Archive for the 'Public Health' Category

Keep Children Healthy

Saturday, September 23rd, 2017

I am writing this column in Northern Ghana, where 1 in 16 children dies before 5 years of age. Although that number is high when compared to developed countries, there has been amazing progress since 1960 when one in 5 died.

The under-five mortality rate is a valuable statistic because it gives an overall idea about the state of health and healthcare in a country. It reflects the social, economic and environmental conditions in which children live. It is defined as the number of children who die before their 5th birthday per 1000 live births, and is also called the child mortality rate.

The UN set 8 Millennium Development Goals, one of which was to: “Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.” In Ghana during that period the rate went from 127 to 62 deaths per 1000 births. This halving reflects global progress; worldwide child mortality dropped from 90 to 45 in this period. Although we didn’t hit the goal, cutting the death rate in half is still an amazing accomplishment. Sadly, worldwide almost 6 million young children still die each year.

There is hope, however. Ghana recently trained several thousand Community Health Workers (CHWs). These “barefoot doctors” live close to the people they serve and treat illnesses as well as advocating prevention.

I traveled with a midwifery training-team to a village clinic. This part of the country has more than its share of maternal and infant deaths. Two midwives from the Baptist Medical Centre did an excellent job of teaching the clinic’s staff, which included 2 midwives and 3 midwifery students. Two rooms away another student midwife performed a delivery so quietly that I was amazed when a nurse brought out the healthy baby who was just minutes old.

While in the health center I saw a bottle of high-potency vitamin A capsules and was reminded of a remarkable study performed in this region. The overall death rate of children was lowered by 20% if they were given vitamin A supplementation. It appears the vitamin helps children fight infections such as measles and diarrhea, even where vitamin A deficiency is not prevalent.

If we are concerned about overpopulation, why should the death of children trouble us? Of course there are humanitarian reasons to keep children alive and healthy—they are our future! Demographers have found that people choose to have large families where there is a high child mortality rate.

It may appear paradoxical that preventing deaths will help eventually to slow population growth, but it is true. One of the best-known demographers of Africa, John Caldwell, cited three requirements before people will choose to have smaller families: educating girls and women, making effective contraception available and reducing the under-five mortality. He said that people only consider having a small family when child mortality is less than 130 per 1000. I could understand that number better when I converted it to a percentage—13%. That means that one in seven children dies—the thought is distressing!

In addition to training midwives, Ghana has instituted other ways to have healthier children. As I walk to the hospital I pass a nutrition center where small children are fed healthy, local food. Young kids with kwashiorkor (protein deficiency) and marasmus (severe malnutrition) are referred from the hospital, from outlying clinics and by CHWs. They spend 2 weeks or longer there being fed; many are still breast feeding. Every child is accompanied by a parent who is taught many ways to promote health, including nutrition and good hygiene.

Three days ago a young pregnant woman came to the hospital complaining of headache. Her blood pressure was elevated and the doctor noticed that she kept bumping into things, as though she couldn’t see well. Her mother gave the history that the patient had had an episode of shaking—a seizure. The doctor diagnosed eclampsia, the worst form of Pregnancy Induced Hypertension (PIH), with cortical blindness—a type of stroke. It was necessary to induce labor to save the mother’s life and hopefully her vision will improve. Unfortunately the very premature baby didn’t survive.

I am in Ghana studying PIH because it is more common here than in the USA. PIH can endanger the mother’s health and life, and has no treatment other than delivery of the baby. It is one of the most common causes of loss of life for babies and mothers, yet is poorly understood. Perhaps my study will shed light on this cause of obstetrical tragedies.

© Richard Grossman MD, 2017

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

constitution_we_the_people

            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

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