Ramblings on Chikungunya from a Naturopathic Medical Student

If you are in Jamaica Chikungunya has probably already debilitated you and your family, or you are living with serious fear of it. You are sleeping under mosquito nets and bathing in DEET but still you and everyone around you are in serious discomfort and pain. What the hell is going on?!

Clearly you know by now that the disease is transmitted by a mosquito, the Aedes aegypti to be exact. Chikungunya refers to the actual virus that your friendly mosquito is carrying with it. 

What is a virus? Why do viruses want to hurt you? What is its purpose anyway? Where did it even come from? 

Well, where did we come from? 

Viruses are extremely ancient microorganisms that have evolved so many exquisite ways of replicating and staying alive. We often feel we are the most evolved and indestructible beings but viruses are wayyyy ahead of us. They have varying levels of virulence (ability to cause disease), usually as a result of finding ways to evade the immune system or killing off competitors. They move and grow and evolve through cycles as everything else in life. So they are here for the same reasons we are. Just as it is instinctively within us to stay alive, reproduce, and protect our ourselves and our progeny, you can imagine that a virus, that also carries life force, the Vis, does just this - at our expense (think of all the things we do to stay alive at the expense of other Beings and the environment). And they are really good at it because of how long they’ve been around. 

A similar case can be made for the mosquito who bites you for his blood meal. The really interesting thing is that the mosquito is likely to be somewhat oblivious of the passenger he carries. Ever wonder how it is that the mosquito is able to carry such a virulent virus in its body without being harmed? Physiologically, when the mosquito ingests your blood, the red blood cells are destroyed in its gut, but some of the contents of the blood (including the chikungunya virus when it bites an infected person) travels to its salivary glands. Once it bites your sister it injects its saliva into her skin first before it starts taking her blood. The virus travels with the saliva and now enters your sister’s body. This is why all of your family is likely to be infected around the same time. This is called anthroponotic (human-to-vector-to-human) transmission. It is noteworthy that this anthroponotic transmission is highest when the patient is viremic (when the virus enters the blood stream) and thus most infectious during the first 2–6 days of illness.

The fact that mosquitoes remain unharmed in the process completely makes sense for a smart virus. If the mosquito got sick it would not be an effective means of transportation. There is no fitness cost for the mosquito which is probably why it is spreading so rapidly. 

So how the hell did it get to Jamaica? Chikungunya outbreaks have occurred in countries in Africa, Asia and Europe, before appearing in the Caribbean in 2013. Most likely an infected person from one of these areas traveled to Jamaica and now the virus is having orgies in your body! Damn globalization. 

OK -- so what now? There is no cure and no treatment. Great. This is because the scientific community simply cannot keep up with the smarts of viruses. It takes us extremely long to fully understand how each individual virus works and then develop antidotes to its life cycle. And then there are all the economic and political considerations of who actually gets the treatment, how quickly and at what cost. Its a shit show. 

Chikungunya and Naturopathic Medicine

For me as a naturopathic medical student, chikungunya represents both a wonderful opportunity to practice the foundations of nature cure medicine, as well as a challenge in terms of understanding how infectious disease fits into our philosophy. 

Process of Healing

Allopathic medical philosophy postulates “identify and treat the disease”. In naturopathic medicine, rather than viewing the ill patient as experiencing a “disease,” the naturopathic physician views the ill person as functioning within a process of disturbance and recovery, in the context of nature and natural systems. A virus is not understood so much to be a separate disease entity, but a general and fundamental process of disturbance and recovery within the living body.

Any virus that overwhelms the immune system such that symptoms arise represents the disturbing factor. The symptom you experience is simply the process whereby the body restores itself after a sufficient amount of disturbance accumulates within the system. In attempting to kill the virus in your body, inflammation occurs (heat, redness, pain). Often times the symptomatic experience is viewed as negative and suppressed with medications (panadol!) but we must realize that these measures are not cures; they reduce the symptomatic expression of the virus but often lengthen the process of healing. If the natural inflammatory reaction is allowed to run its full course, the discharge process occurs and you get better. 

