Centered Around a Common Purpose – Dr. Nasim Ahmadiyeh M.D., Ph.D

This is a reflection written by Dr. Nasim Ahmadiyeh M.D., Ph.D for the new series from The Bahá’í Chair for World Peace on Learning During the Covid-19 Pandemic.

There is no cure for one infected with the 2019 novel coronavirus which can cause the disease commonly known as COVID-19.  All we can do is wait it out, support the body and hope the immune system can fight the virus and survive its scourge. Ironically, or perhaps poetically, what is needed to fight the virus in one body, can lend insight into what is needed to fight the virus globally.

The immune system is an intricate, responsive, adaptive system made up of various (diverse) cellular components with robust channels of communication.  When one type of cell senses danger (the virus), the cell sends signals, recruiting the help of other immune-fighting cells, in an orchestrated cascade of help. These newly-recruited cells multiply in number, march to the site of assault, spray chemicals at the virus (or more precisely, the virally infected cells) or engulf it. In the process, the body might experience inflammation, fever, and a host of other systemic effects. This is why we feel ill.  But it is all in pursuit of a higher aim: to preserve the human body as a whole.  Indeed, the body channels all its energies towards fighting this intrusion, and in a body with a healthy immune system, the body usually wins this fight. If any part of that coordinated response were to fail, however, if the cell that first saw the intruder failed to send a warning signal to recruit others, if those recruited to assist in the fight failed to do their part, if some organ systems are already weak with pre-existing conditions, if other organs choose to siphon energy to their own aims or ignore the siren calls – the body will likely die and the virus win.

Humanity as a body has experienced its own collective assault attributed to this virus, and we might reflect on our collective response. When the virus first appeared in Wuhan, China, we can ask, was the alarm loudly sounded?  When Italy was devastated and tried to share what it was learning, did we heed its call? Did we as a humanity mobilize our efforts and resources the best we could to fight this pandemic? Did we rush to the aid of those most in need at any given time or did we try to shore up our own stores of whatever weapons we imagined we would need to keep our corner of the world/country/state/county safer?

Emerging accounts suggest that when the virus first appeared in Wuhan, China, the number of deaths and the severity of the outbreak were minimized if not suppressed.  Even though we saw the unfoldment of the horrors of the virus overwhelming an affluent part of Italy, bringing that region to its knees, we did not adequately learn from their experience nor prepare for battle. In the United States of America, the response was slow, checkered, and not proportional to the facts.  Restricting some people but not all, from travelling from certain countries, but not others, and largely ignoring community spread early on, made little sense. The stay-at-home orders that went into effect were haphazard and varied, causing confusion among a people with little faith in leaders and yet ill-prepared – by an educational system fraught with inequities and out of sync with its purpose – to think for themselves.  With all the available lead-time, we still have not been able to ensure an adequate supply of personal protective equipment for all frontline workers, not to mention the challenges surrounding testing. When New York City emerged as the eventual epicenter in the United States, and we watched in anticipation of the slaughter that was to take place, most felt helpless, wanting very much to help but not knowing how or where to channel that desire.

A friend from Ghana and I were chatting one day, wondering aloud why the rest of the medical workforce from around the United States didn’t just go to New York’s aid? Later that day, I looked into volunteering in New York. One of the better-known academic hospitals in New York was hiring critical care doctors for pay, but it was surprisingly difficult to find a way to lend support to other hospitals in the city, even as a physician.  I myself work as a surgeon at a safety-net hospital in Kansas City, Missouri. Our hospitals intentionally sat at less-than-capacity, preparing for our surge which was anticipated to be almost a full month away. We sat restlessly idle and busy at once, trying to figure out how to care for our non-COVID contingent in a COVID world.  I wondered how many other capable doctors and nurses were in the same situation as I and my colleagues. There was no coordinated response nationally to go to New York’s aid.  Instead, just as New York was in its direst hour of need, states were outbidding each other for precious medical gear and supplies; and just as our fellow humans were suffering in other parts of the globe, shipments of personal protective equipment to Germany, France and Canada, were diverted back to the United States through physical interception as well as outbidding tactics.  Even within New York itself, the gaps were widening as private-sector philanthropists helped procure personal protective equipment for wealthy hospitals while its safety-net hospitals, already overburdened with caring for a population at greatest risk and operating with outdated infrastructure, came up short.  Simultaneously, the plight of those in the Democratic Republic of Congo, for example, and other materially less-resourced countries was largely ignored and the magnitude of their plight remains largely unknown.  Is their need not the same as ours? Indeed, it is likely greater.  Do we not believe we have or can summon and channel the collective resources to meet this challenge globally? It would be ludicrous to imagine a COVID-infected body under attack, where the kidneys or heart refused to give it their all, because the infection was primarily the lung’s problem.  Reports came out that Oregon sent some ventilators to New York. An encouraging sign of health but far short of the coordinated and unified response the immune system mounts when it is trying to overcome the assault of the virus in a single body.

