Archive for the 'Public Health' Category

Walk Carefully

Sunday, March 26th, 2017

Walk Carefully

            This month’s column has almost nothing to do with human population. It details an event that was life-changing for me, and could have been life-ending. However, getting bumped off by a careless driver is no way to solve overpopulation! I write to help others be safer.

Back in November my wife and I were crossing Main Avenue in the crosswalk on the way to one of Durango’s restaurants. We weren’t sure if it was north or south of 7th Street, and I remember looking to the left to see if the eatery was in that direction.

The next thing I knew was waking up in the CT scanner at Mercy. I had been hit by a car whose driver “didn’t see me”. Fortunately he stopped; unfortunately he parked with my foot under a tire.

Happily the results of the CT scan and other tests showed nothing terrible was done. I had a broken bone in my right ankle in addition to multiple bruises and “road rash”. The concussion saved me from remembering the accident, and its aftereffects are gradually resolving. There was a large bruise on my left leg where the car had probably first hit me. The hematoma became infected and had to be drained.

The hematoma and dead skin that covered it seeded another infection. I went back to the operating room to have that removed, leaving an open wound. Now, almost 4 months after the accident, I am still recovering but am almost healed.

I am very fortunate: my injuries could have been so much worse. Searching the Herald archives since my accident I found 4 more pedestrians who had been hit by vehicles in Durango and one in Hermosa, so mine was not an isolated misfortune. It would seem that it isn’t safe to be a pedestrian in Durango!

There are several lessons when looking at my accident from a public health standpoint. Everyone knows that drugs and alcohol are among the most common causes of motor vehicle accidents. Texting and talking on a cell phone are frequent causes of accidents. Apparently none of these possible factors was pertinent to my accident.

One possible contributing factor is that I was wearing a blue jacket and dark jeans. These are less visible than lighter colors. Although the “dark skies” initiative is admirable, I think that the lights in downtown Durango are dimmer than they should be.

The care I received has been excellent. A woman who was working at a store close by came and kept my neck from moving and made sure I was responsive. My wife and others told the driver that he was parked on my foot and got him to move the vehicle. The police and ambulance arrived quickly. They started two IVs and drove me to Mercy with all the proper precautions. An emergency physician evaluated me and ordered appropriate tests. Then they applied a splint to the broken ankle.

There was a surprise in the ER—a bouquet of flowers brought by unknown well-wishers. It turned out that they had just started one of new restaurants where Francisco’s had been. We ate dinner there a month or so after the accident; their chile rellenos are excellent!

I have several suggestions to try to prevent pedestrians from being hurt in the future. Individuals can avoid trauma by being more paranoid when crossing streets—even in the crosswalk. Wear light-colored clothes at night; even better, wear clothes that have reflective markings.

The City of Durango already is concerned about lighting. From Christina Rinderle’s column “From the Mayor” in the January 29th Herald: “Other items were placed in the high impact/low effort quadrant that we hope to be “quick wins”, like enhancing downtown lighting to make it safer and more inviting….”

A traffic light at the corner of 7th and Main would help. My wife, Gail, has a suggestion for a less expensive solution. Mount spotlights aimed at the crosswalks on poles at the corners of Main that do not have traffic lights. When a pedestrian wants to cross, s/he would push a button to turn on the spotlight for long enough to safely cross the street.

I feel very fortunate that my injuries were no worse, but even with relatively minor trauma it is taking me 3 surgeries and over 4 months to recover. Please be careful!

© Richard Grossman MD, 2017

Shape the World You Want by Voting

Monday, October 24th, 2016

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            In November we will have the opportunity to vote, and thus help shape our world—both nationally and locally. Please vote, even if you don’t follow my suggestions!

Most politicians have personality traits that set them aside from the normal populace. Usually those traits are an asset. Unfortunately this is not true with one of the current presidential candidates who has a personality disorder: narcissism. This psychiatric illness is concerning for someone who must make decisions that will affect our country and the whole world. A person with narcissism thinks of himself, not of his constituency. This narcissistic personality disorder has allowed Trump to lie with impunity; he probably believes his own untruths! I fear what might happen if he were president and had to make a decision about launching a nuclear attack. Trump is a disgrace to our country.

Several amendments to the Colorado constitution are on the ballot. One would create a new healthcare system for citizens of our state. Currently we don’t have a healthcare system in our country; we have a tangle of fiefdoms run by overpaid administrators. Insurance companies and other financial parasites suck half of healthcare dollars away from actual care. We need a single payer system such as the other 9 of the richest countries have. Unfortunately, I don’t think that ColoradoCare will do what is needed. I will vote against proposed amendment 69.

My main concern about 69 is women’s issues. The ColoradoCare’s board of trustees might end up with a majority adverse to contraception. It couldn’t happen, you say? Surely the board would realize that reproductive health is a human right and saves up to $7 for every dollar spent? Unfortunately our elected officials don’t always make rational decisions. Remember what happened in the Colorado legislature to the bill that would have paid for effective IUDs? Sponsored by Republican Representative Coram, that bill was killed in our state senate.

There are economic reasons to support Amendment 70, which will raise the minimum wage in Colorado from $8.31 to $12.00 per hour over the next 4 years. Boosting the economy is one. For me, however, it is just ethical to pay employees close to a living wage—about $13.00 for a single person in La Plata County. I will vote for 70.

