E ʻike pono kākou i ke ʻano o kēia huakino weliweli i kapa ʻia ʻo "Superbug"?

Ua lohe paha ʻoe i kekahi e kamaʻilio ana e pili ana i kēia mau "superbugs" ma ka nūpepa, ma ke TV, a i ʻole ma ke kino? Ke lohe ʻoe i kēia inoa, makaʻu iki ʻoe, ʻeā? He aha ke ʻano o "superbug"? He mea weliweli maoli anei kēia? I kēia lā, e kamaʻilio mākou e pili ana i kēia me nā kikoʻī, maʻalahi loa, ma ke ʻano hiki iā ʻoe ke hoʻomaopopo.

He aha ka "superbug"? I ka ʻōlelo maʻalahi...

I ka ʻōlelo maʻalahi, ʻo ka "superbug" he ʻano microbe i kūʻē i nā lāʻau lapaʻau a mākou e hāʻawi ai e mālama i kahi maʻi, ʻoi aku hoʻi nā antibiotics, a ʻaʻole hiki ke luku maʻalahi ʻia. Ua kapa ʻia kēia mau mea he "multidrug-resistant microbes," ʻo ia hoʻi he kūʻē lākou i nā ʻano lāʻau lapaʻau he nui.

E noʻonoʻo, loaʻa iā ʻoe kahi maʻi bacteria a hāʻawi ke kauka iā ʻoe i ka lāʻau lapaʻau. ʻO ka maʻamau, pepehi ka lāʻau i ka bacteria. Akā, inā he ʻano bacteria "superbug" kēia, ua "hoʻololi" ia i ka lāʻau lapaʻau. No laila, inā hāʻawi ʻoe iā ia, ʻaʻole ia e make. ʻO ia ka manawa e hoʻomaka ai ka pilikia. Me he mea lā i ka wā e hele ai mākou i ke kaua, ua mākaukau mua ka ʻenemi no nā mea kaua a mākou e hoʻohana ai.

ʻO kēia mau "superbugs" ka mea i loaʻa pinepine ʻia i nā bacteria . ʻO ia hoʻi, he mau bacteria lākou i ulu aʻe e kūʻē i kekahi mau ʻano antibiotics. Eia nō naʻe, hiki i kekahi mau fungi ke lilo i "superbugs" i kūʻē i nā lāʻau antifungal.

Ua noʻonoʻo paha ʻoe no ke aha e ʻōlelo mau ai nā kauka, "E lawe i nā lāʻau antibiotic e like me ke kauoha, no ka manawa kūpono," a "Mai lawe i nā lāʻau antibiotic i ka wā ʻaʻole pono ʻoe iā lākou"? ʻO ke kumu nui o kēlā, ʻo ia ke pale ʻana i ka ulu ʻana o kēia mau "superbugs."

Ke hoʻopili pinepine ʻia nā pathogens i nā antibiotics, loaʻa iā lākou nā ala hou e pale aku ai iā lākou. Ua like ia me kahi ʻaihue e kali ana e hoʻohālua iā mākou i kēlā me kēia lā i ko mākou hele ʻana ma ke alanui hoʻokahi. No laila, inā e komo kahi "superbug" i kūʻē i nā lāʻau he nui i loko o ko mākou kino, hiki ke hoʻoweliweli i ke ola, a hiki ʻole ke mālama ʻia.

He aha nā ʻano "superbugs" maʻamau?

ʻOiai hiki i kekahi bacteria ke hoʻomohala i ke kū'ē ʻana i nā lāʻau antibiotic, ʻo kekahi mau ʻano bacteria e lilo pinepine i "superbugs." Eia kekahi mau laʻana:

• ʻO Staphylococcus aureus (no ka laʻana ʻo MRSA - methicillin-resistant Staphylococcus aureus)
• ʻO nā Enterobacterales Kūʻē i ka Carbapenem ( CREs ) a me nā Enterobacterales kūʻē i ka lāʻau lapaʻau ʻē aʻe. Hoʻokomo pū kēia i nā bacteria e like me Klebsiella pneumoniae, E. coli, Salmonella, a me Shigella.
• ʻO ka bacteria e hoʻoulu ai i ka gonorrhea (Neisseria gonorrhoeae)
• ʻO ka Pseudomonas aeruginosa
• ʻO ka Acinetobacter baumannii
• ʻO ka Mycobacterium tuberculosis (ka bacteria e hoʻoulu ai i ka maʻi puʻupuʻu )
• ʻO Streptococcus pneumoniae (ka bacteria e hoʻoulu ai i ka maʻi pneumococcal)
• ʻO Campylobacter
• ʻO ka Mycoplasma genitalium
• ʻO Bordetella pertussis (ka bacteria e hoʻoulu ai i ka ʻū whooping)

Ma waena o nā maʻi fungal, hiki iā Candida auris lāua ʻo Aspergillus fumigatus ke lilo i "superbugs".

