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The Roads We Take

Let's talk about pathways.

And don't worry, I'll try to steer this away from the typical "Sara failed (again) and now needs to justify why that's okay on a public forum with a punny name" post.

Nah, we're going to talk about infectious disease emergence.

And there may or may not be some relevant personal life anecdotes thrown in there. We'll see where it goes.

When we talk about emerging infectious diseases we are talking about a disease that is either appearing in a population for the first time, rapidly increasing in incidence, or expanding in geographic range. Often times, pathogen emergence is associated with cross-species transmission, or "host-jumping," meaning the pathogen (virus, bacteria, etc.) that is usually found in one species now finds another species to be an equally (or more) hospitable environment.

There are three stages of pathogen emergence in a new host:

1. Spillover

2. Limited transmission

3. Sustained onward transmission (this is when it becomes an epidemic)

In class, we have been talking about these processes. Very specific mutations or situations must line up to allow a spillover to occur or to sustain transmission in the population--sometimes to the extent that the disease becomes endemic, like with HIV (*cough the Swiss Cheese model is everywhere cough*). In short, so much has to happen for these pathogens to emerge--and yet disease emergence is not a "new" concept. At least 30 new diseases have emerged in the last 20 years (most of which are zoonotic) and many of these have had pretty drastic impacts (case and point: Ebola).

When these crises emerge, it is so important to be able to respond to them quickly and efficiently. This means strengthening preparedness measures, especially in the poorest communities that are hit the hardest. It means prioritizing these tools and infrastructure development now for something unknown in the future.

But if you look at what is actually on the agenda, what has the strongest political weight, you'll see that it isn't usually preparedness and prevention work. We tend to follow more of a crisis-response mechanism, working to control or limit or treat an outbreak only when it pops up and draws our attention. This makes sense because prioritizing a future generation or population or state that does not yet exist is a difficult economic argument to make. Comparing today's costs and benefits with tomorrow's is like comparing apples and oranges. This balance of arguing for future affairs with immediate resources has become more and more interesting to me over the last few years (and I'm going to stop myself here and save this for another post before I go down the rabbit hole of generational time preferences and health policy).

Switching gears a bit, I read this line in The Unbearable Lightness of Being a few weeks ago that rang so true I wrote it down and it's been bouncing around in my head, with increasing volume, over the past few days: "The thing that gives our every move its meaning is always totally unknown to us." The author describes the man who is motivated by celebrity and fame but doesn't know what those things are or what they entail, yet still works towards them. And when I use the term "know" here I don't mean to be aware of or to understand something, I mean to be something or to have personal and real experience. The student applying for medical school doesn't know what it is like to be a doctor, yet still soldiers on in preparation. The decision-maker today cannot put themselves in the shoes of the future person or place they are influencing, because they do not know what it is to be that state of being. I see this in my own pursuits of education and purpose in life--wanting to be a "prestigious scholar" or to work in global health development but having no clue what it means to do so.

I think this concept of being driven by something you don't know is beautifully ironic. Because we find ourselves getting so caught up in this elusive end goal we sometimes get lost along the way--trading what we do know or currently live for something that doesn't exist. It reminds me of those platitudes that sing something along the lines of "it's the journey, not the destination." It reminds me of Robert Frost's memorialized verse "Two roads diverged in a wood, and I took the one less traveled by, and that has made all the difference." [In Dublin a few weekends ago, Arush forced me to take the path that is quite literally less traveled by (namely because there was no designated path), promising the resulting view would be worth it.]

And while the end goal might be an important argument in strategies for disease control and prevention, this final state is not the most imperative in our own lives.

The process, the paths, mean so much more. Why put all this stock in a target that you do not know when it's the experiences along the way--the growth, the new lessons, the changes--that actually shape that final result? I know this is a lesson that has been touted before but instead of actually listening, I found myself forcing the holes of Swiss Cheese in my life to align and point to a specified trajectory--to that "thing that gives [my] every move its meaning" but in reality is unknown.

For someone that thought she learned a lot about flexibility and being open to change over the last four years, I realized this week that I scramble and panic when I don't have a plan. So I guess this is my public declaration, a reminder to myself, repeating the words that I have heard from many consolations in the last week: it is okay to not know the final destination. In reality, so few of us do. My goal for the rest of this year then, and my time as an MSc student and a Fulbright scholar, is to explore this journey and where it takes me without trying to figure out what the next step "should" be or predict where it is supposed to lead me. To appreciate that which is in front of me instead of living in a constant state of crisis control. And to always find the little ways to love and contribute to worldly enterprise.


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