Now that so many medical profession-als have died, operations at many major hospitals have been severely curtailed, and society has paid a terrible price, Taiwanese-so proud of accomplishments in gene sequencing, cow cloning, test tube babies, and other aspects of cutting-edge science-have realized that "advanced medicine" does not necessarily mean "advanced public health."

It is said that the Pingpu Aborigines took great pains to protect their water sources from pollution. When Han Chinese arrived in Taiwan, they found they could frighten off Aborigines without a fight just by "putting dead dogs in the water and hanging dead cats from trees," because the Aborigines knew when they saw them that there was probably an epidemic coming. Lacking antibiotics, keeping their environment healthy was the only way they could ensure the continued existence of the tribe.

Every group has its own approach to ensuring the continued existence of the community. Modern people, in contrast to our ancestors, may enjoy advanced technology, but we pay little attention to the most basic measures for keeping our environment healthy. There are two approaches to coping with disease: preventing it by attention to environmental maintenance, and curing it medically after it hits. These are two different cultural outlooks, which require different ways of life, and which can produce two very different outcomes.

Watching their colleagues fall victims to SARS one after another, two doctors from St. Mary's Hospital in Luotung (Ilan County) said with anguish that the SARS epidemic can be considered an all-out effort by microbes in defense of their existence. Whether fully accurate or not, this idea hits one nail right on the head: The major approach of modern medicine of treating patients with antibiotics is being severely tested. Perhaps because technology is so advanced, and there are so many astonishing devices and amazing medicines, modern life has been turned upside down, and there is too much emphasis on pharmaceuticals and medical technology.

Of course there is no necessary contradiction between public health and clinical treatment: neither can replace the other, and in fact they are mutually supportive. But public health operates on a deeper level. One hundred years ago, the recently arrived colonial authorities from Japan undertook two major projects in Taiwan's cities to prevent epidemics-providing an uninterrupted supply of clean water, and building systems to remove polluted water. These measures were not the product of good intentions or of some innate Japanese love of cleanliness, but rather of the fact that to take Taipei the Japanese lost only 200 soldiers in combat but 20 times that number to tropical diseases. They knew very well that occupying Taiwan permanently depended to a great extent on maintaining a healthy environment for the occupiers.

It is perhaps only now that people on both sides of the Taiwan Strait realize that spitting saliva or betelnut juice on the street is more than a problem of aesthetics. And don't even mention the mindset of people in Taipei who are only concerned about their own space, who keep their apartments spotless while their dogs freely relieve themselves in our public parks. And what is the reason that Shunde (near Guangdong, China) was the place of origin of the SARS virus? With economic growth in the PRC, demand for meat is rising, and producers, thinking only about increasing supply, mixed their animals and themselves carelessly together under poor hygienic conditions, thus giving rise to a killer microbe. And beyond SARS, remember that China has to feed well over a billion people, and if they are not careful to take basic hygienic measures (like freezing meat to kill germs, or electrical slaughtering), it could be a hotbed for the production of even more viruses.

Diseases bred by people have their own survival strategies, which rely on large concentrations of people. Since we apparently have no choice but to live in close proximity, we have to manage the earth to the best of our ability. We need to get back to a basic humanism in everything from lifestyle and development models to urban planning and individual hygiene. SARS tells us that what we need is not more skyscrapers, department stores, or hospitals with central air conditioning, but more attention to public health, to the maintenance of public spaces, to the diversification of our living environment, to water quality, to reducing the quantity of garbage. It is precisely because there is no escaping modern life that we need to take a lesson from the Pingpu Aborigines and maintain a high level of environmental awareness and public consciousness. We cannot just build more buildings, clear more land, cut down more forests, produce more goods, destroy more water resources, and introduce more viruses, thinking that modern medicine can fix whatever goes wrong.

Besides lending encouragement to those sitting through quarantine, and sympathy to those who have lost loved ones, when the storm passes and we all breath a sigh of relief, let's be sure not to go right back to where we started.