Fewer snacks and sugared drinks. These promote bacterial activity and acidify the mouth. Sodas, syrups, and fruit juices are especially bad, since they are not only sugary but also acidic. Water should be the preferred drink, especially for young children.
An appropriate diet. Prefer whole foods over processed foods, replace white sugar with unrefined cane sugar or honey, and decrease your consumption of foods containing sugar as much as possible. The good news is that unless you live near a source of sugarcane or sugar beet production, you will not be consuming much sugar anyway.
Regular trips to the dentist. This will allow you to get cavities treated at an early stage. Dental lesions will then be kept to a minimum. Cavities cannot be healed; their progress can be stopped with cleaning and the sealing of the remaining cavity. Ideally, dental visits should occur every six months. Once a year should be enough for an adult with few cavity or gum problems. While you are at it, verify that you have a good bite. This often has an impact on your other bodily functions.
Once living in your SAB, if you notice that your gums are swollen or irritated, continue brushing your teeth and cleaning between your teeth (flossing), and massage your gums with a toothbrush or your fingers. Wash your mouth with salt water for several days and eat mostly fresh green vegetables and fruits. If, despite an exemplary preventive regimen, a cavity develops and no dentist is available, redouble your efforts to keep the cavity from becoming larger. But if it does, and the pain becomes unbearable, there is only one solution—pulling the tooth. To do so, you will need a certain number of tools: a dental mirror to see behind your teeth, a hook to find cavities, and a speculum and wood to displace the tongue. Then you must wash your hands with soap, sterilize your instruments, and have the patient rinse his mouth until no traces of food remain. Verify by touching the tooth that it is, indeed, the cause of the pain and not something else (such as a broken jaw), and, above all, make sure you have the right tooth. Once it is identified, administer a mild analgesic (paracetamol) and apply clove oil. Equip yourself with cotton and gauze in case of bleeding. If you have any local anesthetic (lidocaine, procaine, etc.), administer it to the gums on both sides, close to the teeth, with a sterile syringe. Unless you have dental forceps, use pliers or a clamp to pull the tooth. Do not jerk it suddenly, so as not to break the tooth or the roots, which could become infected. (Note: some teeth have only a single root, some two, and the molars have four.) Verify the whole procedure by referring to an appropriate guide to dentistry. Once you have a firm grip on the tooth, act as if you have a stake stuck in the ground: manipulate the tooth in one direction and the other until it becomes loose and starts to come out more easily. Cover the wound with a disinfectant (chlorhexidine or clove oil) and place a little gauze on it, asking the patient to bite down for 30 minutes. This should stop the bleeding. Then stitch the wound as you would any other. You can only hope that the patient has not suffered too much (and that the experience doesn’t do too much harm to your friendship). If after a few days the patient experiences pain in his tongue and sinus cavity, this means that the wound has become infected. It must be treated like any other infection, which we shall discuss below. Of course, if you have the tools and the know-how to treat a cavity by drilling and filling it, this is preferable to pulling the tooth.
So one of the first things to do in case of a serious economic crisis is to immediately visit the dentist for full treatment of cavities or other problems. Do not wait—your dentist could save your life. For that matter, put down this book, call your dentist, make an appointment, and tell him I sent you. Take heart: it won’t hurt as much as having a tooth pulled.
Medicine
We must be realistic. The immense knowledge and know-how developed by modern medicine will not necessarily be there for us in a crisis. If we are lucky, a certain number of doctors, medications, instruments, and sophisticated machines will remain permanently in operation. If not, we will have to rely on more rudimentary methods.
Here are the two cases to consider: either you have access to medical expertise (you are a doctor yourself or you have a doctor, or at least persons with medical knowledge, in your SAB) or you are left to your own devices and must get along as best you can with the knowledge and competence you can acquire.
In both cases, here is what you should do now:
Identify the doctors, hospitals, dispensaries, clinics, and pharmacies nearest you.
