Negav Development: Healthcare

I'm going to start a series of threads about the development of Negav, partly inspired by Stabs' threads, because I think the wiki entry lacks a lot of information, information I believe will help us gain a better understanding of the workings of the city and help alleviate possible conflicting ideas among writers. I'm not bringing them to the idea forum because they're not exactly idea, at least not to me, rather it's just bringing up questions to the public, and hopefully getting some feedback and answers.

First, healthcare. I'm cheating a bit with this one because I already talked to Karbo over notes about hospitals and he answered me that it would be in form of guilds, and since I made it a semi-important point in my stories, I also submitted an idea for healers' guilds with some help from French-Snack. You can read it for yourself over there. I was inspired by the description for the Hydromancers' Guild, by the way. The reason I'm bringing this up first, aside from having worked on it and I not wanting another idea to replace it cause I'd hate to have to change stuff in my story again, is because of the transport thread, specifically the mention of ambulances. In my mind, before we establish how an ambulance in Negav would look like and operate, we should probably establish how healthcare is handled first.

Anyway, what do you think of the submission? Does it sounds like a reasonable handling of healthcare in Negav? Do you think I missed certain things? Do you think some parts are unnecessary? Don't be afraid to speak up?

Well if you posted an idea and want feedback, which is what this seems like, then yes, it should go into the ideas thread. I don't know where to begin with actual discussion and ideas, other than making my own idea here, which would further cement my opinion that this belongs with the ideas.

Anyway, all I really have to say is that I like it, but the IVs with felaryan soil seem a bit awkward to me. It sounds like it'd work, as the soil wouldn't have bacteria and contagions it it unlike our world due to obvious reasons, but I would admit to enjoy seeing other techniques talked about and how maybe using some other material would amplify healing.

For example, maybe there are some kind of mineral or material used as a battery to augment the healing effect in addition to the soil, or some kind of spells. There have got to be healing spells in addition to regular magic. Just because the soil heals, doesn't mean healing magic wont work. It'd probably function differently, but I can also see this guild performing research on anything to do with healing patients, in the battlefield or off it. I mean we know that the soil basically boosts immune systems like crazy right? (I still cant get my head around that. Every time I just hear "autoimmune disease, go!" I really think that explanation does WORSE.) Or however the soil works, mimicked by healers who try to magically or manually to get similar results. I am suddenly reminded of the bending arts from the avatar cartoon.

Uh, reading your post, I think you read the thing wrong. First of all, it doesn't inject soil via intravenous therapy, that would be impossible. It's mostly use to inject blood and nutrition, more so the latter cause all the best healing magic in the world isn't going to give your body the nutrients it needs to keep working. They would rarely have to use it, anyway, since it would only be necessary if the patient is in a critical, life-threatening state, which I doubt would happen very often.

The idea of a battery to amplify the effect of the soil, that's essentially the mineral water, it helps the patient recover a little bit faster that using the soil alone. Also, I did state that doctors do learn curative magic, but I prefer to see it used to accelerate the healing of specific wounds. For example, a surgery, instead of stitching the cut, they instead use healing magic to seal it shut, and then let the soil help the patient recover its strength.

Also, what battlefield? I have honestly no idea what you're talking about? The guilds are hospitals. Why would they be in a battlefield and where would that battlefield even be?

Just a mention to the immune system, I think it should be clarified. I prefer to think that it's very difficult to catch something in Felarya, if you are in relatively good health. If, however, you are in poor health, like you got malnutrition, you're anemic, stuff like that, then you may be susceptible to catch something. In Negav that would be next to impossible, unless you go out of your way to live in a pig sty and don't properly care for yourself, or you live in the shittiest part of town, which would be the slum in The Pit.

"Instead of intravenous therapy, the guild offers patients water infused with granulated minerals from the soil every hours." Is what confused me then. I thought that meant IVs had a bit of soil in it.

Well, what about surgery, reparing broken limbs. I know taking one thing at a time is important, but places to throw ideas at for fixing medical issues in different ways. I just feel using soil for every single method feels a bit over-powered and forced. Or that anyone can be a doctor since all they'd have to do is use soil. That doesn't require a doctorate.

Battlefield as in, you know, healing techniques when you're fighting? That in addition to at the hospital.