What makes the immune system work is its coordinated response. The coordinated response is possible because all action taken by the diverse players is centered around a common purpose: defeat the intruder and save the whole, even at momentary or isolated personal loss or sacrifice. In the absence of this, there would be chaos and destruction with great harm to the body but no benefit.  We to need a common purpose, a central principle which can guide our individual and collective actions. We need to know what we are fighting for.  And it seems we need to be convinced of our essential oneness. What would happen if we viewed our collective goal in this pandemic to be to reduce suffering and save the most number of lives or even life-years around the world, not just within our borders? How would our mobilization and response look different?

In the human body, each organ system thrives when every other organ system thrives, and each suffers when the others suffer. The tiniest injury to the body, a splinter in one’s foot, will bring us to a halt, as we focus all our efforts at removing the source of pain. The pandemic has unveiled our interdependence: that what I do impacts others, that my wellbeing is tied to the wellbeing of the whole.  But it has also uncovered the crater-like gaping holes in the ground beneath our feet: the institutions and structures upon which a flourishing society (for some) was once built are inadequate to the needs and aspirations of the present day.

The immune system was not always the beautifully orchestrated system it is now. It went through an evolutionary process of trial-and-error, nature’s own learning process, refining the system to optimize the health and survival of the human body.  Similarly, we as a global community may not have all the answers at the outset.  Once we decide on a common premise and purpose from which to work and toward which we hope to move, we then need to approach the rebuilding of society with an attitude of learning, but one which invites the participation of all.  This will necessitate drawing on the strengths of scientists and analysts, but also ensuring that every person in the world has access to education that allows for the development of observation, insight and analysis.  We need to be able to think for ourselves, independent of trends or marketing influences, coercion, or blind imitation of tradition.  We need to be able to discern and distinguish truth from half-truths or from outright lies. We need to be able to evolve and refine our understanding as new information comes our way.  We too – like the immune system – need to be able to adapt to new realities.   We then need mechanisms whereby such an informed inhabitant of the planet can contribute to the generation of knowledge and learning.  With an expanded, world-embracing vision comes the prospect of world-wide contributions from all segments of society, thus richly adding to the fertility of the soil of our collective endeavors and making it more likely that the new social structures we are building represent the best of humanity’s efforts, and can best satisfy the needs of the whole.

The night before I was to perform surgery without optimal personal protective equipment and with uncertainty about potential risks to myself, my seven-year-old daughter sat with me and prayed out loud “O God, please, pleeeaaaase, let this pandemic stop. And if it is not your will to stop it, then please help us learn something from it”.

Unlike the cells of the immune system within a human body, we as human beings can exercise free will. We have an intellect that can analyze the best of science, and a spirit that can resonate with the best of universal religious teachings.  We can make ourselves go into battle and not leave a fallen soldier behind; we can make ourselves go to the hospital to care for another life even though this places our own lives at risk.  We can put another’s wellbeing before our own; we can demonstrate courage in the face of adversity. We have the resources – both material and spiritual – to rally around a common endeavor and to restructure a society adequate to our time and common aspirations.   We don’t live in a just or equal society.  But can we agree that we should?   That we all matter the same?  Can we organize ourselves around the central premise that we are one people, then set about rebuilding societal structures that both reflect and help promote this?  The health and life of humankind, it would appear, depend on it.

About the Author:

Nasim Ahmadiyeh M.D., Ph.D. is assistant professor of surgery at University of Missouri-Kansas City School of Medicine, breast surgical oncologist and Medical Director of the Comprehensive Breast Care Program at Truman Medical Centers, the primary safety-net/essential hospital in the Kansas City, Missouri, metro area.  Her recent research focuses on cancer health disparities among the safety-net population.