Buy some medical-emergency manuals.
Buy a few medical tools and instruments.
Identify courses available at universities nearby or given by specialized organizations such as those that train humanitarian workers who travel to natural disaster areas or isolated areas. You will certainly find specialized courses—evening or continuation education—on first aid, emergency care, and holistic medicine. Your goal should not necessarily be to get a diploma but to learn the basic ideas and, if possible, get a little experience. For example, you should learn how to administer an injection (intravenous or intramuscular), perform cardiac massage, apply bandages or medication for burns, set up an intravenous drip, etc.
Stock up on medications that will allow you to treat a certain number of problems (see list below).
Verify that you and all persons in your SAB, especially children, are up-to-date with vaccinations. See a doctor who can immunize you against hepatitis A and B, tetanus, poliomyelitis, yellow fever, tuberculosis, measles, etc.
To get started, let’s look at a few basic principles of survival medicine:
Be aware of your surroundings. Unless you are a doctor yourself, one might very well be difficult to reach. This is why you must learn as much as you can to increase your know-how and experience.
Use common sense: if you know there is no doctor available and you don’t know what to do, ask around. If no one can help you, call upon your good sense and improvise. For example, if a woman has given birth and continues to bleed, and you are 30 minutes from a doctor or hospital, take her there as quickly as possible; however, if you are two days away from help and cannot communicate, look up a childbirth manual and take the initiative by massaging her belly (perhaps the placenta has not come detached properly), while someone else goes for help.
Use what is most effective in modern medicine along with what works the best in traditional medicine. This combination may be better than either one taken separately. Respect local traditions unless you identify harmful methods. But if certain methods do neither harm nor good (e.g. in certain lands, there exists a belief that biting the serpent that bit you can help you recover), let auto-suggestion (i.e., the placebo effect) operate; it may help and, in the worst case, it will have no adverse effects. Work with local healers if there are any: midwives, veterinarians, retired doctors, etc. Learn and ask questions. Do not waste chances for learning or observing, but ask—e.g., if you are present at surgical operations. Get used to the sight of blood and wounds.
Lead by example. If you care for your own health, others may imitate you, but if you make no effort, it will be hard for others to follow your recommendations. This goes for excess drinking, overeating, smoking, and sanitation tasks. If you give instructions to empty overflowing latrines, take part in this unpleasant but necessary task yourself; you will gain respect. Teach the people around you, especially once you are in your SAB, how to avoid getting sick, how to maintain good hygiene, how to care for oneself, and eat and drink in a healthy way. Learn to observe and ask the right questions: why does diarrhea occur? Why did this or that animal die? What could have caused these cases of malnutrition, depression, or other illness? Proper diagnosis is of the greatest importance. For example, a person has a cough that he thinks is a problem requiring treatment. Now, his real problem might be smoking. He must find the will to quit, and this is not a medical problem but a social and psychological one. What he needs is not medicine but a strong will, the support of his family and friends, and perhaps some practical advice on how to break a habit.
Maintain a proper
balance between prevention and cure.You must not fail to treat real problems on the pretext of preventive action. The treatment of a slight illness can keep it from becoming a serious one. Make use of treatment to teach and practice prevention. For example, if a mother of a baby with intestinal worms comes to have it treated, take advantage of the situation to explain how such worms are caught and reproduce, and what must be done to keep them from returning.
Then you must learn to classify medical problems.
All kinds of problems—whether they have a psychological, bacterial, natural, or viral cause; are due to an injury; or are chronic—there exist three categories of seriousness: slight, medium, and severe.
Treatment must be administered as a function of the type and seriousness of the problem. Let us be clear and pragmatic: everything serious (heart attack, impalement, amputation of a limb, deep or extensive burns, open fractures, poisoning, serious behavioral problems, etc.) will require emergency hospitalization. Even a very good surgeon cannot perform a liver operation without an operating theater! So we must concern ourselves only with slighter categories and a few more serious cases. But whatever happens, consult a doctor as soon as possible if you can.