Also, with your comments about the immune system, yes, and even those in the Pit aren't knowing for carrying disease. In fact, disease has never been touched on other than "it doesn't happen." The excuse was of course boosted immune system which will only make me repeat my issues with that explanation.

I could have reworded it to glasses of water now that I think about it.  For surgery, there's more than repairing broken limbs.  High cholesterol level for example.  The best healing magic or healing soil in the world ain't gonna get that stuff out of your arteries.  Sometimes people may develop organ defects and other things that aren't considered diseases, like a scoliosis for example, and that also needs to be corrected surgically.  The soil ain't gonna set that spine of yours straight again, I can tell you that much, and there's much more than that like various types of poisoning and how they deal with amputation.  What I mean by the soil is the recovery period.  What do you do after you get treatment from the doc?  You lay in bed and you rest until you've regained your strength.  That's pretty much all the soil is used for, to help you regain your strength faster after you received your treatment.  I could also make that a little bit clearer now that I think about it.

This is more to raise a point than me giving away an idea in the hopes of it getting a wiki.  This is information I got from Karbo while noting him and posting it here.  The point I am making is that he already has specific views for Negav, but he hasn't made them public in the wiki.  It leaves us confused about how certain aspects work, which leads to conflicting ideas like the one you suggested.  The purposes of the threads I am making is to make Karbo spill the beans, to give us clearer details about how the city works, because so long he stays silent, we'll never reach a satisfying answer.

Also, to address your point about Holy Oak, that wouldn't work because Holy Oaks are extremely rare.  Their entry in the wiki says so.

The wiki wrote:

Holy Oak
Few in number, there mighty, pure white oaks are scattered throughout Felarya. Many people build settlements near these trees because, for reasons unknown, the revitalizing power of Felarya's soil is increased tenfold around them. As an added bonus, nothing with demon blood in their veins (such as succubi) will be able to see or sense prey close to the tree and will be repelled by its presence.

It says it right there, they are few in numbers, which means they are excessively rare and Negavians probably have absolutely no clue where to even start looking for one.

Well for bone or spine placement you could use some enchanted material that are set to encase the back, the arms, or wherever the broken bone is, and it would sort of "attract" the bones toward the right direction. Like how those neck-cones encourage the neck to realign properly. Hell, you could even get fancy. Come up with some sort of new material or modify an existing one with "plot magic", and have these items hover in mid air over various important points and joints of the body which would act like a detached cast, so to speak.

I suppose we could always use a cast, but what's the fun in that? I'd like to try and be different first, before going with the norm.

Then there's limb removal. A way to nullify pain, keeping the blood from spilling out is basic I think.

Alcohol poisoning? Needing to detox someone I think would be complicated.

As for the more complex surgeries like going into an organ, transferring adrenaline or some other liquid I can't imagine doing it any other way than we do here in current tech. However, due to the way magi-tech works there's got to be an answer out there for a different way of doing that.

Like I said, I think having hovering minerals, like Mazhir or some other "battery" enchanted to form some kind of shield on one side of the body when floating in the air, you could make four of them form a shield (designed to prevent some sort of bodily function to reduce trauma? I'm no medical expert, so I'm just fumbling around in the dark here.) around the intended operating zone before going in. Though there still has to be something more practical.

I'll think on it more and ramble less.

It's not necessary to go into details about how things go in there because, as you said, we're not medical experts and we don't want medical experts out there call us out for thinking we know more about their job than we do. Once again, the point of this thread is to show a piece of information that Karbo hasn't added to Negav's wiki entry, which leads to many, many conflicting ideas, as we are having this very moment.

If the point of this thread is to say that taxes collected by the Ps'Isol go towards maintaining hospitals, I approve.

Shady Knight wrote:

 The point I am making is that he already has specific views for Negav, but he hasn't made them public in the wiki.  It leaves us confused about how certain aspects work, which leads to conflicting ideas like the one you suggested.  The purposes of the threads I am making is to make Karbo spill the beans, to give us clearer details about how the city works, because so long he stays silent, we'll never reach a satisfying answer..

Those are interesting threads that pose good questions indeed. I'd just wish you would cease to hammer the "karbo didn't said that" again and again.
In the case of health-care, like Ilceren put it, it would probably a bit less prevalent than in other worlds. And like you mentioned in your idea, an important part of it would be to provide a good recovery environment, while of course having a staff competent in interventions and operations since the soil won't just fix everything.