Akā e hoʻomanaʻo i kēia: ʻoiai ua loaʻa iā ʻoe kahi maʻi germ ma kēia papa inoa, ʻaʻole ia he manaʻo ua loaʻa iā ʻoe kahi "superbug." Aia nā ʻano germs i kūʻē i ka lāʻau lapaʻau, a me nā ʻano maʻi (make).

He aha nā hōʻailona o ka maʻi "superbug"?

Hiki ke ʻokoʻa nā hōʻailona o ka maʻi "superbug" ma muli o kahi o kou kino i loaʻa ai ka maʻi. ʻO kekahi mau hōʻailona maʻamau:

• kuni
• Anuanu
• He ʻulaʻula o ka ʻili, a i ʻole kahi ʻāpana ʻili i ʻulaʻula, ʻeleʻele, ʻeha, pehu, a piha paha i ka pus a i ʻole ke wai.
• Kuke
• Pōkole o ka hanu
• ʻEha umauma a ʻōpū paha
• Luhi nui a hiamoe paha (`Lethargy`)
• ʻEha ʻiʻo a hui paha
• Ke koko haʻahaʻa
• Hoʻonui ʻia ka helu o ka puʻuwai (Tachycardia)
• Hypothermia (haʻahaʻa o ke kino)

ʻAʻole hiki ke hana ʻia kēia mau hōʻailona e nā "superbugs" wale nō akā e nā maʻi ʻē aʻe he nui. No laila, inā loaʻa iā ʻoe kēia mau hōʻailona, ​​ʻoiai inā ʻaʻole lākou e hoʻomaikaʻi me ka mālama ʻana, e ʻike koke i ke kauka.

Pehea lā e kū mai ai kēia mau "superbugs"?

Nui nā kumu e kūʻē ai nā "superbugs" i nā lāʻau lapaʻau. I kekahi manawa, he mea ia e hana maoli ʻia. ʻO ia hoʻi, ulu lākou e noho pū me nā meaola ʻē aʻe. I kekahi manawa, hoʻomohala nā bacteria a i ʻole nā ​​​​fungi i nā ʻano pale e ālai a luku paha i nā antibiotics a i ʻole nā ​​​​lāʻau antifungal.

ʻOi loa aku ma nā haukapila a me nā wahi mālama ola kino ʻē aʻe, hiki i ka bacteria ke kū i nā antibiotics a nā kauka e hoʻohana pinepine ai. Nui nā "superbugs" e ulu ana ma kēia mau wahi. ʻOiai me ka hoʻohana pono ʻana i nā antibiotics, hiki ke paʻakikī ke pale aku i kēia.

Hiki i nā bacteria ke hoʻoili i kā lākou mau genes kū'ē ('genes kū'ē') i nā bacteria ʻē aʻe i loaʻa mua. Ua kapa ʻia kēia ʻo 'horizontal gene transfer'. Eia kekahi, hiki iā lākou ke ola i nā antibiotics, hana hou, a hoʻoili i kā lākou mau genes (me ka hiki ke kū'ē) i nā poʻe ʻē aʻe.

Pehea e hoʻopilikia ai kahi "superbug" iā mākou?

