Archive for the 'Public Health' Category

River Spill was a Signal to End Business as Usual

Thursday, August 27th, 2015

3 kayakers on Animas

Our Animas River received a serious insult recently. Fortunately the river seems to be recovering, but we cannot predict what the long-term effects will be.

Contractors working for the United States Environmental Protection Agency recently released a huge amount of toxic water and tailings from the Gold King Mine. The water spilled into the Animas River, originally named “el rio de las animas perdidas” or the “river of lost souls”.

It wasn’t long before the finger pointing started. The EPA was blamed not only for the spill but also for the long delay in notifying our community. To the EPA’s credit, they are taking responsibility for the accident and for monitoring its environmental effects. There is also talk of compensating the businesses for their loss of revenue.

I am impressed that the EPA’s chief, Gina McCarthy, came to Durango to take command of the event. This is so different from the way the chief executive of BP reacted during the Deepwater Horizon disaster. While his well was polluting the Gulf of Mexico, Tony Hayward went to a sailboat race.

I know little about mining and mine remediation, but I have had plenty of home maintenance projects go awry. I can understand how the contractors working for the EPA could make the mistake that resulted in this tragedy. Fortunately the EPA is accepting responsibility, but I’ll bet that they will be careful in hiring those same contractors again!

The laws that govern hard-rock mining were written over 140 years ago, when the west was wilder and the number of people of European descent was small. Mining claims were inexpensive and easily available. The laws allowed mining with little concern for environmental protection or for remediation. This has lead to hundreds of mines such as Gold King where the value was extracted and the shaft abandoned. Water continues to flow through many of these mines, picking up silt and poisonous metals, as it has for decades. Before the deluge on August 5th up to 250 gallons of contaminated water poured out of the Gold King every minute—that’s 360,000 gallons every day! The flow has increased significantly since the dam was broken.

Folks have been concerned about pollution from the mines in Silverton for years, but insufficient remediation has been done. Being inundated by an estimated 3 million gallons of sickly orange water at one time has finally brought attention to the problem. Unfortunately, it includes international attention that puts southwest Colorado in a bad light.

This is an opportunity for those who believe that the government is too big and has too much power to be critical of the EPA. Many politicians have want to abolish it. We should be wary of their efforts to use this spill as an excuse. That doesn’t make much sense to me, however. If we didn’t have any laws that controlled mining, the Animas would run orange every day!

I think that this catastrophe (to use the word the Herald chose for its headline) will finally motivate cleanup of the Silverton mines. Even more important is to prevent future hard-rock mining problems by changing the ancient mining laws. Furthermore, this spill should motivate legislators to pass “good Samaritan” laws to protect people who work to clean up the mines from liability if things go wrong.

But maybe there is a broader lesson to be learned from the Gold King misfortune. Let me ask a couple of questions: what are we doing now that will result in Gold King-like problems in the future? Are companies charging enough to pay for cleanup that will be required in the future? I think you know what my answers will be.

Let’s look at electricity. Much of our power is generated using coal; indeed, we have two coal-fired power plants just across the border in New Mexico. Testing the mud at the bottom of Narraguinnep Reservoir north of Cortez showed low levels of mercury until about the 1970 stratum, when those plants started up. We are advised against eating fish that are caught there, a consequence of mercury from the power plants. A neurotoxin, mercury is especially bad for the most vulnerable—developing fetuses and the young. Yet the coal companies are trying to reduce the price they pay to the government for coal mined on federal land and they fight public safety regulations.

Climate change is much worse than the mercury problem since it affects all of life. Future generations may never recover from the damage we are causing with anthropogenic climate change.

            © Richard Grossman MD, 2015

Provide Family Planning in the Democratic Republic of the Congo

Sunday, February 22nd, 2015

DR Congo woman & child small 

The London Summit on Family Planning was the start of something big. If kept, an array of promises made at the groundbreaking July 11 [2012] event could have a major impact on the lives of women and girls for years to come.

                                               Susan A. Cohen, Guttmacher Institute

 

In a prior article I wrote about how it was possible for one doctor to perform hundreds of tubal ligations in one day—but probably not honor the rights of the patients. The next column was about putting human and reproductive rights first and foremost. Today’s column focuses on one country where FP2020 is making amazing improvements in the lives of women and children.

FP2020 is the nickname of the ambitious program started in 2012 at the London Summit on Family Planning. Its goal is to reach 120 million women of the 225 million who are unable to access modern contraception, but wish to regulate their fertility. These are women in developing countries who currently have little or no access to reproductive health care. Typically they have high fertility rates and high rates of child deaths, illegal abortion and maternal mortality. Often these women are the poorest of the poor, have little schooling and are subservient to men. Many of these women live grim lives.

A very high percentage of people in wealthy countries already use family planning (FP); indeed, that is part of how we became wealthy. It is time to share that knowledge and technology with our less fortunate brothers and sisters. Unfortunately where access to FP is limited, infrastructure is also challenging—transportation, sanitation and communication are often poor. Reaching these people will be difficult.

Providing full reproductive health care for every woman in the world who does not currently have access to those services would cost a whopping 40 billion dollars annually—about the same amount as the US military spends in a month. The lives saved by such an investment would make that money very well spent, however. Reaching all people in developing countries with FP and with maternal and newborn care would prevent 79,000 maternal deaths, 26 million abortions and 21 million unplanned births each year.

The cost of providing just FP services for these people would be about nine billion dollars a year. Because moms will be healthier, improved birth spacing alone would prevent over a million infant deaths globally each year!