Using tobacco is incompatible with good health; therefore it is beneficial to decrease its use. Taxing tobacco is a good idea, and increasing the current tax with Amendment 72 is a great plan. The tax is a disincentive, and the money will further healthcare and medical research.

I am of the age when terminal illnesses become common—although I’ve been lucky so far. We have come a long way with hospice and palliative care, but there are people with terminal illnesses whose lives are miserable and would like to take “life-ending, doctor-prescribed sleeping medication”. I have cared for some people whose last days were wretched and who wanted an end to their misery. I support Proposition 106, the “Medical Aid in Dying” initiative.

In La Plata County we have the opportunity with Ballot Issue 1B to fund a new terminal and other improvements to our airport. As one who flies fairly often, I am aware of the problems with our current facilities. However, I see reasons to vote against the expansion. I suspect air service is in its heyday. As the price of fuel rises and constraints on emissions come into play, it seems likely that people will fly less rather than more. Furthermore, the airport expansion would propel county expansion, but is that what we want? Isn’t our population big enough as it is? Let’s not vote for this big tax increase.

There are three Ballot Issues I do support even though they will mean an increase in taxes. 1A will be used to maintain our roads and bridges. Roads are used by everyone and are essential for our economy. I believe that having our roads in good condition is more important than a new airport terminal, and at much less cost. Furthermore, well-maintained roads improve the safety of all who travel in our county, so I consider this an issue of public health. Two Ballot Issues are for money to improve our schools, 3A for Durango and 3B for Bayfield. Educating our children well is vital for our future; please vote for this support.

            I don’t like politics, but chose this subject because this election is so important that we all need to participate in the democratic process.

                                           © Richard Grossman MD, 2016

Move Upstream

Wednesday, September 28th, 2016

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“Many children in this area have families that are unable to care for them. Fortunately, there are orphanages here in town that are able to care for small babies until their families are able to care for them again. The situation here is desperate, and many of the babies brought to the orphanages are severely malnourished.”                                                                        Phil and Laura Olaniyi

            Laura and Phil formerly lived in Durango but moved to Mozambique where they are starting an orphanage, “Heart for the Needy”. Let’s look at some of the statistics for this East African country.

Mozambique is one of the fastest growing countries in the world; women there have an average of almost 6 children. The country’s infant mortality is tragic, with 83 of every thousand children dying before they reach one year of age. This is one reason for the high fertility, since couples usually don’t choose to have small families until they know their children will live to adulthood. The maternal mortality rate is also very high. The average per capita income is only $3 a day.

These statistics don’t begin to tell the anguish of a mother who cannot care for her child, or the grief of a family who cannot care for a baby whose mother died in childbirth. Fortunately there are compassionate people such as Laura and Phil to care for these abandoned children. Even though they are far away I feel close to them in a way since I have worked with both of them—and I helped when Laura was born.

I agree with a statement Laura made on her blog: “Let’s be honest for a second, though. An orphanage is only putting a Band-Aid on the real problem – poverty & oppression.”

I admire Laura for being so perceptive, but I want to add another cause of “the real problem”—undesired fertility. In Mozambique only a quarter of girls are enrolled in secondary school, and only 11% of married women use modern contraception. The fertility of non-educated women is twice that of women with secondary school education, 6.8 and 3.4, respectively. This is an example of the wonderful power of educating women!

In the developing world young women often have very little power or control over their lives. Older men approach them with offers of money or coveted goods in exchange for sex. Rape is also common. The story of such an unfortunate young woman is told in the short YouTube video “Not Yet Rain”, filmed in Ethiopia.

“An ounce of prevention is worth a pound of cure.” Karen Shragg has used a similar expression in the title of her book: “Move Upstream: A Call to Solve Overpopulation”. In it Karen points out that so many of the problems we face, including climate change, ocean fisheries depletion, and extinction of species, are caused by increasing human overpopulation. Similarly, the need for orphanages is (in part) a symptom of unwanted fertility.

I have two friends who live in Bayfield who spent part of their childhoods in orphanages. Both are productive citizens who might not have survived if there had not been institutions to care for them as small children. In addition, relatives adopted a boy from the Democratic Republic of Congo when he was 3 years old. Mason’s birth parents died when he was small, so his grandmother took over his care. Unfortunately, she was unable to meet his needs then he was well cared for in an orphanage. Mason has joined a loving family in Durango who are giving him opportunities that would be impossible in Congo.

Orphanages provide a wonderful opportunity to care for some of the world’s most vulnerable children. There are few orphanages left in the U.S.A., but in developing countries there are many, and there is much need. As Laura points out, however, orphanages are just a Band-Aid for the real problems—terrible poverty, low status of women and many unplanned pregnancies.

We should “move upstream” to get at the root of the problem rather than just using Band-Aids. Steps that will help include supporting international family planning organizations such as the Population Media Center, and help the Population Connection terminate the Helms amendment, which restricts government funded agencies from even talking about abortion.

Until we have solved the problem of unplanned pregnancies, the only humane action is to care for orphans the way Laura and Phil are. I am sending them a check to help them as they build Heart for the Needy. What a boon it will be for orphans in Mozambique!

© Richard Grossman MD, 2016

Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.