Editor's Note
The World Comes Home
I inhabit a very small world. I practice in a six-provider clinic in a middle-class suburb of a city historically isolated by geography and meteorology. I live 10 minutes from my office and don’t even have to brave the exigencies of the Crosstown Expressway on my way to work if I don’t want to. My wife and I do our share of cocooning, curling up with a Netflix movie on Friday night, shunning the masses in theaters and restaurants. I could just mind my own business and let the world pass by.
Except the world won’t let me do that. No longer is Minnesota simply the land of Norwegian bachelor farmers and Lutheran blondes. A trip to the mall or the airport proves that diversity is blossoming here like crocuses in May. A cab ride to the airport or a latte at Starbucks can bring us face to face with a country and a crisis that we read about that morning in the newspaper. We can’t ignore the Somali civil war because our barrista came to Minneapolis to escape its ravages. Culture shock happens daily at the coffee shop and in a cab.
It also happens at the clinic. Minnesota physicians are seeing patients with diseases described in those sections of Harrison’s Textbook of Medicine that most of us skipped over in medical school (see Stauffer and Rothenberger’s article on five diseases Minnesota physicians should know about, p. 42). Clinics specifically devoted to the refugee population are sprouting up. Medical staffs at others are learning that the cultural backgrounds and psychological histories of these newcomers are almost as important as their unique medical problems. And some physicians are leaving the high-tech, well-heeled tundra for the low-tech, in-need desert and jungle to minister to a wider world. Global medicine means the world’s problems are interwoven, and the weave is getting tighter.
Global medicine also means that all of us, and perhaps particularly physicians, need to understand what is happening to our planet. Debated by many, denied by some, global warming has recently been declared real and accelerating by the Intergovernmental Panel on Climate Change. Climate change doesn’t just melt ice packs, raise ocean levels, or spawn more powerful hurricanes. It also modifies human health and disease (see Sellman and Hamilton’s review on p. 47). As our environment changes, our diseases change. Pathogens adapt, disease vectors travel, and, suddenly, West Nile virus invades Minnesota. Infectious disease experts predict future appearances in temperate regions of diseases such as dengue fever that were previously seen only in the tropics. A warmer globe will change the practice of medicine in the same way it changes our weather and our lives.
All of this change prompts a vague, or not so vague, sense of dis-ease. We all settle into a life that seems to suit us, finding a “comfort zone” in which to lead our lives. But, like it or not, that zone has been breached by a world that insists we listen to its creaks and moans and do what we can to mind its business.
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at cmeyer1@fairview.org