Senators Asleep
Editor: How can our senators sleep at night knowing that there are 6 million children in America going to bed hungry? How many others could be fed and housed with the raise our senators are awarding themselves?
No wonder there is so much voter apathy. Why bother? With such insensitive politicians in the driver's seat, this is no longer a "government of the people, by the people and for the people."
Agnes McAvinue.
Baltimore.
State Work
Editor: Much has been said recently about Gov. William Donald Schaefer's decision to require state employees to work more hours each week without providing any compensation. It should be noted that the hardship does not end there.
State employees will not be receiving their incremental or cost-of-living increases this year. A number of positions within the state system have been frozen or eliminated.
As a psychologist employed part-time at the Walter P. Carter Center, a state psychiatric hospital, I have the opportunity to regularly see the impact of these decisions. One group of state employees which is particularly hard hit by them is the nursing staff at the Carter Center.
While difficult fiscal decisions must be made to help balance the state's budget, it is important to consider the impact of these decisions on both the state employees and the people they serve.
At the Carter Center these new decisions only serve to further degrade staff morale, create additional financial hardship for hard-working employees who are already underpaid, and most importantly, make it difficult to provide critical aspects of patient care.
While no one will challenge cutting back on excess or waste, some areas can only be cut back so far before vital services suffer. While the governor's decision may provide savings in some ways, in other ways it may be an extremely costly one.
Jeffrey E. Barnett.
Annapolis.
HIV Danger
Editor: As a practicing orthopedic surgeon, I am thoroughly familiar with the mechanism of transmitting the HIV virus from patients and from physicians to each other, and with the hysteria that has swept the nation and Congress about the latter possibility.
Let me first point out that the chances of physician-to-patient transfer are so remote as to be negligible for all intents and purposes.
The only documented incident is that of the Florida dentist, and even the Center for Communicable Diseases has been unable to come up with a plausible mechanism by which one, let alone five patients, could have become infected, considering the extreme vulnerability of the virus and its short lifetime in the open environment.
The patient-to-physician transfer is a more likely event. But while we senior and attending physicians are in a position to practice "safe surgery," it is those young physicians in training, the residents and interns who are at the front of the battle, in shock-trauma units, emergency rooms and operating rooms, who routinely are exposed to the body fluids of patients from the inner cities who are most likely to carry the virus.
These men and women are not the typical "fat cat doctors," so eagerly bashed around by public and press alike, but recent medical school graduates shouldered with huge debts from their education, supporting young families on marginal salaries.
If society feels protected by compulsory testing of physicians, eliminating those who are HIV positive from their midst, then that same society is obligated to support these young doctors with generous disability and life insurance policies in the event that they become HIV positive and must end their careers.
As long as we are able to rid ourselves of neither AIDS nor Sen. Jesse Helms, we should at least not punish those who have been infected, which itself is enough of a catastrophe.
Robert O. Kan, M.D.
Baltimore.
Mansion Spending
Editor: First, I read with disgust of the $1.7 million that was spent to completely re-do the Governor's Mansion.
By the way, does anyone even live there? I thought Gov. William Donald Schaefer lived in one of his other residences. Does Hilda Mae Snoops live there?
Then I read, with even more disgust, of the governor's flip, arrogant and sarcastic replies as to why so much of the taxpayers' money was spent.
Are all governors absolute rulers, or is Maryland's the only one?
Why do the taxpayers never hear about things like this until after the damage has been done?
And what happens now? Governor Schaefer tells us all to butt out and goes about his daily business of running our state into the ground, and we are all $1.7 million poorer.
Aren't these people accountable for their actions?
Is this really the last we will hear of this disgraceful situation? Am I really the only person in Maryland who wonders about these things?
Marcy Shackelford.
Towson. Editor: The facts are in: It takes two to four weeks for a traffic ticket to degrade in a landfill; a cotton rag, one to five months; a tin can, 100 years; aluminum can, 200 to 500 years; a plastic six-pack cover, 450 years; and a glass bottle more than 500 years.
Landfills have never been a good solution to the disposal of our waste since the earth can't consume these products as fast as we use them.
Now, more than ever, recycling these products is a remedy for reducing the amount of trash we bury, litter-ally, in our backyards.
