spend more money on “administrative costs” than others, I think you’ll find it’s just a bit more complicated than that]

Instead, some of these folk want to send homeopathic first aid kits. Or “trained homeopaths”.

To me this smacks of arrogance, and insularity.

It seems to me that it would be a bit like me thinking that I knew exactly – and better than the people at the sharp end – the precise medical interventions, and indeed brand of supplies, that were needed to deal with a diarrhoeal disease outbreak, or some other epidemic, in an unprecedented disaster setting halfway around the world.

It would also be a bit like me telling Oxfam, or the Red Cross, or Médecins Sans Frontières, that I was not going to donate money, but instead was going to buy £££ worth of the remedy of my personal choice – say branded Generic Evul Pharma Dioralyte – and send it to their depot.

Now, I’m sure they could use the Dioralyte, which is a perfectly good product for treating water, and more particularly salt, loss in diarrhoea. Even if it does taste a bit bleagh. (I speak from experience)

On the other hand, perhaps they would prefer something else, like a cheaper unbranded version. Or, in an emergency setting, they might prefer a bunch of water boilers (for sterilizing water) plus a crate of 10 kg tubs of NaCl (sodium chloride, aka salt) and glucose, or sucrose. For the reason why this is useful stuff, see the end of the post.

Or alternatively, perhaps what they would really need is a generator to run the water-boilers. Or bottled gas. Or  well-digging equipment to find a source of water.

Perhaps they need all of the above.

The point, of course, is that I DON’T KNOW just what what would be most useful for the people in the disaster zone, or the local workers on the ground. The local aid workers on the ground, on the other hand, do know.

And what we can do, hopefully, is give their organisations the resources to buy what they say they need and to get it to them.

It isn’t really enough. But it is,  hopefully, something real.


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Edit: There is a brilliant blog post from the British Red Cross blog, pointed out by Zeno (see first comment below), that makes the point about why donating money – not items – really is the best way to help. Highly recommended.

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Appendix:  Salt, sugar and water

When you have diarrhoea you lose water, and salts. The best way to treat you is to replace these, orally if at all possible (and intravenously if that is not enough). For oral rehydration the World Health Organisation defines Oral Rehydration Solutions, and most manufactured (packet) formulae follow these.  The basic points are that they contain salts, and also sugars. This is because you need to replace the lost salts, and salt and sugar are absorbed together in the small intestine via linked transport (“co-transport” is the technical term) of sodium ions and glucose into your intestinal epithelial cells. [Sucrose, table sugar, can be used since it is rapidly broken down into glucose and fructose].

Since severe diarrhoeal disease means that you lose not just water, but also sodium, potassium and chloride ions, the rehydration formulae contain not only NaCl (sodium chloride) but also potassium chloride (KCl). Some versions contain bicarbonate too, since diarrhoea also leads to the loss of bicarbonate ions.   More fascinating stuff about diarrhoea and oral rehydration therapy at Wikipedia.

In emergency settings, simpler “homemade” versions are also used. Perhaps the most famous is:

– one level teaspoon of salt
– eight level teaspoons of sugar

– dissolved in one litre of clean drinking water, or water that has been boiled for 10 minutes and then cooled.

This simple recipe has saved innumerable lives – some estimate as many as fifty million in the last three decades. It is particularly important for children under five who are at increased risk from diarrhoeal disease – the second leading infectious killer of under-fives worldwide.   As Ben Goldacre says, behold the power of ideas, and the scientific principles on which these ideas are based.