Saturday, October 18, 2014
Friday, October 17, 2014
It is a superior virus that has evolved and fine-tuned its mechanism of transmission to be near-perfect. That's why we're all so terrified. We know we can't destroy it. All we can do is try to divert it, outrun it.
I've worked in health care for a few years now. One of the first things I took advantage of was training to become FEMA-certified for hazmat ops in a hospital setting. My rationale for this was that, in my home state of Maine, natural disasters are almost a given. We're also, though you may not know it, a state that has many major ports that receive hazardous liquids from ships and transport them inland. In the back of my mind, of course, I was aware that any hospital in the world could potentially find itself at the epicenter of a scene from The Hot Zone. That was several years ago. Today I'm thinking, by God, I might actually have to use this training. Mostly, though, I'm aware of just that -- that I did receive training. Lots of it. Because you can't just expect any nurse or any doctor or any health care worker or layperson to understand the deconning procedures by way of some kind of pamphlet or 10-minute training video. Not only is it mentally rigorous, but it's physically exhausting.
Getting the suit on is easy enough, but it requires team work. Your gloves, all layers of them, are taped to your suit. This provides an extra layer of protection and also limits your movement. There is a very specific way to tape all the way around so that there are no gaps or "tenting" of the tape. If you don't do this properly, there ends up being more than enough open pockets for contamination to seep in.
If you're wearing a respirator, it needs to be tested prior to donning to make sure it is in good condition and that the filter has been changed recently, so that it will do its job. Ebola is not airborne. It is not like influenza, which spreads on particles that you sneeze or cough. However, Ebola lives in vomit, diarrhea and saliva -- and these avenues for infection can travel. Projectile vomiting is called so for a reason. Particles that are in vomit may aerosolize at the moment the patient vomits. This is why if the nurses in Dallas were in the room when the first patient, Thomas Duncan, was actively vomiting, it would be fairly easy for them to become infected. Especially if they were not utilizing their PPE correctly.
The other consideration is this: The "doffing" procedure, that is, the removal of PPE, is the most crucial part. It is also the point at which the majority of mistakes are made, and my guess is that this is what happened in Dallas.
The PPE, if worn correctly, does an excellent job of protecting you while you are wearing it. But eventually you'll need to take it off. Before you begin, you need to decon the outside of the PPE. That's the first thing. This is often done in the field with hoses or mobile showers/tents. Once this crucial step has occurred, the removal of PPE needs to be done in pairs. You cannot safely remove it by yourself. One reason you are wearing several sets of gloves is so that you have sterile gloves beneath your exterior gloves that will help you to get out of your suit. The procedure for this is taught in FEMA courses, and you run drills with a buddy over and over again until you get it right. You remove the tape and discard it. You throw it away from you. You step out of your boots -- careful not to let your body touch the sides. Your partner helps you to slither out of the suit, again, not touching the outside of it. This is difficult, and it cannot be rushed. The respirators need to be deconned, batteries changed, filters changed. The hoods, once deconnned, need to be stored properly. If the suits are disposable, they need to be disposed of properly. If not, they need to be thoroughly deconned and stored safely. And they always need to be checked for rips, tears, holes, punctures or any other even tiny, practically invisible openings that could make the suit vulnerable.
Can anyone tell me if this happened in Dallas?
We run at least an annual drill at my hospital each year. We are a small hospital and thus are a small emergency response team. But because we make a point to review our protocols, train our staff (actually practice donning/doffing gear), I realized this week that this puts us ahead at some much larger and more notable hospitals in the United States. Every hospital should be running these types of emergency response drills yearly, at least. To hear that the nurses in Dallas reported that there were no protocols at their hospital broke my heart. Their health care system failed them. In the United States we always talk about how the health care system is failing patients, but the truth is, it has failed its employees too. Not just doctors and nurses, but allied health professionals as well. The presence of Ebola on American soil has drawn out the true vulnerabilities in the health care system, and they are not fiscally based. We spend trillions of dollars on health care in this country -- yet the allocation of those funds are grossly disproportionate to how other countries spend their health care expenditures. We aren't focused on population health. Now, with Ebola threatening our population, the truth is out.
