Skilled Tradesmen as Public Health Experts: Or, why you should make friends with a good plumber…

The following is another post by our friend Pete Farmer,  who holds advanced degrees in research biology and history, and is also an RN and EMT.

January 4, 2011  

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If you are at all interested in medical preparedness and the issues that accompany it, you may wish to consider establishing a good relationship with as many skilled tradesmen as possible, and even consider acquiring some basic home-repair and “handyman” skills yourself. Why? The answer is simple. The foundation upon which modern public health rests is comprised not only of medical and scientific discovery, but upon many hundreds of years of advances in fields such as civil and sanitary engineering, the construction trades, manufacturing, and much more. All of us, to a greater or lesser degree, depend upon and take for granted abundant clean water, pest abatement, garbage and waste disposal, electrical/gas power, and shelter. The people who assure that we receive these services are the engineers, technicians, and tradesmen who build and run what we’ll call the public health infrastructure. That includes everyone from the sanitary engineer at the local water purification plant, to the microbiologist who tests your water for Escherichia Coli bacteria and other pathogens, to the building contractor who builds your home, to the plumber who comes running when your pipes burst.  

Maintaining optimal health is orders-of-magnitude more difficult when the basic public health infrastructure of our lives breaks down. This can easily be proven by historical reference to pre-industrial societies whose public health measures were lacking or all-but-nonexistent. Cholera, dysentery, bubonic plague, and other communicable and parasitic disorders were common, and morbidity & mortality from these disorders was high. 

In a post-apocalyptic or disaster scenario, among the most critical tasks for early responders is to restore basic services – water, power, communications – in addition to rendering first aid and medical care, and the provision of food, clothing, and shelter for those affected. Modern high-tech healthcare providers are, almost without exception, highly dependent upon having adequate power, light, and water on command, when and where they need it. Very often, they need distilled, sterile, or deionized water – for everything from scrubbing for surgery to reconstituting drugs for injection. They need high-capacity, surge-protected power, and bright light for examination, diagnosis, and treatment of their patients, and so on. That is why hospitals have extensive engineering departments devoted to maintaining these services, and often have redundant or “independent” sources of power (generators), water, and light. 

Leaving aside the special needs of acute care providers, let’s consider what the average person can do to assure these services are uninterrupted or at least started again as soon as possible after disaster strikes. 

Establish contacts with competent professionals in the building and construction trades, i.e., plumber, heating and air conditioning, electrical, carpentry, etc. Depending on your financial and other circumstances, consider preemptive service to assure that your personal water, power, and heat/cooling infrastructure is in good condition. If you live in a rural area, and can install a large-capacity fresh water tank, consider doing so, or sink a well, or both. 

Redundancy is desirable if you can afford it. Build or purchase back-up systems in case you lose water, power, heat, or other utilities. James Rawles, among others, has written extensively on this topic. Depending on your circumstances, specific needs, and budget, you may wish to purchase a diesel or propane-powered generator, or invest in solar power to augment electricity supplied by the local grid. One relative of mine has installed a home heating system that burns waste coffee grounds from a local coffee manufacturer; another has his home heated with a computer-controlled stove that burns corn kernels. The possibilities are extensive, so do your homework and shop around. A rainwater catchment tank may suit your needs. If you own a pool, it is a ready source of relatively clean water. 

If you are permitted to do so by local zoning ordinances, consider using propane to heat your home and run your vehicles. A large propane tank is unremarkable in most rural communities, and this simple hydrocarbon offers many advantages relative to conventional gasoline, diesel fuel, and natural gas. Conversion kits are available to modify your vehicle for this purpose; any competent mechanic can perform this service. Why propane? True, you are dependent upon deliveries of your fuel, but once it is in that tank adjacent to your home, it is much less subject to being interrupted by events out of your control. A broken gas main on the other side of town doesn’t affect you. And you own it, it is yours to use as you please. 

Another way in which a skilled tradesman can be of help is by inspecting your insulation, roofing, windows, and other parts of your home, and making recommendations for repairs or upgrades to your existing facilities. In a grid-down scenario, having adequate insulation may be not only a money-saver and a luxury, but a life-saver. 

A useful tip I learned from those in tornado or hurricane country is to have on hand the tools and supplies for doing basic reinforcement and/or expedient repairs to your home, in expectation either of being hit with a powerful storm or cleaning up after one. If you have sufficient forewarning of an approaching hurricane, it is standard operating procedure to tape your windows to minimize flying glass, and to reinforce weaker structural areas with plywood or other materials. Some plywood and plastic sheeting, along with various sizes of rough boards, can be used to do makeshift repairs after a storm. Again, consult your local tradesman for the specific tools and supplies to keep on hand. If you live in “tornado alley,” you need a storm cellar or similar reinforced, protected area in which to shelter.  