Funding is a major challenge for FP2020. The programs are jointly supported by developing countries and by donor (wealthy) countries. In addition, generous funding has come from foundations; the Bill and Melinda Gates Foundation is a major source of financial support as well as being a prime mover. Assistance also comes from the UN and the US Agency for International Development, among many other organizations.

One of the FP2020 programs is in the Democratic Republic of the Congo. This beleaguered country has had a miserable history of colonialism, dictators and civil war. Average income there is less than two dollars per day. Only 53 % women are literate, and only one in twenty married women uses a modern method of contraception. Indeed, a 1933 law makes contraception illegal! The average woman bears over 6 children in her lifetime and the country will double in population every 23 years—exacerbating many of its economic and political problems.

Despite these challenges, FP2020 is seeing successes in DRCongo. One project was to map existing FP resources, using a sophisticated system of data collection with cell phones. They now know where there are trained FP personnel and which pharmacies have pills or injectable birth control. Fortunately, all sites offer condoms.

Women in DRCongo have been relying on traditional methods of FP for years, with too many unintended pregnancies—more than a million in 2013. Contraceptive implants (such as Nexplanon®) were introduced in 2014 with great success. So far, the program has recruited almost 200,000 new users of modern contraception.

What FP2020 has meant to women in DRCongo is telling. More than 300,000 unintended pregnancies were averted in 2013. Calculations suggest that 1481 women’s lives were saved, and 76,000 unsafe abortions were prevented by the use of modern contraception.

FP2020 offers hope for the future, especially for people in countries such as DRCongo. I am optimistic that FP2020 can help women and families lead healthier and happier lives and will be a model for the future of family planning. And I expect it and future programs will be built on respect for the people that they serve.

© Richard Grossman MD, 2015

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Thank you! Richard Grossman MD, MPH  richard@population-matters.org

Condemn “Assembly Line” Sterilizations

Saturday, January 3rd, 2015

News media focused in November on deaths in India after women had surgery at a sterilization “camp”. Authorities suspect that the surgeon caused more than a dozen deaths, so he is in prison.

More people are added to the population of India each year than to any other country. India has family planning programs, but abuses occur. This epidemic of deaths may have occurred because of disregard for established standards.

Indian gynecologist Pravin Mehta holds the world’s record for the number of tubal ligations that one doctor has done—over a quarter million. He told me how he could do 300 surgeries in one day; Henry Ford would have been amazed!

I didn’t realize how crude Mehta’s process was until I saw a movie of him working in a surgery camp. Operations were performed in a tent, and conditions were very primitive.

Nevertheless, Dr. Mehta’s safety record was remarkable. He offered a reward for anyone who reported a problem, including pregnancy, after his surgery, but gave out very few rewards. Indeed, I believe that his complication rate was lower than surgeons doing tubal ligations under modern conditions.

Were all these surgeries truly voluntary? During the era when Dr. Mehta worked—1970s and 1980s—India had aggressive sterilization programs for both men and women. Acceptors were given a small stipend if they agreed to the surgery. Recently the stipend for a person getting sterilized was equivalent to less than $10—a small sum by our standards but more than a villager might see in a month.

Reports of the recent sterilization tragedy frequently mention that women wanted to limit their family size, but that they were not given information about temporary methods of family planning. Even if women knew about temporary methods, they were not available.

Many problems were found after these Indian surgeries that killed many young mothers. The operating room was not clean, the staff were untrained, the medicine was contaminated. The same syringe and needle were used to inject local anesthesia for many women. Even worse were systemic problems: almost all of the funding was used for administration and too little paid for actual health care, there was little counseling or informed consent, no access to temporary contraceptive methods, and providers were pressured by numerical targets.

Two Americans are making a documentary about sterilization. Quartz published quotes from some of the Indian women they interviewed; here is the link: http://qz.com/299712/these-are-the-voices-you-did-not-hear-after-the-chhattisgarh-sterilization-tragedy/. One of the women, Archana, said:

“I was 19 when I got married and I have 3 kids. I don’t have much income, that’s why I got sterilized. When our income is limited what’s the use of having so many kids? ASHAs [Accredited Social Health Activists] came to visit me and told me about sterilization. When I got sterilized I went with my sister-in-law to the hospital and was given Rs600 in compensation. My husband and my mother-in-law were supportive. It took me about a month to recover fully. After a week I had to cook for my kids and take care of the house. I would have liked an entire month to recover, but we didn’t have anyone else to do the work. I chose this method because I had so many kids, and I didn’t know of other methods of contraception at that time. Now I’ve learned about more temporary methods. Copper T is not available here, you have to go to the cities, but you can get pills and condoms here.”

Please remember that conditions and standards in developing countries are different from what we know. Nevertheless, people must be respected and well informed about their health care.

Can family planning programs provide services to millions of people and yet assure that care is truly voluntary? Delegates at the International Conference on Population and Development 20 years ago felt that it is best if family planning were a part of comprehensive reproductive health programs. Since then our population has grown by 1,600 million people, with consequent increasing problems. Much of this growth is in developing countries, but remember that it is we in the rich countries who cause the worst impact because of our consumption!

Some of the family planning workers have real concern for the people they serve. After this tragedy one ASHA (health activist), Mitanin, is quoted as saying: “with what face we will tell people to go for sterilization?  Now, even if they come to us for it, we will hesitate.”

A new program, FP2020, is working to provide quality family planning services while respecting reproductive justice. More about FP2020 soon.

© Richard Grossman MD, 2014

Woman after sterilsation surgery in Bilaspur

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