The truth is, in terms of virology, Ebola should not be a threat to American citizens. We have clean water. We have information. We have the means to educate ourselves, practice proper hand-washing procedures, protect ourselves with hazmat suits. The CDC Disease Detectives were dispatched to Dallas almost immediately to work on the front lines to identify those who might be at risk, who could have been exposed. We have the technology, and we certainly have the money to keep Ebola at bay. What we don't have is communication. What we don't have is a health care system that values preventative care. What we don't have is an equal playing field between nurses and physicians and allied health professionals and patients. What we don't have is a culture of health where we work symbiotically with one another and with the technology that was created specifically to bridge communication gaps, but has in so many ways failed. What we don't have is the social culture of transparency, what we don't have is a stopgap against mounting hysteria and hypochondria, what we don't have is nation of health literate individuals. We don't even have health-literate professionals. Most doctors are specialists and are well versed only in their field. Ask your orthopedist a general question about your health -- see if they can comfortably answer it.
Health care operates in silos -- we can't properly isolate our patients, but we sure as hell can isolate ourselves as health care workers.
As we slide now into flu season, into a time of year when we are normally braced for winter diseases, colds, flus, sick days and cancelled plans, the American people has also now been truly exposed to another disease entirely: the excruciating truth about our health care system's dysfunction -- and the prognosis doesn't look good.
Note: In response to some comments, I would like to clarify that I am FEMA-trained in level 3 hazmat in a hospital setting. I am a student, health guide and writer, but I am not a nurse.
Thursday, October 16, 2014
Fluorescent tubes serve as an energy-efficient alternative to incandescent light bulbs, but they contain low levels of toxic mercury which can be released into the air or water if the tubes are broken. That can lead to short-term health risk for exposed individuals and lasting environmental damage to soil and water. To minimize that risk, government agencies have established easy to follow guidelines for the safe recycling or disposal of fluorescent bulbs and tubes.
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- 1 Contact your municipal or county government center for information about fluorescent tube recycling programs in your area. Recycling pickup of toxic materials may occur only a few times a year in your community, so you may need to store your used fluorescent tubes temporarily.
- 2 Store used fluorescent tubes in a closed container, such as the tubes' original cardboard packaging or a large plastic trash bag. Many local recycling or environmental regulatory agencies recommend sealing the storage container or bag prior to pickup.
- 3 Place the sealed container of old fluorescent tubes in your trash receptacle for regular pickup if no other options exist. Do this only if your local waste agency does not incinerate its garbage.
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Have you ever tracked how much waste you create during a week, or even a month? Every time I clean my house or walk down a neighborhood street I marvel at the sheer amount of waste we create. But where does it all go? And what happens when large companies, ones that use tons of toxic chemicals, are not forced to dispose of waste in safe, healthy ways? In Campania, Italy, the toxic waste situation has become so dire that children and adults alike are developing rare cancers. Photographer Greg Kahn set out to document this issue in a country that is simultaneously beautiful and torn apart by organized crime and governmental failure. I corresponded with Kahn over email and asked him about his project which he calls “The Sleep of Reason,” after a famous Goya etching called “The Sleep of Reason Produces Monsters.”
JANNA DOTSCHKAL: How did you first find out about the waste dumping problem in Italy?
GREG KAHN: I first heard about toxic waste dumping in southern Italy from a good friend who is working in Naples. As we talked about environmental issues, he relayed what he had seen and heard about toxic waste dumping north of where he lived and I began researching. I read as much as I could about the issue, and then contacted a gentleman named Antonio Giordano, who heads a cancer research center in southern Italy, and teaches at Temple University in Philadelphia, PA. He relayed first-hand accounts of witnessing dozens of children in hospitals with rare brain cancers—the kind that only 1 in 100,000 get. But seven children in a town of 40,000 developed the same rare cancer. This town is located in an area next to a large, illegal toxic waste dump that was recently unearthed.
JANNA: What compelled you to work on this story?
GREG: Before embarking on this project, I imagined Italy as fairly idyllic—rolling hills, sun-covered vineyards, and fertile farmland. This story seemed to fall through the cracks of international public attention. It was covered initially in foreign media when Carmine Schiavone, a member of a Mafia family in the Campania region, went to authorities and told them about “millions of tons” of toxic waste buried deep in the earth in what once was some of the most fertile farmland in Italy. I wanted to see how this legacy of poisoning the ground was impacting the communities. There is a psychological torment every time families cook dinner, take a shower, or venture outside and breathe. Even the air is contaminated. Instead of focusing on the Mafia, I wanted to focus on the culture, and examine how a once beautiful part of the world had become something of a modern wasteland.