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Is your budget limited? You can take simpler but still valuable measures, such as keeping stored drinking water on hand in sufficient quantity to last a specific number of weeks or months without municipal water service. Keep a decent water purification system on hand, as well as simple chlorine bleach, which may be used to purify impure water. Most hiking stores also sell water purification tablets. Buy several propane lanterns or similar devices to light your home in the event you lose electrical power – and don’t forget the humble candle. They still work fine, and are cheap. Be aware of the necessity of adequate ventilation when using any combustion source of light; do not fall prey to CO (carbon monoxide) poisoning! Observe common-sense fire safety rules, and having a fire extinguisher on hand is always prudent. In case you lose your heating system, keep adequate bedding materials on hand to compensate for the cold. Commercially-available sleeping bags rated to various temperature ranges are adequate for most of us.

 Most folks take for granted a clean, dry place to perform their basic functions of elimination. However, in a post-disaster scenario, you may lose that facility and have to resort to something more primitive, along the lines of a latrine or outhouse. Again, think ahead… do some contingency planning, and remember – you’ll need to site any field-expedient latrine or toilet well-away from your dwelling, any ground water, and preferably downstream of any ponds, streams, etc. on your property. A good reference for this situation would be to consult a military field manual on establishing field sanitary facilities. A common and useful method of containing/disposing of solid waste is to use a cut-in-half 55-gallon drum as the receptacle of your latrine; the waste therein can be burned using gasoline. Solid waste can also be buried or composted. And take note of the prevailing wind direction when sitting your latrine; no point in being downwind any more than you have to. This seems a trivial matter – but as any soldier can tell you, having a clean, dry, and sanitary toilet is critical not only to public health, but morale. And don’t forget the TP…   

Pest abatement: this will vary according to your locale, circumstances, and the prevailing climate in your region; the key factor is to think a bit about how to minimize insect, rodent, or other infestation, not only in your home, but in a post-disaster scenario. If you live in a tropical/subtropical region, or it is hot and humid with standing water, you will need to think about mosquito abatement. That means repellent, mosquito netting, protective clothing, and perhaps chemical agents to treat standing water. In a pinch, oil works as it establishes a thin film on top of the water, prohibiting mosquito larvae from getting established. As far as rodents or other small mammals are concerned, commercially-available traps and poisons are an option, and a dog or cat also can work wonders in keeping them away. Make friends with your local pest control specialist, and you can prevent these issues from becoming problems in the first place. Be aware of local rules and regulations regarding pesticides and similar chemicals. Take the time to familiarize yourself with the local insect varieties, such as ticks, bees, wasps, etc. and make the necessary preparations. If you or a member of your group is allergic to bee stings or similar, have an adequate supply of epinephrine on hand (usually in the form of an “epi-pen” auto-injector, which must be refrigerated). Your general practice M.D./D.O. is a good resource for preparation in this area. Adequate food storage will also do much to minimize pests – so assure that your food is secured properly. Speaking of food…    

If the power goes out, do you have adequate stocks of food on hand, in non-perishable form? If not, consider getting some MREs (Meals Ready to Eat), dehydrated food, or other foods stable in long-term storage. Costco and many other commercial outlets sell pre-made kits containing survival food, or you can easily put together your own cache. In addition to stockpiling a supply of safe, clean water, don’t forget to lay in a good supply of soap, and some basic cleaning gear – buckets, towels, and the like. If the water main bursts, or you lose your source of clean water, not only will you need potable water for drinking and food preparation, you’ll need it for bathing and cleaning. Plan accordingly. 

The foregoing are simply some suggestions on how to get started. The important thing is to devote some thoughtful time and effort to assuring the infrastructure which protects your health. Even the best post-disaster medical care is severely handicapped by inconsistent and/or unreliable food, water, shelter, and sanitation. So, make friends with your contractor or tradesman – you’ll be glad you did. 

Copyright © 2011 Peter Farmer

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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One Response to Skilled Tradesmen as Public Health Experts: Or, why you should make friends with a good plumber…

  1. Pete’s article reminds me of an experience from two decades ago.

    I had arranged to take my kids to Disney World with a friend. It was a long drive from Kentucky, and we arrived in the middle of the night. Since my friend’s aunt’s house had been closed for the winter, the electricity was off, so we used a flashlight upon entering.

    Dead tired, I headed straight for the bathroom, lifted the toilet seat, and nearly sat down.

    “Yikes! Rats!” I squealed, noticing three dead rodents floating in the commode.

    Immediately thankful that I had not carried my children to bed, we high-tailed it out of there to a hotel. When we returned in the light of day it was clear the rats had had the run of the place for weeks. The neighbor had been in to shoot a few and set out some rat poison.

    “Is that Mickey Mouse?” my three-year-old asked, spying a sick rat wobbling behind the front door.

    “NO!” I responded, mentally counting my cash and wondering if I could afford a whole week in a hotel.

    We ended up staying a few days in the rat house, squeezed into the sunroom, separated by glass doors from the rest of the house. By the third day I’d had enough and left.

    The moral of the story? The problem was caused by a combination of the water being shut off and the city working on the sewer lines. The rats had come up the dry lines, and encountering neither water nor obstruction, had infested the house. The same thing could happen in any widespread disaster, so plan ahead. Yuk!

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