Public Health Onstage
Medical Essays and Original Short Plays
by
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SEXUALLY TRANSMITTED DISEASES: UPDATE FOR LOUISIANA There are many sexually transmitted diseases, but those that are tracked and quantified in Louisiana and nationally usually include gonorrhea, chlamydia and primary and secondary syphilis. HIV/AIDS is also transmitted sexually, but it is often tracked separately. Louisiana ranks in the top 2 states in the U.S. with respect to STDs rates: Primary and secondary syphilis (#1), Gonorrhea (#1), chlamydia (#2) in 2015. If HIV/AIDS is included, we also rank consistently among the top 5 states (#2 in 2015). These extraordinary statistics, which usually lag a year or two behind, translate into significant morbidity and economic loss, both locally and nationally. There are some significant demographic differences with respect to STDs both in the nation, the state and our region. In our region, cases for both gonorrhea and chlamydia are more commonly diagnosed in woman, 64% and 73% respectively (not unlike state or national statistics). Some of this relates to “sampling error” since sexually active women are systematically checked in annual gynecological exams (at least in the context of the health units) and men only seek assistance when symptomatic. With syphilis, on the contrary, over 85% of those diagnosed regionally are men (similar to state and national figures), which is skewed by the high incidence of syphilis cases in the population of men having sex with men. Not only are there disparities with sex, but also with ethnicity. For reasons probably related to low income and lower educational attainment rather than race, African-Americans are disproportionately represented in all STDs (and HIV/AIDS) regionally, with 79% of cases of gonorrhea, 60% of chlamydia cases and 69% of those with primary and secondary syphilis. The same holds true with HIV/AIDS, with about 75% of cases in African Americans both regionally and in the state as a whole. With both gonorrhea and chlamydia, the majority of cases in Central Louisiana (69% and 74% respectively) occur in the 15 to 24 year old range, hardly a surprise and not different from national statistics. Syphilis, on the contrary, occurs more often in older adults in our region of Louisiana, with 62% of cases in the 25 to 44 year old group, most of these in men who have sex with men (MSM). Since young people are the primary recipients and transmitters of at least some STDs, they should receive adequate, realistic education about the risks and consequences of infection in a clear, dispassionate and scientifically accurate manner. While this ideally should come from the family, parents may lack the knowledge or skill to correctly transmit this information. In addition, many people (around 25% for syphilis and HIV) are unaware that they have a STD or HIV, both often asymptomatic. Appropriate testing (and contact tracing by the Office of Public Health for syphilis and HIV) can help reduce the risk of transmission in the general population. Adolescents, by their neurobiological makeup, are saturated with hormones and yet lack the development of the frontal lobe where reason and impulse control originate. Their impulsive decision-making and lack of control provide a perfect storm for high-risk behavior, whether it is drug or alcohol use, driving without a seatbelt, or engaging in unprotected sex. Only proper education (from whatever reliable source), avoidance of high-risk environments and role-playing to develop automatic healthy behaviors offer any hopes of improving our dreadful STD statistics. Sadly, attempts to introduce comprehensive ST education at the junior high and high school levels are often opposed by school superintendents, fearful for their jobs, and politicians, fearful of not being re-elected. As far as STDs are concerned, however, ignorance is NOT bliss and silence is NOT golden. SEX ED AND THE SUPERINTENDENT CAST OF CHARACTERS DARLENE JACOBS: School superintendent. Fussy, self-important woman (or man) with frumpy clothing and an exaggerated speech pattern. Possible mild Southern regional accent. GEORGE FAIRCLOTH: Public Health official. Man or woman, well dressed. Educated speech pattern with no regional accent. HENRIETTA PARKER: Older African-American Woman with an educated speech pattern. Black Southern accent but not overwhelming. Nicely dressed. SETTING Superintendent’s office. A desk and a couple of chairs. DARLENE and GEORGE are sitting or standing in the DARLENE’s OFFICE. There is a knock on the door. DARLENE: Yes? HENRIETTA: (Pokes her head through a crack in the door) I’m here to see you? Is this the right time and place? DARLENE: Yes, of course. Come on in and join us. How are you doing today? HENRIETTA: (Enters. Extends her hand to DARLENE) Nice to see you again, and I’m not doing well at all! DARLENE: Sorry to hear that. (To GEORGE) Mrs. Parker, this is Mr. George Faircloth from the Office of Public Health. I invited him here to meet with you. This is Mrs. Henrietta Parker from the school board GEORGE stands and extends his hand. HENRIETTA refuses to take it. HENRIETTA: I know this man and his filth. My sister over at Garfield Middle Magnet told me how he came in and told a pack of dirty lies to those kids about sex. GEORGE: Which lies, exactly? HENRIETTA: That we are number one and number two in this state for all of those nasty sexual transmitted diseases, including HIV. It just can’t be true! GEORGE: I’m afraid it is true. And it has been that way for some time. HENRIETTA: And what good does it do exactly to fill young, impressionable minds with all sorts of dirty ideas? GEORGE: Mrs. Parker, with all due respect, if you turn on the television, you have everything you need to know about sex, except the truth. HENRIETTA: Truth! What you talking about? Truth comes from God, not from disgusting slides about pustule-covered vaginas and dripping penises. Kids don’t need to be seeing that sort of thing.
