Letter Re: Extended Care of the Chronically Ill in TEOTWAWKI

Hello Jim,
I am a 10 Cent Challenge subscriber and have looked at your site daily — great job!

I have a medical background and would advise readers to consider what gear they will need if a friend, relative or team member becomes ill, hurt, disabled etc. The basic first aid supplies will not provide the level of comfort et cetera needed. We are talking basic nursing care, not “first aid”. Take care, stay safe and God Bless! – Dave T.

JWR Replies:
Thanks for bringing that subject up again. Aside for fairly some brief mentions (such as photovoltaically-powered CPAP machines for sleep apnea patients, and refrigeration of insulin) we haven’t given this the emphasis that it deserves.

Acute Care
Preparing to care for injuries or acute illnesses, is well within the reach of most middle class families. You should of course build up a large supply of bandages, antibiotics, and so forth. Also plan ahead for such mundane items as drinking straws, hot water bottles, bed pans, and diaper wipes. I also recommend looking for an older-style used, adjustable hand-crank hospital bed. Just watch Craig’s List regularly, and chances are that you will eventually find one at a bargain price.

Chronic Care
It may be difficult for us to confront issue of care for the chronically ill, because it can seem so overwhelming. But for the vast majority of us that do not subscribe to the “park granny on an ice floe” (senilicide and invalidicide) mentality, these issues demand our attention, our concerted planning, and considerable financial commitment. Since there are such a wide range of chronic illnesses and disabilities, it is impossible to address them all, but I will mention a few:

Lets start with the most difficult to mitigate: Chronic kidney disease requiring dialysis. In a “grid-down” situation, dialysis patients will be out of luck once the hospital backup generators run out of fuel. To see a loved one slowly have their blood turn toxic and die would be absolutely heartbreaking. My suggested solution may seem odd, but think this through: Move to the Big Island of Hawaii, or to a natural gas producing region, or to near a refinery in an oil-producing state.

In Hawaii, each island has its own independent power generation infrastructure. For many years, the Hawaiian Electric Company (HECO) utility has used diesel fired generators (using crude oil that is shipped in and then fractioned at refineries), but they may soon switch over to natural gas, using imported liquefied natural gas (LNG). There are any number of different circumstances, including an EMP attack, wherein the continental US power grids will go down, but the lights will stay on in Hawaii. My only unanswered question is: how much a of crude oil supply is kept on hand? And if and when HECO switches over to LNG, will the number of months of reserve fuel increase or decrease?

As for natural gas-producing regions (such as parts of Oklahoma, Arkansas, Texas, New Mexico, and several other states), such a move would first require considerable research. You would have to find a community adjacent to natural gas fields with a kidney dialysis center that that has a natural gas-fired backup generator and that is in an area with sufficient wellhead pressure to pressurize local lines. (You can expect to be making a lot of phone calls, finding such a rarity!) As I’ve mentioned previously in SurvivalBlog, in the late 1990s, my mentor Dr. Gary North bought a property in Arkansas that had its own natural gas well, and two-natural gas-fired generators. To borrow the modern parlance, talk about a “sweet” set -up!

Another option might be to find a dialysis center with a diesel-powered backup generator that is within 25 miles of a refinery that is also in oil country. (Providing a local source of crude oil for resupply.) As biodiesel plants start to come on line in the next few years, this should widen your range of choices. But keep in mind that you will want to find a biodiesel plant that is independent of grid power. The key word to watch for in your web searches is co-generation. A plant that has co-generation capability is likely one that could operate without the need of the power grid.

Next down the list is diabetes. As previously mentioned in SurvivalBlog, relatively small and inexpensive (under $3,000) packaged photovoltaic power systems with inverters (such as those sold by Ready Made Resources) can be used to operate a compact refrigerator (such as the Engel compact refrigerator/freezers sold by Safecastle). A system of this size could also be used to run a CPAP machine or other AC-powered medical equipment with similar amperage demands.

Another category of chronic illness to consider is the care of post-surgical “-ostomy” patients–folk s that have had a colostomy, iliostomy, urostomy, and so forth. These often require keeping on hand a large supply of medical appliances, bags, catheters, and so forth. Thankfully, most of these items have fairly long shelf lives and are not too expensive to stock up on–at least compared to some of those “$5 per pill” blood thinner medications.

Yet another category of chronic disease to consider is bronchial and lung ailments. There are some ailments that can be relieved (at least to an extent) by relocating. Getting to a more suitable elevation, moving to avoiding pollen or fungi, and so forth can make a considerable difference. If this is your situation, then I suggest that you go ahead and make the move soon if you have the opportunity. Chronic asthma is quite common, and of course an acute asthma attack can be life threatening. Ironically, buying a wood stove–one of the key preparedness measures that I recommend to my clients–is not good for someone that has an asthmatic in their family. If that is your case, then consider moving to the southwest, where passive solar heating is an option, or moving to an area where you can use geothermal heating. I mention a few such locales, such as Klamath Falls, Oregon, in my book “Rawles on Retreats and Relocation”.

For the many folks that now depend on medical oxygen cylinders, it is wise to at least stock up on extra cylinders. One alternative suitable for long term scenarios is to buy a medical oxygen concentrator. High volume units are fairly expensive, but owning your own would be an incredible resource for charity or barter as well as for your own family’s use. Large (high volume) units can sometime be found through used medical equipment dealers such as East Tennessee Sterilizer Service. Smaller, factory new oxygen concentrators are available in the US from Liberty Medical, and in England from Pure O2, Ltd.