Hiki iā ʻoe ke loaʻa i ka "superbug" ma kēia mau ʻano:

• Ma ka launa pololei ʻana me kekahi i loaʻa i ka maʻi a i ʻole i noho ʻia. Lawe maoli kekahi poʻe i ka bacteria a i ʻole ka fungi "superbug" ma luna a i loko paha o ko lākou kino, akā ʻaʻole lākou e maʻi. Ua kapa ʻia kēia he 'colonization.' Inā lawe ʻoe i kahi germ ma kēia ʻano, hiki iā ʻoe ke hoʻoili iā ia i nā poʻe ʻē aʻe, a hiki iā lākou ke maʻi.
• Ma ka hoʻopā ʻana i nā mea a i ʻole nā ​​ʻili i haumia i nā germs.
• Ma ka kaʻana like ʻana i nā mea i haumia me nā poʻe ʻē aʻe. Eia kekahi laʻana, nā mea moe, nā lole, nā lako lapaʻau a i ʻole nā ​​​​lako haʻuki, nā kāwele, nā ʻumiʻumi, a i ʻole nā ​​​​​​mea ʻai.
• Nā lako lapaʻau i haumia a me nā mea lapaʻau i loko o kou kino (e laʻa, kahi laina venous waena a i ʻole ka paipu hanu).
• Mai ka meaʻai a i ʻole ka wai i haumia ʻia a me nā huahana waiū i hoʻomaʻemaʻe ʻole ʻia.

ʻO wai ka mea i ʻoi aku ka nui o ka pilikia o ka loaʻa ʻana o kahi maʻi "superbug"?

Aia paha ʻoe i kahi pilikia kiʻekiʻe o ka hoʻomohala ʻana i kahi maʻi "superbug" inā ʻoe:

• Inā loaʻa iā ʻoe kahi laina venous waena, kahi paipu hanu, kahi paipu hānai, a i ʻole kekahi paipu a mea hana ʻē aʻe i hoʻokomo ʻia i loko o kou kino, hiki i kēia mau mea ke ʻae i ka "superbug" e komo i kou kino mai waho.
• Inā ua lōʻihi kou lawe ʻana i nā lāʻau antibiotic a i ʻole ke hoʻohana pinepine nei ʻoe iā lākou. ʻO ka lōʻihi o ka hoʻohana ʻana i nā lāʻau antibiotic e hoʻonui i ka manawa e kūʻē ai nā bacteria. Hiki iā ia ke pepehi i nā bacteria "maikaʻi" (ʻaʻole ʻino) i loko o kou kino. ʻO kēia mau bacteria "maikaʻi" ka mea e pale ai i nā bacteria ʻē aʻe mai ka ulu ʻana ma waho o ke kaohi a me ka hoʻoulu ʻana i nā maʻi.
• Inā he maʻi olakino kou e hoʻonāwaliwali ana i kou ʻōnaehana pale ʻana, e like me ka maʻi HIV, nā maʻi ʻaʻai koko, a i ʻole ka maʻi diabetes, a inā ua loaʻa iā ʻoe kahi hoʻoili kino a i ʻole ka hoʻoili cell stem. ʻO kēia mau kūlana e paʻakikī ai i kou kino ke hakakā i nā maʻi.
• Inā ʻoe e noho ana ma ka haukapila no ka manawa lōʻihi a i ʻole ma kahi hale mālama lōʻihi. Loaʻa nā "superbugs" he nui ma nā wahi mālama ola.

He aha nā pilikia o nā "superbugs"?

Inā ʻaʻole hiki i nā kauka ke kāohi koke i kahi maʻi, hiki iā ia ke alakaʻi i nā pilikia koʻikoʻi. Nā Laʻana:

• ʻO Sepsis a me ka haʻalulu septic (kahi pane koʻikoʻi i ka maʻi e hoʻoulu ai i ke koko haʻahaʻa, hōʻino ʻia nā ʻiʻo, a me ka hāʻule ʻana o nā ʻōkana).
• Ka hāʻule ʻana o ka hanu.
• Ka nalowale ʻana o nā lālā i loaʻa i ka maʻi (ʻoki ʻia).

He mau kūlana weliweli maoli kēia, ʻeā? ʻO ia ke kumu e pono ai kākou e hopohopo nui e pili ana i nā "superbugs."

Pehea e ʻike ai i nā "superbugs"?

