what's in the water?

Sorry its been a long break between posts. I have had so many observations in public health this month that I can't wait to share.

My adventures in Panama and Nicaragua were quite enjoyable. I was able to travel a great deal, and to spend time at Michele's site in the mountains of Jinotega. I learned how to milk a cow, make cheese, produce coffee from tree to cup, and to surf. Michele and I went surfing on one of our last days and we were both able to stand up on our boards a couple of times, which we were quite proud of. I have so many fun and wonderful experiences to share. The interaction with the children was one of my favorite parts...but that is for another blog post.

As for now, I'm quite reflective on why my energy and interest has been consumed with learning about safe water management. Up until this trip, I understood the importance of water from a spoiled American's perspective, with most of my passion based on what I have learned in text books and class. I've traveled a bit, I know not to use the tap water and what the consequences are when you forget and rinse your toothbrush in the tap water. Or so I'd thought.

The last few days of my trip, I started having spells of stomach sickness (to put it nicely), and figured it would go away on its own. Now, 3 weeks later, I believe I may have a visitor who has made a cozy home in my intestines. Naturally, as a public health student specializing in safe water and sanitation, it irks me to think that I was not careful enough with my water consumption. How could a parasite or any form of contamination enter my body?

Then, I reflected on what I ate, drank and was exposed to, and I realized how extremely difficult it is to avoid exposure to protozoa and other pathogens when the water of a community is not safe. The only things I can come up with were coffee in a local's home (which I assumed was boiled) and juice at a restaurant (who uses bottled water, but perhaps the ice cubes were from the tap???) Imagine what it must be like for those who live with such conditions. I'm sure their bodies adapt and for many, immunity builds and they are not always this sick. I know you can build tolerance to certain bacteria, which is why that's what I thought this was (as Michele did not get sick and has been there 8 months now). But I tested negative for a bacterial infection, and was given antibiotics just to be safe...which do not seem to be working.

I'm not certain of the immunity one can build for parasites. Perhaps its more of an adaptation to the lifestyle of constant exposure, where you always have symptoms. There is only so much any digestive system can tolerate before its too much and unfortunately, survival of the fittest often dictates the outcome. Most of the time, children are the ones in a community who suffer the most, with severe illness and death. I now understand why so many children -- between 1.5 & 2 million a year -- die from diarrhea related illness. When someone spoiled, like myself, who is educated on the consequences of dehydration, and who has access to a flush toilet and adequate safe water and sanitation...and warm showers for that matter...has difficulty staying well with this, one can only imagine how a child in an underdeveloped context, with parents who are not educated on the consequences of dehydration, can so easily die.

The bittersweet part about this experience for me is that even though I am miserable, and shamefully have been throwing myself a pity party, I now have first hand experience on why it is soooo incredibly important to teach people about safe water, and to bring it to as many as possible. A great life truth really, that I had to get ill myself in order to really see what I'm investing in this education for. And for now, I have self diagnosed with having Giardia, which is a parasite with quite a few unpleasant symptoms, all of which I have. Nothing has shown up in my lab results yet though, and I've been told by several (including doctors) that Giardia seems to be one of the most difficult to diagnose, as it easily sneaks by undetected in labs. Many are warning me of the long road ahead on the path to feeling better...which I am refusing to believe. Perhaps they'll find something and treat it. Perhaps there really is nothing there, and I'm just a hypochondriac who is self diagnosing.

Or perhaps I'll get tough and tolerant in the meantime.

Consider it: being grateful for clean, safe water that is easily accessible.

Unlearn it: that nice solid, healthy looking poop is what everyone in the world must see everyday, because you do. Or for that matter, that some people ever see it or get that satisfaction.

Another semester done...

Thank goodness!! Finally free to pack and clean and get ready for my adventures with Mike in Panama and Nicaragua!!! So, so very excited. :)

Check out my final paper, on child marriage and pregnancy. I think it turned out pretty good...could've been better with less procrastination, but overall I'm happy its done, and I'm homework free for the next month!

If you read it, drop me a comment and tell me your thoughts. I welcome comments and criticisms! I'm always trying to get more insight into my writing. :)


Happy Holidays and stay warm!!

Density Equalizing Cartograms

I'm a big fan of maps -- I find that they can be a great tool for illustrating a point, and for better understanding a concept. Gapminder is one of my favorite websites for this. In class the other day, one of my professors was using a different kind of map, which I found to be quite useful for his points.