JANNA: Why focus on Italy? Isn’t toxic waste dumping an issue in other countries?
GREG: What’s been shocking to me is this problem isn’t necessarily worse than in other parts of the world, but it’s as bad as developing nations that don’t have the same resources as Italy. In the Campania region, piles of garbage line the highways, farmland, and playgrounds. Heaps of waste and industrial by-products sit under overpasses, and are torched in large fires that billow poisonous black smoke. It’s not uncommon to see mounds of asbestos lying along the highway and appliances—stripped of their copper and recyclables—scattered about the countryside. Suddenly, this wasn’t just a story of the Mafia inflicting catastrophic damage to a region, but a systemic cultural issue of waste disposal. Piles of waste from a variety of sources, including residents and local businesses, are all covered with thin layers of soil. They look like tumors on the land.
JANNA: Is the waste issue widespread, or is it concentrated in pockets? What do the areas surrounding Campania look like?
GREG: There are two separate views of the issue. One is cosmetic. It’s the piles of trash visible from the road, or the columns of black smoke that can be seen for miles, drifting over communities every day during the warm months. But the more serious consequences come from what isn’t experienced by sight or smell. The Mafia concealed their crimes, burying the waste so far below the ground that it’s mixing with the water table. And because the Mafia didn’t keep any records of illegally burying the industrial waste, the hospital waste, and everything in between, the whole area is affected. No one knows which crops have been growing on top of dump sites, or which ones have been irrigated with contaminated water. Families I talked to had their own theories about what was causing their illnesses. Some blamed the food, while others pointed at the water or air. No one had any answers, and it adds to the public’s frustration not only with the Mafia, but with the government as well.
JANNA: What do you hopes do you have for this project, moving forward?
GREG: In the short term, I want this project to lead to action in the region. There is plenty that can be done to reverse the current situation. And although there is no magic potion to cleanse the land, healing can start by ending the continuous dumping of toxic materials. But even the cleanup is jeopardized. Some Italian officials worry that the Mafia now own all the companies tasked with cleaning dump sites, generating profit for the Mafia by fixing a problem they caused. And no one would be surprised if the waste was then simply moved to another location instead of being disposed of properly.
In the long term, I hope this project is used to talk about the problems concerning waste disposal worldwide. As the world’s population and the demand for raw materials increases to support the growing public, it is crucial to find a set of responsible solutions for waste disposal. Southern Italy’s situation isn’t only Italy’s problem, because flowing water or drifting air currents don’t respect political boundaries.
JANNA: Is there a good solution to the toxic waste problem?
GREG: There is no easy or quick solution to the problems facing the Campania region in Italy. Waste education and cultural practices need to be changed. A major obstacle I see is a lack of organization to combat the issues. Some farmers voluntarily take soil samples to clear their crops from being labeled poisonous. Others don’t, for fear of jeopardizing their livelihood. Some residents pay $400 to send hair samples to testing labs in the United States to check for heavy metal accumulation in their bodies. But not everyone can afford testing. And while the initial efforts are scattered and disorganized, there is a groundswell of reaction to the growing health and environmental crisis. “It’s here now, but it can be anywhere,” Luisa Crisci, a mother that lost her child to a rare brain cancer, said. “The problem is 30 years old, the difference is that we’re aware of it now.”
JANNA: What is remarkable about people’s response to this situation?
GREG: What struck me the most was that there were still many people all over Campania who were not resigned to their circumstances, but instead, kept pushing back against Mafia control. The Mafia are the ones with overwhelming power and money, inflicting consequences of their greed on others. But every year on March 20, thousands gather at the entrance to Casal di Principe, a stronghold of the Camorra, and march through the narrow streets with signs, chanting that they will not be intimidated. It’s a demonstration to commemorate Giuseppe Diana, a local priest that was murdered for telling his parishioners to shun the Mafia. Every year, the protest ends with a rally at Father Diana’s grave giving a sense of purpose to the community that things can be changed.
Greg Kahn is a founding member of Grain, a photography collective. View more of Grain’s work and ongoing projects on their website. You can also find him on Twitter and Instagram.
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