Examples from the Past

Lessons from Covid-19 #14

“What has been will be again, what has been done will be done again; There is nothing new under the sun.” (Ecclesiates1:9)

 

A small sprout from the ground has the intrinsic qualities to grow into the complex adaptive system of grown trees and a forest. Can the organizational structure of the early church be the seed that generates a  platform that supports a vast network of interdependent organizations working in concert with one another?

Jesus hinted at what could be accomplished in a thriving complex adaptive system (CAS) of interdependent parts of the body accomplishing things that no part could do alone. After three year ministry with his small group he said:

“Very truly  I tell you, whoever believes in me will do the works I have been doing, and they will do even greater things than these, because I am going to the Father.” (John 16:24). 

Jesus knew both our strengths and possibilities as well as our weaknesses. Our quality of being human CAS in social organizations that are also CAS provided the ability to do “even greater things than these,” noting at the same time there would always be:

 “wars and rumours of wars.” (Matthew 24:6)

There are many metaphorical biblical references to things such as infertile soil, weeds, thorns, building upon sand rather than rock, and now a pandemic, that harm growth, health, and stability in individual lives and society. 

During Covid-19, we have seen like never before conflicts of interests among individuals, organizations, societies, and nations alongside unprecedented attempts to adapt to these events. What can we build on to escape this dilemma? The goal of this series is to present the organizational structure to do this at an individual and organizational level.

In the Bible, during the reign of King Solomon, a similar cry went out. Wisdom, (the voice of simplifying complex issues) is recorded as saying :

“Out in the open wisdom calls aloud, she raises her voice in the public square...On top of the wall she cries out , at the city gate she makes her speech...When calamity overtakes you like a storm...when distress and trouble overwhelm you...the complacency of fools will destroy them...but whoever listens to me will live in safety.” (Proverbs 1:20,21,27,33)

A sense of adventure has been woven into this as well, for as the great 19th century Canadian physician Sir William Osler noted:

“To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.”

Covid-19 has driven physicians, patients, governments, economists, and  others to weigh in collectively, each with different perspectives and needs. The books that Sir William referred to are considered in this series as the aggregate of exponentially increasing knowledge that is available. 

The series is about a system organizational structure to access and apply the knowledge in a wise way

There were many epidemics, and a few pandemics, before Covid-19.  One of them in the mid-19th century included a series of events which resulted in a pronouncement that needs to be brought to the forefront again during Covid -19.

An outbreak of an infectious disease threatened the health and survival of a population. As during Covid-19, the most susceptible were those from the disadvantaged sections of society. They were poorer than the more highly educated successful classes of society. They had lower levels of education, and often lived in crowded and unsanitary conditions. They were outside the mainstream of political power. They were not well organized, and had a weak voice individually and collectively. 

In Covid -19, public health physicians, administrators, and political leaders are making pronouncements on quarantines and personal distancing. In the 19th century outbreak, the physician most identified with the outbreak recognized that control required more than just a medical cure such as a drug or vaccine. 

It was the first time that what we now refer to as the determinants of health (DOHs) were formally presented as important factors in the cause, treatment and control of communicable disease. This public health physician was also busy in the laboratory studying and publishing in journals the features of the cells of our various body organs, and correlating changes in these microscopic cellular structures with diseases. 

Recognizing that DOHs were important factors in health and disease, the physician was also engaged and advocating politically, at municipal, provincial and national levels of government. He introduced changes to the political and social culture and priorities in his country that recognized the need for policies that also encouraged personal responsibility for health. 

As an elected representative to the legislative bodies, he also proposed reforms through education and legislation to improve the economy of the nation through improving the determinants of health, by integrating health policy with economic aims. 

He struggled for years to align the interests of opposing political parties and physician groups towards improved sanitation and sewage disposal in the capital city.  

Concerted prolonged efforts eventually accomplished this major public health initiative on behalf of citizens, the health of the economy and wealth of the nation. Then, as now, there was opposition to ultimate goals which we generally accept, but remained frustratingly out of reach. 

In his writings to the early church, Paul linked high ideals with a practical application and habit:

“...whatever is true, whatever is noble, whatever is right , whatever is pure, whatever is lovely, whatever is  admirable -if anything is excellent or praiseworthy- think about such things. Whatever you have learned or received or heard from me, put it into practice, and the God of peace will be with you. “(Philippians 4:8-9)  

In Canada, another disadvantaged group and their marginalized providers have seen the highest death rates in the country from the pandemic. This time it’s residents of long term care homes, with even the military being called upon to address a known problem in health care.

In the 19th century outbreak, the infecting organism was the pathogen causing typhus, a disease with a high mortality rate among disadvantaged populations. The location was Upper Silesia, a poorer state in the developing German Federation. 

The canalization of Berlin to replace the removal of human waste in animal-drawn carts was the massive public works and public health project to improve health and the economy.

The physician was Dr. Rudolf Virchow, who in addition to being a politician, is now recognized as the father of modern pathology and the founder of social medicine. 

Social medicine is not to be confused with “socialized medicine,” which is the negative term applied by defenders of the American system in describing the Canadian system as government-controlled. Rather, social medicine is that branch of medicine which addresses determinants of health (social and economic conditions) as factors in health outcomes.

In Virchow’s day, the treatment of disease was primitive compared to today. Now acute medical care, and expensive technology has taken centre stage, leaving public health and social determinants as a lower priority in healthcare. 

In turn, this has relegated social medicine and its concern with economies and population health to a lesser role. Rather than an organizational structure to integrate both these health system components, we have a disconnected system. 

Covid-19 management has had a drastic effect on the rest of acute medical care and the economy, with the disadvantaged bearing the greatest brunt of this mismatch.

This is a failure of the requirements of Paul's early church organizational model. It’s system of “ligaments and sinews” which refer to the systems enabling integration and successful interdependent among the members of the system  (including public health and social medicine), have been atrophied and severed into what is known today as the “silos”  of healthcare.

Dr Virchows famous declaration in 1848, while the typhus outbreak was at its peak was that:

“Medicine is a social science, and all politics is medicine on a grand scale.”

Simply put, all human struggle and conflict through the ages have had to do with the betterment of one over another, relating to both the vigor and health of the victors, and the political forces always involved. 

Our next step in this series, as always, is to continue developing the working hypothesis for the organizational structure, originating in Scripture, that acknowledges the statement of Virchow in constructing the framework to enable his statement to help us work to our individual and collective benefit. 

The ultimate appeal of this organizational structure is a method to change the culture and narrative for health and the economy and climate rescue from one of perpetual scarcity and conflict, to one of created wealth and abundance. 

A key feature of an organizational structure that complements the complex adaptive system (CAS) nature of creation and human growth and interaction, is that it moves from hierarchy to an expanded version of the early church model.

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