SEEING WHAT IT IS TO BE HUMAN

By John Gillies
Contact the author by e-mail at christopher.johnstone@ntlworld.com

Seeing what it is to be human

Jose Saramago's novel is the story of an epidemic in an un-named town in an un-named European country. The sole effect of the infection, if such it is, is sudden, complete blindness. He describes the effect as white blindness, "as if he were caught in a mist or had fallen into a milky sea". We follow the epidemic from its start, when a man driving a car becomes suddenly blind at traffic lights, to the strange place that is the country of the blind. We see what happens through the eyes of a woman who has miraculously kept her sight. Originally written in Portuguese, it seems to lose little in translation.

It is an upsetting, profoundly moving novel. In close and harrowing detail, we follow the disintegration of society through the device of a small group of people who leave the asylum in which they have been contained in the early stages of the epidemic. This incarceration-a little like Castro's response to the HIV threat in Cuba in the 1980s but less successful-predictably fails. As civil society progressively disintegrates, we see all the virtues and vices of human beings on display-kindness, courage, generosity, magnanimity, depravity, selfishness, gratuitous violence-the best and worst of human behaviour.

I won't say any more about the unfolding of the story as it is much better read than described. However, it is important to note that Saramago does not have a Hobbesian view of mankind, and the book is permeated with examples of how human beings can survive, and find friendship, mutual support and even humour in the most appalling circumstances. It is a tribute to the perseverance of hope in the human spirit. Blindness can be used as a metaphor as well of course, as we show when we use the phrase 'I don't see that' to indicate lack of understanding. Different epistemologies are often blind to one another.

'Deep surroondin' darkness I discern
is aye the price o' licht.'

Hugh MacDiarmid tells us¹. Saramago has spoken elsewhere about 'the blindness of reason', and there is something important there for us in general practice to consider when we look to our uncertain future.

The author was born into poverty in 1922, and won the Nobel Prize for literature in 1998. His acceptance speech² shows him as a man who respects the human not the rank, and has a Burnsian feel to it. He knew Miguel Torga, the Portuguese doctor/writer well and has cited him as an influence on his life and work.

Pandemic flu

We now face the threat of a pandemic of influenza of avian origin. GPs, practices and Health Boards are currently working on plans to deal with the consequences. Estimates of its severity vary from the merely appalling-warehouses used as mortuaries, hospitals closed through staff morbidity and mortality--,to the truly catastrophic-a decline in World economic activity by 20%, serious civil disorder3 . As with HIV/ AIDS and as in the 1918 pandemic, the greatest casualties will be in the poorest parts of the world. In truth, no one knows what the severity of the outbreak will be. It seems likely that at the very least, some pretty coercive public health measures will be needed. So planning seems like a good idea^4,5 , accepting the military dictum that no plan survives first contact with the enemy. (In that context, the Executive's plans for dealing with a pandemic have been criticised in a recent commissioned report by Coventry University for underestimating the effect on health care provision and mortuary facilities⁶.) We are a much healthier population than in 1918, when society was fractured and dislocated by war, but we also have a culture of entitlement, an unhealthy focus on individual human rights, a press that is likely to be hostile to and unsupportive of government efforts, and, I suspect, many societal illusions about the benefits of antiviral drugs and other medical measures. These factors will make it much more difficult to deal with a pandemic at all levels. I keep hoping that when it happens, it will be like the millennium bug problem, vastly overstated and of little consequence. But we are dealing with biology, not technology here.

I'm sure that there is a growing literature on the clinical features, epidemiology, psychology and sociology of an event like this. I suggest that the Scottish Executive adds this extraordinary novel to the reading lists of those responsible for planning for pandemic flu. We should not bind ourselves so tightly to science that we lose sight of the power of the imagination to reveal us as we really are. When things get bad, it may help us, as my mother used to say to us as children, to behave.

References:

MacDiarmid Hugh. Milk-wort and Bog-cotton in The Complete Poems.p. 331. Penguin Modern Classics. London 1978.
http://nobelprize.org/nobel_prizes/literature/laureates/1998/lecture-e.html
Foreign Affairs. The Next Pandemic? July/ August 2005, pp3-50.
http://www.scotland.gov.uk/Topics/Health/health/AvianInfluenza/Contingency-Plan
http://www.rcgp.org.uk/service_continuity/service_continuity_home.aspx
http://www.scotland.gov.uk/Publications/2006/11/21153440/0

Other hoolet online articles by John Gillies can be found at:
hoolet edition 40 - 6^th WONCA
hoolet edition 33 - 5 Things I Wish I'd Known Before Becoming a GP
hoolet edition 29 - Hearts in the Borders

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.