Shock Trauma
Falling from a ladder while picking fruit, cutting oneself while woodcutting, and spraining an ankle while running are all physical traumas that can occur in your SAB (indeed, these occurences will likely be common). You must also consider the possibility of more unusual types of injuries, such as bullet wounds. Shock trauma is a large category of trauma, direct or indirect: falls, puncture wounds, cuts, or blunt trauma, and these involve, in increasing order of seriousness: bruises, open wounds, hematomas, sprains, dislocations, and fractures. These injuries involve soft tissue (skin, fat, muscle), the skeleton (bones and articulations), and/or vital areas such arteries, veins, nerves, organs. Since the list of possible injuries and treatments is very long, let us take just three examples from among the many cases you should research yourself:
In case of a cut, you must disinfect it with iodine or a chlorhexadine antiseptic, then stitch it with a sterilized needle and suture. If possible, administer a local anesthetic (e.g., lidocaine, procaine).
If a foreign object is in a wound, you must also disinfect and, if possible, remove the foreign object with tongs—you might also use retractors to keep the wound open during the procedure. Sometimes, if the foreign object is too small or close to an organ that might be damaged, it may be preferable to leave it inside and try to prevent infections by administering antibiotics.
For fractures, keep the limb immobile with a splint and recommend rest. Plan on having preformed splints for the neck, ankles, or wrist; you will find them at a pharmacy; they will also be useful for sprains. If you have an open fracture, it must be treated as a wound; try to put the bone back in place while removing bone fragments. Good luck!
For any surgical operation, always wear gloves, eye protection (glasses at the very least), a mask, and an apron. You must wash your hands before and after an operation and, if possible, disinfect them with an alcohol-based disinfectant. For pain, or in order to administer a general anesthetic, use morphine. The dosage is a function of the patient’s weight: for a 70-kilogram or 154-pound adult, 7 milligrams are necessary; for 100 kilogram or 220 pounds and up, you will need 10 milligrams. Morphine is administered by injection (into the fatty tissue under the skin). You must then bandage any wounds with the help of a homeostatic tourniquet and compress bandages.
The best way to avoid wounds is, of course, to prevent them from happening. Wear shoes outside, wear protective clothing when you are doing dangerous work, protect your eyes, protect your hands with gloves, wear a helmet, etc. Be prudent, attentive, deliberate, and careful.
Burns
A burn can be caused by:
by contact with something hot (solid, liquid, or gas);
by contact with a caustic substance;
by friction;
by the effect of combustion (the action of a flame);
by the effects of radiation (sunburns being the best example);
by the effect of an electrical current (electrical burns);
or by cold (frostbite).
There are three degrees of seriousness:
First-degree burns are the least serious and most common. Only the epidermis is affected, causing redness. The area of the burn becomes sensitive, as with sunburn. Such burns require no special treatment since the skin retains its power of regeneration.
Second-degree burns damage the epidermis and, to a lesser degree, the dermis. These burns involve the appearance of boils on the affected areas. The skin can heal on its own, provided the patient is careful to avoid infection.
Third-degree burns are the most serious. They destroy all of the skin (dermis and epidermis). The damaged skin takes on a white, brown, or black coloration and becomes insensitive, dry, and subject to infection. In this case, there is no possibility that the skin can regenerate itself, for all of the living skin cells have been destroyed. If the lesion is large, a skin graft is indispensable for the patient’s survival.
The basic treatment for a burn consists in moistening it with cold water, gently and without pressure. Do not pour water directly upon the burn, for this applies microbes on a lesion that has just been sterilized by heat. Moistening a burn limits its extension and consequences, as well as relieves pain.
