Inspired by Pinchgut Opera’s public health analysis of Salieri’s The Chimney Sweep, is this light-hearted look at five famous characters from classical opera, as they may have been treated by a (best practice) comprehensive primary health care service. Scroll down for the identity of these dramatic patients and the public health lessons they can teach us.
Case notes: The patient, an elderly woman, presented with severe burns to all parts of her body. Further questioning revealed that she had received these burns when escaping from an oven, into which she claimed to have been pushed by two children, one of whom she had been planning to eat. After treating the burns, a psycho-social examination revealed that the patient has been living alone, in a remote part of a wood in sub-standard housing and with limited social contact.
Primary care intervention: A mental health care plan, in conjunction with appropriate peer support, would assist in reducing the patient’s social isolation. A dietician should also form part of her comprehensive care team in order to support the patient from orienting her diet away from small children towards more appropriate sources of nutrition. There is also a clear need to improve her housing conditions, in particular to encourage her to avoid confectionary as a core building material in favour of more stable and weather proof products.
Case notes: The patient presented as pale and feverish, with a persistent dry cough and complaining of lethargy. She had been living in some kind of students’ and artists’ commune, which she described as ‘bohemian’ but admitted that it had only primitive plumbing and sanitation. Unable to afford any medication, her condition had become more serious and required urgent treatment to prevent it from becoming life threatening.
Primary care intervention: Immediate treatment for the patient’s respiratory illness would be the first priority, which may involve admitting her to hospital until her condition stabilises. On discharge she would benefit from a home and community care package to assist her with daily living tasks. Contact tracing should also be undertaken to reduce the spread of this condition through the artist and student communities.
Case notes: The patient presented in a state of delirium believing that she was some sort of god-like figure responsible for capturing the sun and plunging the world into darkness. She had attempted to marry off her daughter to an elderly servant and then tried to murder her when she refused, claiming that her daughter was in league with ‘the enemy’.
Primary care intervention: A mental health care plan, developed in conjunction with a psychiatrist, would assist in addressing the patient’s delusions and improving her mental state. Counselling, both individually and family-based, would help her and her daughter develop a more functional and mutually respectful relationship.
Case notes: The patient appeared agitated and reported hearing statues talking to him late at night. He reported having invited one of the statues to dinner but was now worried that it was planning to avenge his sexual transgressions. On taking a sexual history, the patient described himself somewhat proudly as a sex tourist and claimed to have slept with over 2000 women across Europe, with 1003 in Spain alone (although curiously only 91 in Turkey).
Primary care intervention: Counselling on safe sex practices, together with regular attendance at a Sex Addicts Anonymous peer support group would help address his sexual addiction and concurrent mental health issues. Contact tracing of previous sexual partners is also important, pending the results of STD testing.
Casenotes: A young Roma woman employed at a local tobacco factory in a low-skilled role and recently accused of a workplace murder, had escaped from custody and, while on the run, died tragically at the scene of a bull fight.
Primary care intervention: Workplace safety breaches contributed to the original incident in the tobacco factory which led to the tragic chain of events that subsequently unfolded. Clearly, the employer is at fault for the poor occupational health and safety practices and this urgently needs to be addressed, along with the provision of onsite workplace counselling and training in dispute resolution, to prevent similar occurrences in the future. A social determinants of health (SDOH) analysis would have predicted that the patient, being from a low-income, culturally marginalised group with few employment opportunities, would have a reduced life expectancy (although the SDOH literature is silent on the relationship between socio-economic status and the probability of dying at a bullfight).
Answers (and the public health lessons )
Patient A is the Witch from Hansel and Gretel (Humperdinck), from whom we learn that those who promote junk food to children may not have their best interests at heart.
Patient B is Mimi from La Boheme (Puccini) who reminds us of the importance of standards for building, plumbing and sanitation which reduce the transmission of infectious diseases and who also highlights the importance of universal access to primary health care.
Patient C is the Queen of the Night from The Magic Flute (Mozart), who reinforces the need for increased support for parents (in particular single parents) from all social classes and a greater investment in early childhood education in order to prevent the development of more serious mental health and social problems in later life.
Patient D is Don Giovanni from Don Giovanni (Mozart) who provides an excellent example of why we need universal safe sex education programs and accessible, legal and safe forms of birth control.
Patient E is Carmen from Carmen (Bizet) and her story illustrates that while tobacco industry may not be responsible for every health problem in society, it can always be blamed for something.