I apologize for the constant remarks against you, Karbo.  I'll refrain from doing that again in the future. In any case, healing guilds would primarily offer a good recovery environment for patients who need emergency treatment, perhaps even intensive care, right?

Karbo wrote:

Those are interesting threads that pose good questions indeed. I'd just wish you would cease to hammer the "karbo didn't said that" again and again.
In the case of health-care, like Ilceren put it, it would probably a bit less prevalent than in other worlds. And like you mentioned in your idea, an important part of it would be to provide a good recovery environment, while of course having a staff competent in interventions and operations since the soil won't just fix everything.

Of course, but what we're wondering about here, are the methods used for various scenarios. Dirt incorporation only seems natural, but what about the other ones? I mean if someone breaks a bone or needs an infusion or some kind of surgery.

Like I said, it's not necessary to go into details and making something magic just to be different will often result in something that's more impractical than anything. But for the sake of keeping the discussion going, maybe we could think of some more things we could find in these guilds. They probably won't make it in the entry, if it gets a wiki entry, but why the heck not? First, I want to give Ilceren a belated apology when he brought up the Holy Oak, I was a little too rude in my reply.

In any case, I thought a little more about it and I got the idea of plaster made from a combination of soil and whatever else is used to make plaster shells, as to put the broken limb in direct contact with the energy of the soil. The only drawback I can think of is that it's only gonna work for a broken arm or leg, cause I think a casing for broken ribs are made of plastic or some other material. As for surgeries, I always had the itdea that doctors would put patients to sleep by casting a spell that puts them in a very deep sleep. I also read somewhere of some form of electro-therapy to stimulate someone's muscles, which is apparently used to reverse muscle atrophy, so rudimentary electric magic. I also made mention of a spell where the healer lay its hand on the patient to find out what its condition is and what it's suffering from a few times in my story, so that could be used in place of tests or X-Ray's to find out about ailments. I presume more skillful healers are able to gather more precise information out of it.

I was going to bring up detox, but as Ilceren pointed out and Karbo confirmed, the guilds would most likely be used for whatever Negav considers emergencies, so detoxification by itself probably wouldn't warrant a trip to the hospital as I'm fairly certain first aid kits would carry a few remedies for just that. But for someone who is infected by something and needs to receive emergency treatments for something else, I'm actually torn between doctors making remedies or using spells to cure the patient.

That's all I can think of for now.

Shady Knight wrote:

I'm actually torn between doctors making remedies or using spells to cure the patient.

Can't they do both?

Remedies and potions could be the common stuff available to citizens and adventurers, while healing spells could be something found amoung the Magiocrats and their freinds. Essentially healing magic could be a privilege of the upper class, remedies could be for everyone else below them.

I don't think it would work that way, but at the same time, I think you raised a way for both to be used at the same time. Remedies would probably be standard treatment and something nurses could make as part of their job, but spells would most likely be used to deal with life-threatening infections or anything that must be treated as quickly as possible, or if the patient is in no condition to take the remedy himself.

Though somewhat unrelated, I do believe it's highly probable that important figures such as the Magiocrats and other important mages would have priority on waiting lists, with council members at the very top.

I can just imagine a bunch of people watching as a council member gets rushed into the ICU. That wouldn't happen every day.

With all the layers of protection council members have on them, I think the mere fact of a council member getting rushed to the ICU would be enough to cause mass panic, but yeah, wouldn't happen every day is a very light way to put it.

Woulden't the Council members just get teleported into the best available operation room? I woulden't think the public would get to see anything.

which would be a good way for the council members to make themselves seem powerful and infallible. The Magiocrats surely woulden't want anyone seeing anything that could reveal that they are just as flawed as everyone else.

You could teleport into an operation room or have someone do so, but it will do you little good if you don't warn the doctors in advance, and Heaven help you if you teleport in the room while it's in use.

