Snowflakes and Starfish

In a snowstorm each snowflake that falls is said to be unique.

There was a study done in 2006 (Walenksy, JID) in which the authors demonstrated in bar graphs the months of life saved by effective anti-retroviral medication when compared with the gains by drugs against several other chronic, life-threatening conditions such as relapsed lymphoma and coronary artery disease after a heart attack.  The per-person survival gains for HIV drugs were 160 months, that is, over ten years, compared with 90 months for lymphoma and 50 months for heart disease.  Ultimately, the article concluded that in the ten years since the arrival of therapy, more than 3 million years of life had been saved.  By now perhaps that number has doubled.

For nearly ten years my clinic supported a small HIV-treatment program in Nigeria, north of Lagos.  We named it the Starfish program after a story about a man walking on a beach littered with thousands of starfish.  On the beach was a boy picking up starfish and one by one throwing them back into the sea.  The man approached the boy and asked what he was doing, that given the number of starfish on the beach, his efforts wouldn’t make any difference. The boy kept on bending over and picking up starfish and throwing them into the water.  “It makes a difference to this one,” he said as he threw.

I teach an elective Narrative Medicine class to first year medical students.  One of the students is writing about her experiences in an orphanage for sick babies in China.  The name of the orphanage is Starfish.  The student wrote the same story about the boy on the beach as the origin of the name of the orphanage.

For lives to be saved, for years of life to be gained, we need to continue to get patients into care.  Patients and doctors need to be aware of risk and amenable to testing.  Testing needs to be available, straightforward and inexpensive.  And once a diagnosis is made, care needs to be accessible, affordable and multidisciplinary.