Inā loaʻa iā ʻoe nā hōʻailona o kahi maʻi a ʻaʻole lākou e hoʻomaikaʻi me ka mālama ʻana, manaʻo paha kāu kauka he "superbug" kou. E ʻimi lākou i nā bacteria a me nā fungi i loko o nā laʻana o nā wai kino a i ʻole nā ​​​​ʻiʻo, a i ʻole e hoʻāʻo e hoʻoulu iā lākou. Hiki i kēia mau laʻana ke komo pū me:

• Koko
• Mimi
• Noho
• ʻO ka wai a i ʻole ka ʻiʻo i lawe ʻia mai kahi ʻeha
• ʻO ka phlegm (ka mea huna e puka mai ana mai nā māmā me ka ʻū - 'Sputum')

Inā he mau mea lapaʻau kāu i hoʻokomo ʻia i loko o kou kino, a inā paha ua hoʻokomo ʻia ʻoe i ka haukapila i hala koke aku nei, e haʻi aku i kāu kauka e pili ana i kēlā.

Aia kekahi lāʻau lapaʻau no nā "superbugs"?

ʻAʻohe lāʻau hoʻokahi e hiki ke ho'ōla i nā "superbugs." ʻO ia ke kumu he mea weliweli loa lākou. Hoʻōla nā kauka i nā "superbugs" ma ka loaʻa ʻana o kahi lāʻau e hana kūʻē i ka germ kikoʻī i hoʻoulu ai i ka maʻi. Pono paha ʻoe i ka hui pū ʻana o nā lāʻau lapaʻau, e like me nā ʻano antibiotics like ʻole, e hakakā i ka maʻi.

Eia kekahi, mālama nā kauka i nā maʻi ʻili ma ka mālama ʻana i nā ʻeha hāmama. Hiki i kēia ke komo pū me ka hoʻokahe ʻana i ka ʻeha a me ka wehe ʻana i nā ʻiʻo i loaʻa i ka maʻi ma ke ʻoki ʻana. Hiki iā lākou ke wehe i nā mea lapaʻau i loaʻa i ka maʻi, e like me nā lālā prosthetic.

Hiki ke mālama ʻia kekahi mau maʻi fungal kū'ē, e like me Candida auris, me nā lāʻau antifungal i kapa ʻia ʻo echinocandins.

He aha ka mea e hana ai inā loaʻa iā ʻoe kahi "superbug"?

Inā loaʻa iā ʻoe kahi "superbug," pono paha ʻoe e mālama ʻia no ka lōʻihi ma mua o ka mea i manaʻo ʻia a i ʻole me nā ʻano lāʻau lapaʻau he nui. No kekahi poʻe, hiki i ka maʻi ke lilo i mea hoʻoweliweli i ke ola. Inā loaʻa iā ʻoe kahi maʻi koʻikoʻi a invasive paha, e hoʻokomo ʻia ʻoe i kahi haukapila a mālama ʻia i hiki i nā limahana olakino ke nānā pono iā ʻoe.

Inā loaʻa iā ʻoe kahi maʻi ʻili, e mālama kāu kauka i kou mau ʻeha ma ka wehe ʻana i ke wai mai loko mai o lākou ma ke ʻoki ʻana. Hiki iā lākou ke kuhikuhi i kahi kirīmi ʻili a i ʻole nā ​​​​​​lāʻau antibiotic waha.

Hiki iā ʻoe ke ola i kahi maʻi "superbug"?

ʻAe, hoʻōla ka poʻe mai nā maʻi "superbug". Eia nō naʻe, i nā maʻi koʻikoʻi a i ʻole nā ​​maʻi e laha ana i ke koko, kiʻekiʻe ka nui o ka make - i kekahi mau hihia a hiki i ka 50%. No laila, ʻaʻole kēia he mea e lawe māmā ʻia.

Āhea wau e ʻike ai i kaʻu kauka?

Inā he mea lapaʻau kāu i hoʻokomo ʻia i loko o kou kino a inā ua nāwaliwali kou ʻōnaehana pale, e nīnau i kāu kauka i nā hōʻailona o ka maʻi āu e makaʻala ai. Inā he mau hōʻailona kānalua kāu, e ʻike i kāu kauka a haʻi iā lākou e pili ana iā lākou.

ʻOiai ʻoe ma ka haukapila, he mea nui e mālama i ke kamaʻilio maikaʻi me kāu hui mālama ola. Inā ʻike ʻoe i nā hōʻailona o kahi maʻi, e like me ka ʻeha, ka piʻi ʻana o ka puʻuwai, ka nāwaliwali, a i ʻole ke kuni, e hoʻomaopopo iā lākou.

Āhea wau e hele ai i ka ʻOihana Pōpilikia (ETU) ?