In the case of a chemical burn, remove the clothes affected by the chemical and run plenty of water over the burn or affected area as early as possible, to remove the substance in question. If the substance gets into the eye, again rinse abundantly with water. A serious burn frequently provokes cardiovascular collapse, shown by an intense paleness of the skin (especially around the lips and eyelids), a rapid pulse, and the feeling of thirst. If the burn is extensive, and the patient must be transported, wrap him in a sterile blanket and keep him still in order to reduce pain. If the burn is on the back, transport the person face-down.
Frostbite is a kind of burn caused by the cold. It may be superficial or deep. Apply moderate external heat to the affected areas. This can be done by bringing the patient close to a radiator or fireplace, for example. This will lead to a remission in the affected area after a few days.
Eye and Ear Troubles
The main forms of eye trauma are: dust, contusions, cuts, and burns. Treatment differs according to the type of problem, but one must always act quickly.
For dust, it is enough to rotate the eye so tears can wash away the dust in a natural way, but a more serious problem, like a cut or foreign body in the eye, renders this solution inapplicable.
For a contusion, administer a pain reliever and hope that the hematoma gets absorbed naturally (as it often does). If pain persists, the eye must be thoroughly examined by an ophthalmologist, or else the patient may lose his sight.
For a cut, the patient’s head must be immediately immobilized; you should place your hands on both sides of the head, in order to eliminate the risk of losing the eye. One must be careful to leave the patient in the position in which he was found. The eye must not move. If an object is lodged in the eye, do not remove it immediately. If possible, put a screen of some kind in front of the victim’s eye so that he is not tempted to try to see what is going on around him, which would cause the eye to move and create complications. Reassure the victim. If there is no possibility of having the victim treated by an emergency ophthalmology service, and no doctor is available, anesthetize the muscles around the eye, administer sedatives and painkillers, and remove the object with sterilized tweezers.
For burns, regular washing with clean water can limit the effects of heat or chemicals.
Be sure to have several pairs of corrective glasses on hand if you need them. Wear good-quality sunglasses to protect your eyes in case of heavy sunshine, especially on ground covered with snow, at high altitudes, or in the desert. If you are nearsighted and have a chance to get surgery, do not hesitate to do so. Procedures
such as LASIK or the PRK will improve your sight. If you are astigmatic or have presbyopia, these will handicap you less than being nearsighted. If you wear contact lenses, be sure to buy a large number, along with bottles of the solution necessary to maintain them.
To treat auditory problems due to shock or loud noises, prescribe rest and hope that the internal ear (perforated eardrum, etc.) heals on its own. Avoid letting water enter the ear in such a case. If you wear a hearing aid, plan on having a backup and a large reserve of batteries.
Psychological Problems
Let us keep things simple, realistic, and pragmatic. Depression will be frequent. Everything you have known will get turned upside down. Social statuses will be in flux, and there will be a great deal of uncertainty. Even if you are well off in your SAB, things won’t be easy. You may have witnessed scenes that have disturbed or traumatized you, or even lost those you loved. Since there will be no counseling center, you will need to be in friendly surroundings and speak to others. Above all, you must know how to distinguish that which is real from that which is imaginary. The best remedy is activity: cutting wood, fixing the roof, making sure everything is working, keeping busy with your vegetable garden, fields, animals, machines, etc. Depressed persons, or those with slight troubles (anxieties, insomnia, nightmares), will often find a good outlet in physical labor. Work by its very nature—tiring yet satisfying, and sometimes exhilarating—promotes better morale; when you’ve finished chopping a pile of wood, you feel like you’ve really done something! Avoid boredom and down time. In any case, you won’t have much of it in an SAB! Eat a good and healthy diet, get plenty of water and physical exercise, get rid of all behavior linked to alcohol, tobacco, or drugs. If you have time, get involved in group leisure activities or team sports. If a person shows signs of serious psychological problems with a potentially dangerous effect on others, he must be taken to a specialist. If there are none, you will have to make decisions of an organizational rather than medical order.
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