Naturopathic treatment focuses on restoring normal health - so supporting the process of moving from an inflammatory reaction to normal health before disease becomes chronic and degenerative (or fatal). The treatments are also used as preventive medicine to bring one to optimaI health such that disturbing factor cannot disturb function. In the case of chikungunya where no allopathic “cure” exists to remove the disturbing factor (the virus) these treatments become extremely applicable. They include: 

1. “Return to Nature”—attend to the basics of diet, dress, exercise, rest, etc.
2. Elementary remedies—water, air, light, electricity 
3. Chemical remedies—botanicals, homeopathy, etc.
4. Mechanical remedies—manipulations, massage, etc. 
5. Mental/spiritual remedies—prayer, positive thinking, doing good works etc.

Ever wonder why all the people in your household are reacting to chikunguya so differently? This is because the process of disturbing normal health is highly dependent on individual factors such as immune competence, fatigue, vitality, genetics, and other host factors. So everyone will also require a different level of treatment. These factors also force us to consider what the actual cause of dis-ease is. Yes, there is a virus disturbing your normal function BUT if we really try to get to the root cause of the disease as we do in naturopathic medicine -- could the true cause be that you are immunocompromised due to chronic stress, for example? We are most immuno-competent at optimal health, thus we our symptomatic experience is less severe. 

The Therapeutic Order

Not all diseases are created equal. Life is a constant balancing act. For a common cold it may be worth it to allow the inflammatory process to take its course in order to most effectively respond to the antigen. However, for the debilitating joint pain in chikungunya, for example, it may be necessary to alleviate that pain to improve your quality of life. This brings us to another element of NM: The Therapeutic Order. You can think of the Therapeutic Order as a risk benefit analysis of various interventions, moving from least to more force. As health care providers we are obligated to move up the hierarchy (pharmaceuticals, surgery etc) if lower interventions (diet, supplements, rest) are not restoring health. Naturopathic doctors are trained with the same diagnostic training as allopathic doctors. We understand different levels of dis-ease and when it is necessary to use greater force of refer to specialists. So you must understand where you fall on the spectrum of the symptomatic experience and act accordingly. Key to reframing our definition of health and disease, through, is to see your body going through a PROCESS rather than simply succumbing to a disease entity. 

Determinants of Health
Another thing that we always consider as NDs is the Determinants of Health: simply put - what determines our health.  

We often think of natural medicine as drinking our green smoothies and taking our supplements in our homes, but natural health is probably more of a community effort than individual. We have all been appalled at the ineffective response of the ministry of health, but it has forced us to realize the magnitude of importance of community health. Chikungunya has been effectively controlled in other countries, not by finding antivirals to kill the virus, but by controlling the vector and lessening host susceptibility.  

What always hurts my heart the most is that poor and vulnerable communities are likely to be most affected due to poorer immune status (e.g. poor nutrition, more stress etc), and less ability to control their environment (e.g. unreliable garbage collection etc). Now more than ever we must look out for our neighbors, help them empty their trash, educate and inform them about unsafe water storage, help nurse them back to to health knowing that that might save your baby. It is often in times of crisis when we finally realize how similar we all are.

There are soooooooooooooooo many more layers to this, some of which you probably thought about as you read this, some will come up as you contemplate the tables in more depth; but this post is already turning into a book! I am only in my second year of 5 years of the program so I have no answers! This post is simply a ramble. I do pray my ramblings can bring you some perspective for your experience with chikungunya in JA. Also, I am not in Jamaica right now! I would love to hear YOUR thoughts and experiences and questions!!! I have many competent professors to nag on your behalf :). 

Before I close, though, I do feel compelled to mention the discoveries we are making in the world of good microbiotica and their ability to strengthen the Vis. The correlations with changes in gut flora and changes in health and disease are staggering. As we build our hatred for the chikunguya virus and practice important sanitation precautions, let us also remember that there is also an alliance we must form with the microbe world. We don't understand it, but what we do know is that they forever live inside and on us and can either cause tremendous harm or offer tremendous support. Again, we are only just scraping the surface of understanding of what health really is so we must remain open to all that we discover. 

I wish for my Jamaica massive pure strength and the usual fighting spirit we have in difficult times. Let chikungunya remind you of the importance of preventive medicine and maintaining optimal health to prepare for times like these. Let it also remind you to take care of another as you would your self and your family. 

Until then, ebola is upon us, and the US is not exempt!

The journey continues...

ALl my Love,
Kiman