Inā loaʻa iā ʻoe kekahi o kēia mau hōʻailona koʻikoʻi, e hele koke i ka lumi pilikia:

• Inā ʻoi aku ke kuni ma mua o 40 degere Celsius (103 Fahrenheit).
• ʻEha nui.
• Nā ʻōʻili.
• Ka huikau a i ʻole ka pio ʻana.
• Ka hāʻule koke ʻana o ke koko (nā hōʻailona: nāwaliwali, poniuniu, maule).

He aha nā nīnau e pono iaʻu e nīnau aku i kaʻu kauka?

He mea kōkua paha ka nīnau ʻana i kāu kauka i nā nīnau e like me kēia:

• He aha nā koho lapaʻau e loaʻa iaʻu?
• Pehea lā wau e lawe ai i kaʻu lāʻau lapaʻau?
• Āhea wau e manaʻo ai e ola hou?
• Pehea i loaʻa ai iaʻu kēia maʻi?
• He aha kaʻu e hana ai e pale aku i kēia ʻano maʻi i ka wā e hiki mai ana?

Hiki ke pale ʻia nā "superbugs"?

ʻO ke ala maikaʻi loa e pale aku ai i ka ulu ʻana o nā "superbugs" ʻo ia ka hoʻohana ʻana i nā antibiotics inā pono loa.

Aia nā alakaʻi no nā limahana mālama ola e hahai ai e pale aku i ka hoʻohana pono ʻole ʻana i nā lāʻau antibiotic. Eia nō naʻe, aia kekahi mau ala e hiki ai iā ʻoe ke kōkua i kēia:

• E lawe i nā lāʻau lapaʻau a pau e like me ke kauoha. Inā kuhikuhi ke kauka i nā lāʻau antibiotic, e lawe iā lākou no ka manawa piha i kauoha ʻia, ʻoiai inā maikaʻi kou manaʻo. Mai hoʻōki i ka hapalua.
• Mai lawe i nā lāʻau antibiotic ke ʻole ʻoe e pono iā lākou. ʻO ka hapa nui o nā anu a me nā maʻi hanu ʻē aʻe ke kumu o nā virus. ʻAʻole e ho'ōla nā lāʻau antibiotic iā lākou.

Pehea e hōʻemi ai i ka laha ʻana o nā "superbugs"?

Hahai nā limahana mālama ola i nā lula palekana a me ka hoʻomaʻemaʻe e hōʻemi i ka pilikia o nā maʻi i loaʻa i ka haukapila (hiki paha i nā "superbugs"). ʻO kēia mau mea:

• E holoi pinepine i kou mau lima.
• Ke hoʻomaʻemaʻe nei i nā ʻili.
• E hōʻoiaʻiʻo ana e hāʻawi wale ʻia nā lāʻau antibiotic i nā kānaka ke loaʻa iā lākou nā maʻi bacteria.
• Ka hoʻomaʻemaʻe ʻana i nā lako lapaʻau.
• Ke hoʻokaʻawale ʻana i nā poʻe me nā maʻi "superbug" i mea e pale ai iā lākou mai ka laha ʻana i nā poʻe ʻē aʻe.

ʻOiai he mea maʻamau nā "superbugs" i nā wahi mālama ola, hiki ke hoʻolaha ʻia lākou ma nā ʻano like ʻole. Hiki iā ʻoe ke hōʻemi i kou pilikia o nā "superbugs" ma ka hahai ʻana i nā hana like a mākou e hahai ai e pale iā mākou iho mai nā maʻi lele maʻamau:

• E mālama i nā ʻeha i maʻemaʻe a uhi ʻia.
• Mai hoʻohana hou i nā nila (ʻoiai ʻo kāu ponoʻī) i hoʻohana ʻia e hoʻokomo i nā lāʻau lapaʻau ʻaʻole lapaʻau.
• E holoi pinepine i nā lole moe, nā kāwele, a me nā lole i ka mahana wai kūpono.
• E hoʻohana i ka disinfectant e holoi i nā ʻili i hoʻopā pinepine ʻia e like me nā kuapo kukui, nā mana mamao, a me nā lako haʻuki.
• E kiʻi i ka lāʻau pale. Aia nā lāʻau pale e kūʻē i nā ʻano bacteria he "superbugs" e like me Bordetella pertussis (whooping cough) a me Streptococcus pneumoniae (maʻi pneumococcal).
• E hoʻomaʻamaʻa i nā ʻano hoʻomaʻemaʻe maikaʻi. ʻO kēia ka holoi pono ʻana i kou mau lima, ke komo ʻana i nā lole maʻemaʻe a maloʻo, a me ka ʻole e kaʻana like i kāu mau mea pilikino me nā poʻe ʻē aʻe.
• E hahai i nā hana palekana no ka meaʻai. ʻO kēia ka mālama pono ʻana i ka meaʻai, ka kuke ʻana i ka ʻiʻo a me ka iʻa i kahi mahana e pepehi ai i ka bacteria, a me ka holoi ʻana a i ʻole ka ʻili ʻana i nā huaʻai a me nā mea kanu ma mua o ka ʻai ʻana.
• E hoʻohana i ka condom a i ʻole ka dental dam i ka wā o ka moekolohe.
• E nīnau i kāu kauka i ka lōʻihi o kou mālama ʻana i nā mea lapaʻau (e like me nā catheters), a pehea e pale ai i nā maʻi i ka wā e kau ana ka mea.

Pehea ka maʻamau o nā "superbugs"?

Ma ʻAmelika Hui Pū ʻIa wale nō, kokoke i 3 miliona mau kānaka e maʻi ana i nā maʻi bacteria kūʻē i ka antibiotic i kēlā me kēia makahiki, a ʻoi aku ma mua o 35,000 e make ana mai ia mau mea. Ke ulu nei hoʻi kēia hoʻoweliweli ma Sri Lanka.

He aha ka maʻi paʻakikī loa e ho'ōla?

ʻO nā bacteria i kū i ke kūpaʻa i nā lāʻau lapaʻau he nui ka mea paʻakikī loa e mālama. ʻO nā maʻi e like me MRSA a me CREs e kū pinepine i nā antibiotic he nui. No laila, ʻo ka loaʻa ʻana o kahi lāʻau lapaʻau kūpono (a i ʻole ka hui pū ʻana o nā lāʻau lapaʻau e hana pū ana) hiki ke paʻakikī a hoʻopau manawa.

ʻOiai ʻaʻole i hana nā kānaka i nā lāʻau antibiotic, aia nō nā "superbugs" - pēlā lākou e noho ai ma ke ʻano. Eia nō naʻe, ʻo ke ʻano o kā mākou hoʻohana ʻana i nā lāʻau antibiotic, ʻoiai ke lawe mākou iā lākou me ke kumu ʻole, ke wikiwiki nei i ko lākou ulu ʻana.

ʻO ka mea hope loa, nā mea e hoʻomanaʻo ai (Leka Lawe-Home)

ʻO ka "superbug" kahi ʻano germ e hiki ke hoʻoulu i nā maʻi koʻikoʻi, paʻakikī ke mālama, a hiki ke hoʻoweliweli i ke ola. Inā loaʻa iā ʻoe nā hōʻailona o kahi maʻi bacteria a fungal paha, ʻoiai inā ua hele koke ʻoe i kahi haukapila a i ʻole kahi mālama ola, e ʻike koke i ke kauka. Hiki i ka mālama koke ke hōʻemi i kou pilikia o ka maʻi nui.

ʻO ka mea nui loa:

• E lawe wale i nā antibiotics inā i kuhikuhi ʻia e ke kauka.
• Inā ʻoe e lawe ana i nā lāʻau antibiotic, e lawe i ka nui i kuhikuhi ʻia no ka lōʻihi i kuhikuhi ʻia. Mai hoʻōki i ka hapalua.
• Mai noi aku i nā lāʻau antibiotic no nā maʻi viral e like me ke anu maʻamau, ʻaʻole lākou e kōkua.
• E mālama mau i ke olakino maikaʻi, ʻoiai ka holoi lima.

ʻO ka hahai ʻana i kēia mau ʻanuʻu maʻalahi e kōkua nui i ka pale ʻana iā kākou a pau mai kēia ʻenemi leo ʻole i kapa ʻia ʻo "superbug." He mea nui ka hana ʻana i kēia mau ʻanuʻu no ka pale ʻana i kou olakino a me ke olakino o ke kaiāulu.

ʻO ka superbug, ke kū'ē'ē antibiotic, kū'ē i nā lāʻau he nui, nā maʻi, nā antibiotics, bacteria, fungi