Funny as that train of thought is, let's get back on topic.  I've been fiddling around spells in D&D, which I use a lot in my work cause I am unoriginal, and I came across Regenerate.  If I can be allowed to put on my nerd cap for a little while, Regenerate is a spell that causes the subject's severed limbs, broken bones, ruined organs, and the like to grow back.  It's very quick if the missing limb is present and touching the stump, but if not, it takes longer for it to grow back on its own.  This would be a very efficient way to deal with amputation in a magic-driven society and could ultimately eliminate all need for organ transplantation.  Someone's kidneys got ruined somehow?  The good doctor will just cut them and grow a new pair.  The catch?  It's a high level spell.  The class that learns it the earliest is the Cleric, but even for them, it's a 7th level spell, so it's still high tier. The only other core class who learns it is the Druid, which is a 9th level spell for them, the highest spell level in the game short of Epic level spells.

Taking off my nerd cap, I imagine that only the best healers in Negav, those who have studied and practiced healing magic for many years, would be able to use such a spell.  Using Darkie's amusing idea, I can imagine the council members having some connection with such respected doctors.  As for how long a limb or organ would grow back?  In D&D it takes at most 20 rounds, which is two minutes, but that's still quick, so I imagine it would take much longer than that in Felarya, most likely hours.

I just thought of another question that might need answering.  I know it's a little silly to ask, but would healthcare in Negav be free?  I think Negav could use an entry about healthcare in general rather than just healers' guilds, cause as Ilceren said, with the soil accelerating natural healing and making the body a lot more resistant to diseases, healthcare would probably be radically different than in real life.

Shady Knight wrote:

As for how long a limb or organ would grow back? In D&D it takes at most 20 rounds, which is two minutes, but that's still quick, so I imagine it would take much longer than that in Felarya, most likely hours.

Hm. I was thinking days. Its a limb, after all. Not some gash.

Shady Knight wrote:

I just thought of another question that might need answering. I know it's a little silly to ask, but would healthcare in Negav be free? I think Negav could use an entry about healthcare in general rather than just healers' guilds, cause as Ilceren said, with the soil accelerating natural healing and making the body a lot more resistant to diseases, healthcare would probably be radically different than in real life.

Well to be honest, the resources (except for dirt) are still hard to come by. You need the minerals and ore required, as well as magic, to make the magitech required for anything (anything that's magitech, anyway) and medical equipment, whatever it may be, would be just as needy. Materials are also hard to come by just because its out there in the wildy.

When it comes to healthcare itself, I suppose we could either make it like social healthcare, or the way the US does it - requiring people to pay for their own insurance/themselves. Though barring the equipment, once you have it its probably easy to keep it running, and not ware out anytime soon. From that perspective the services might be cheap, but there'd need to be some funding for them to be able to get the equipment in the first place, and also to pay the healers/doctors/whatever we want to call them.

The time for a Regenerate-like spell would depend a lot on what is being grown back.  Something tiny like a finger would most likely take little time, relatively speaking, but something big like a whole limb or a major organ would take a long time.

I don't think for the most part medical equipment would be that elaborate, especially if they base it around the healing powers of the soil, but on a rather grim thought, I wonder what equipment for intensive care would look like, especially life support. I think that's where most of the bulky equipment would go.

It would be fun designing that. If Tuc still came to this forum, having gone to medical school, I'm sure he'd be able to help out.

Okay, let's recap the ideas we've come up with so far, in no particular order.

- Due to the effects of the Felaryan soil, healthcare in Negav is a bit less prevalent than in other worlds.
- Hospitals in Negav come in the form of a few guilds who that harness the powers of the Felaryan soil in order to primarily provide a good recovery environment.
- Staff include doctors, skilled mages who employ various magic to medical purposes and specialists in traditional medicines, who provide treatment for whatever the soil can't fix itself, and nurses who assist doctors and tend to the patients during their recovery.
- Common practices include:

-- Filling bed mattresses with the soil.
-- Serving mineral water to keep the patients strong and energized.
-- Making soil-based ointment (new) before applying bandages, plasters to help bones mend faster after it's been set back in place, and various remedies for detoxification.

- While planting Holy Oaks is far-fetched due to their rarity, I propose that oaks in general are used as part of the symbol of healthcare in Negav.
- While unlikely, perhaps the guilds have waiting lists and prioritize treating certain people over others, council members obviously being at the very top.
- Modern, bulky medical equipment would likely not be used outside of dire emergencies such as when patients are in a critical state. We don't have a very good idea of what they would look like, but it may employ some form of magitech.

Does that look good?