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About the Book
Public Health Onstage represents an attempt to combine two visions of public health—the scientific and the artistic. Each one of the short essays deals with some aspect of public health, including human papillomavirus vaccination, medication marketing, safe sleep, malpractice, sexual assault, opioid abuse, and many more. Paired with each scientific essay are one or more original short plays that delve into the same or similar subject matter while exploiting its dramatic potential. Dr. David Holcombe has taken many of the plays from previous publications, including Beauty and the Botox; Old South, New South, No South; Chateau in Hessmer; and Why Go All the Way to Fulton, Louisiana? Some of the medical essays have been extracted from his previously published Mendel’s Garden: Selected Medical Topics. Most of these medical essays have already appeared in Cenla Focus, a regional publication in Central Louisiana, or Visible Horizon, another regional publication by the Council on Aging. Some essays and plays have never been previously published. Combining the scientific and the artistic can be fraught with peril. Their hoped-for synergy can dissolve into nonsense or, worse yet, alienate the reader who becomes completely unreceptive. My hope is that this volume will break new ground in both public health and theater and appeal to the most discriminating critics. Many famous authors have tackled complex social and medical issues in the past (notably Henrik Ibsen and George Bernard Shaw). Physicians have also distinguished themselves as playwrights while steering clear of medical topics entirely (such as Dr. Anton Chekhov.) But this volume hopes to put the medical and theatrical together for the edification and entertainment of the reader and the potential viewer. Scientific readers may gain a new appreciation for the persuasive power of the stage, and theater lovers may acquire some unexpected medical information.
About the Author
David Jeffrey Holcombe, born in San Francisco, California, in 1949, grew up in the East Bay under the shadow of magnificent Mount Diablo. An idyllic childhood among then country roads lined with pear orchards, he attended local public schools with excellent teachers and few social problems. After high school, he attended the University of California in Davis, from which he graduated with a Bachelor of Science in Agriculture (Applied Behavior Science). He subsequently attended the University of Florida in Gainesville, where he obtained a Master of Science in Agriculture (Poultry Science). After four years of unsuccessful attempts to get into medical school in the United States, he left for Belgium, where he attended the Catholic University of Louvain in Brussels, Belgium, from which he graduated Summa Cum Laude in 1981. All during his high school and college years, he continued to paint and write. After returning to the United States in 1983 with his charming Belgian wife, Nicole, they settled in Alexandria, Louisiana where they raised four sons. For twenty years, Dr. Holcombe worked as in internist at the Freedman Clinic of Internal Medicine. He subsequently became the Regional Administrator/Medical Director for the Louisiana Office of Public Health, a position he has held for the last 10 years. Medicine and the arts have co-existed, sometimes peacefully and sometimes painfully during his entire professional career. This on-going tension and underlying passion have given rise to this work, PUBLIC HEALTH ONSTAGE, a compilation of published medical essays and self-published plays.