A much more common situation is caring for someone that requires regular medication that does not require refrigeration. The high cost of some medicines make storing a two year supply difficult. And the policies of most insurance companies–often refusing to pay for more than a month’s worth of medication in advance–only exacerbates the problem. In these cases, I suggest 1.) Re-prioritizing your budget to provide the funds needed to stock up, and 2.) If possible, looking at alternative treatments, including herbs that you can grow in your own garden or greenhouse.

If you decide yo go the route of stocking up your meds to build a multi-year stockpile–all the way to their expiration dates–this will require not only lots of cash but also very conscientious “first in, first out” rotation of your supplies. I have seen a deep, open-backed cabinet used for this method. After you have bought your “all the way to the expiry date supply”, you simply continue to order your monthly supply and put each newly-arrived pill bottle in the back of the cabinet and use the bottle that is closest to the front.

Alternative treatment, such as using herbs or acupuncture, is a touchy subject. Again, it is something that will take considerable research and qualified consultation, and in effect making yourself your own guinea pig. If you decide to use this approach, I recommend that you make any transition gradually, with plenty of qualified supervision. If it takes a lot of extra visits to to your doctor for tests, then so be it. Just do your best to make the transition, before everything hits the fan. Living in Schumeresque times will undoubtedly be extremely stressful, and the additional stress of changing medications might very well be “one stress too many.”

I have seen some folks in preparedness circles on the Internet recommend stockpiling low-cost veterinary medications, but I could only advise using such medications in absolute extremis. (When your only other option is certain death.)

As for using meds beyond their “official” expiration dates, this requires some careful study. Some medications have listed expiries that are overly conservative. (I suspect that any of these expiration terms are driven by the advice of corporate staff malpractice attorneys rather than by the advice of the formulating chemists.) A few drugs, however, are downright dangerous to use past their expiration dates. Consult your local pharmacists with questions about any particular drug. (I lack a “R.Ph.” or “PharmD.” after my name, so please don’t ask me. I am not qualified to give such advice!) Parenthetically, in my novel “Patriots: Surviving the Coming Collapse”, I mentioned a WHO-approved titration test that is useful for some antibiotics. This method was developed for use in Third World countries where out-of date medications seem to end up with amazing regularity.

Speaking of the Third World, there are some valuable lessons that can be learned from studying the way that chronically-ill are treated in poor countries. (I’m not taking about neglect. Rather, I’m talking about creative ways to care for people when there isn’t the money or there aren’t “the proper facilities.”) Do some Internet research on the chronic illness that is of concern to you with search phrases that include “In Cuba”, “In Africa”, “in Thailand”, and so forth.

Elective Surgery and Dental Work
If you have an existing problem that could be cured with elective surgery or dental work, then I strongly recommend that you go ahead and do so, if you have the means. If your condition worsens after medical or dental facilities become unavailable, it could turn a simple inconvenience into something life threatening. I’ve heard of several wealthy preppers that have had their nearsightedness cured by Lasik or PRK, just for the sake of being better prepared for a foreseen new era that will not have the benefit of ophthalmologists and a handy shopping mall “eyeglasses in about an hour” shop. Living free of eyeglasses or contact lenses also makes wearing night vision goggles and NBC protective masks much easier, and makes defensive shooting–particularly at long range–more accurate. Lasik is an expense that I cannot personally justify on my tight budget, but if you can afford it, then do so. (BTW, I even had one consulting client go so far as to have his healthy appendix removed, just to avoid the prospect of appendicitis. That qualifies as “going to extremes”! I would not recommend this, since new research suggests that the appendix does serve to maintain good digestive bacteria populations.)

Fitness and Body Weight
One thing that every well-prepared individual should do is to stay in shape. Good muscle tone prevents back injuries and other muscle strains, and leaves you ready for the rigors of an independent, self-sufficient lifestyle. (There surely will plenty of 19th Century muscle work involved, post-TEOTWAWKI!) Keeping a healthy diet and maintaining an appropriate body weight (or getting back down to a proper weight!) is also very important. Again, it will leave you ready for physical challenges and it falls into the prepper’s “one less stress to worry about” mindset. And, notably, watching your weight will also make you less likely to become diabetic. The only thing more tragic than having a chronic illness is unintentionally making yourself chronically ill!

One important side note: Many injuries and illnesses cause difficulty chewing and digesting solid foods, because of the patient’s weakness, dental problems, or jaw/palate/throat trauma. It is important to have a hand-cranked food grinder available so that you can accommodate the needs of these patients. Old-fashioned grinders (the type that clamp on the edge of a kitchen table) can often be found used, for just a few dollars at yard sales. If you want to buy a new one, they are available from both Ready Made Resources and Lehmans.com.

In Closing
The bottom line is that caring for someone with a chronic illness in a protracted emergency or in the midst of a societal collapse is something that will take plenty of research, planning, and unfortunately, expense. As previously noted, it might even require relocating.

Perhaps some SurvivalBlog readers with (or with loved ones with) chronic health conditions or disabilities would care to chime in. I’d also appreciate hearing from those in a health care professions.