Recycling efforts are springing up all over Baltimore. Whereas New York has curbside recycling, Baltimore must rely on community volunteers to make recycling a reality. It's a great feeling seeing people come together to improve the place they live and the world they live in.
Recycling builds communities, instills pride in the neighborhoods once ruled by the trash monster.
So why wait more than 500 years to figure out what to do with that empty glass jar? Recycle, and give yourself a little more room to play in.
C. J. Riddick.
Baltimore.
Health-Care Workers and AIDS
Editor: In a July 17 Opinion * Commentary column ("AIDS: Putting Doctors to the Test"), Ernest Furgurson discussed issues surrounding the testing of health-care workers for infection with the human immunodeficiency virus.
The fear of patients being infected by doctors, the concern of health-care workers for the loss of their jobs and the question of right to privacy were all examined.
Unfortunately, a significant point was not addressed -- the value of the HIV screening test itself. It does not test for the virus.
A positive test result indicates the presence of antibodies vTC created in response to infection. Since it takes from three weeks to a year for the infected person's body to produce these antibodies, a person, patient or doctor could be infected with the virus, infect others and still test negative. Simply put, someone could have tested negative last week and positive today, and would have been just as able to infect someone a week ago as now.
All the HIV screens come with a disclaimer that infection is not ruled out by a negative result. How often, then, should health-care workers be tested? Annually? Monthly? Weekly? Daily?
The uncertainty is the reason for the universal precautions practiced by all hospitals. The assumption must be that everyone is infected. Precautions to prevent infection can then be taken for everyone.
A negative test result may lead to relaxed precautions despite the fact that the person may still be infected. In the event of widespread mandatory testing, the assumption of risk health-care workers now operate under will be replaced by a false assumption of safety.
I can offer no quick fix or magical solution, and I share the fear of AIDS which has swept this country. However, the mass HIV screening of all health-care workers and all patients will not guarantee the prevention of infection. It may, paradoxically, create an environment where this prevention becomes even more difficult.
Ernest Smith.
Phoenix.
* * *
Editor: We are again witnessing a fascinating replay of the tail wagging the dog as the Centers for Disease Control seek to combat AIDS and hepatitis B.
At the moment, only examination and restriction of infected health-care workers is being proposed while the general public, with a nidus of infection only about half as great but with larger potential, is not being considered for control. Recent estimates show that approximately 0.14 percent of health-care workers have AIDS in contrast to 0.07 percent of the general population. Frightening, however, is the prediction of 60,000-67,000 new cases in the general population a year for each of the next five years.
Inasmuch as the death rate is staggering, controls should be exercised at all points. Surely the patient must be interested in knowing if the health-care worker has AIDS. In equal fashion, health-care workers should also be aware of the status of the patient.
Note that AIDS may be acquired with equal ease by the surgeon and his or her assistants during the excision of a simple sebaceous cyst as during a complex cardiac procedure. One stick of an infected sharp instrument is all that is necessary to transmit the virus. Any operation on such a patient is hazardous to the surgeon and the assistants.
The solution to the problem may be approached more easily by an additional maneuver. Let all patients and health-care workers be tested and the examination be considered part of the routine battery of tests to which these people are exposed. Results of testing would remain confidential.
In bygone days, patients were customarily checked for syphilis, but a great to-do did not follow. Then, proper decisions could be made as to what can be done and who is responsible. At least under such a plan, both parties will be informed. Individual rights will not be abrogated and the tests will help us arrive at a reasonable conclusion to attack this major calamity.
The recent Senate vote to impose prison terms on health-care workers infected with AIDS who do not disclosing their condition is a step in the right direction only under an additional proviso.
The enactment should also include the imprisonment of patients who do not voluntarily reveal their infectious nature to the people from whom they seek help. Otherwise, the proposed statute assumes the nature of a witch-hunt and is decidedly unfair to the medical profession.
One comforting fact is that latex gloves which are permeable to water will not allow the passage of the much-larger virus. Intact gloves are a sure means of protection. Hospital workers are using them in many situations in which hands were unprotected previously.
Joseph M. Miller, M.D.
Timonium.