Density Equalizing Cartograms are maps where sizes of countries are illustrated according to whichever variable you are assessing...so, land area obviously shows a regular map:

Nothing you haven't seen before, I know. But check out these other ones.
Total population:

Total wealth distribution in 2002:

Distribution of girls in the world not enrolled in primary school:

Those with lack of basic sanitation:

HIV prevalence:

Malaria Deaths:

Diarrhea Deaths:

Lack of Nutrition related deaths:

Water Use:

Military Spending in 2002:

Public Health Spending:

Check out more at: www.worldmapper.org

Immigrant Health

I have been volunteering this semester at a health clinic in South Philly that primarily serves Mexican immigrants. It is a great program, and seems to provide great services to a community who otherwise would probably not have access to health care, which translates to them waiting until they have serious medical problems landing them in the ER. This program encourages prevention health care and easy access to doctors, so that ER visits are minimized and the population stays healthier.

Almost all the workers in the clinic are volunteers, myself included. With a few attending doctors, and then medical students and a mix of others such as myself. I decided for 2010 that I want to commit myself more to this program, as I really believe in their mission, and it will also give me a great opportunity to develop my skills in public health outreach and hopefully Spanish!!

So, I applied and was accepted as one of the Programming Coordinators. Which basically means that I will be on a team who develops and organizes health education and outreach programs for the community. I think this will be a fantastic experience for me, and I hope to develop relationships with the other volunteers as well as members of the Mexican community.

My ideas right now include workshops such as:
Agriculture / migrant workers healthy habits
Stress management, including learning about blood pressure, anxiety, depression, etc.
Women's health
Parenting healthy children

we shall see what can be developed. I'm very excited for new challenges and experiences in 2010!

Learning it: Spanish!!

Unlearning it: Over committing myself -- I think this program is a great fit for me, because I will be working with other people to develop programs, I won't be on my own. I think I'm establishing a good balance: work, school, yoga/exercise & volunteering (with some socializing in the mix!)

how to avoid yellow fever.

and no, I'm not referring to a pursuit of Asian women. Ironically, the real virus does not actually occur in Asia...hmmm.


Anyways, so, I am traveling to Panama and Nicaragua in a month (SOO excited!!) and I called travel medicine (after my primary doc turned me down), to see what, if any vaccinations I was required to get before traveling.

I was told a whole laundry list of suggested vaccinations, and one requirement of yellow fever. Apparently I won't be allowed past customs if I do not show proof of this vaccination. When I asked the cost, I was told that they do not accept insurance, and its $75 for the visit and $150 for the vaccine. So I've called around to CVS, other travel medicine offices in Philly, and the cheapest I can find is $180 total.

So then, I was driving to work the other day and heard a story on NPR about a campaign being launched in West Africa for the yellow fever vaccine to be given to 12 million people. So, today in class, I asked, how much will these people (or whoever is assuming the burden of cost for this campaign) paying per vaccination?

I was not given any direct answers. Just that its all relative, to the supply and demand, to the amount being produced at once, to the area of the world its going. Which I understand. But a final guess put the estimates between $3 - $5 for a drug company to produce one vaccination. And, I am all for West Africans getting vaccinated.

But how is it that drug companies in my own country charge me so much more? I suppose I shouldn't gripe, because I'm much wealthier as an American than most African's will ever be. But, I'm seriously going to try to butter up one of the drug reps that comes in to chat up our docs everyday, and see what I can do to get my hands on one of these $3 vaccinations.

Another example of how capitalism is just not all its cracked up to be.

Considering it: Being grateful for the luxury of living in a country where yellow fever isn't a risk.

Unlearning it: Entitlement to cheap vaccinations.

a sunshiney day of library time.

Today I spend my day in the library. Writing my term paper on the link between women's health disparities and early marriage and pregnancy in underdeveloped areas of the world. And prepping for a statistics project.

Normally this would be exciting...I LOVE the library. I love the smell of old books, the quiet, setting up shop for 8 hours researching and writing and being my usually nerdy self. I must say, its been a while since I set up camp for such a day, mainly because that length of concentration is not my strong suit anymore. But today may be especially challenging...its mid November and 71 degrees outside right now. And I want to go play!! But, its also 3 weeks from due dates on all of my term projects, so..play time must wait.

I guess this comes with the territory of mastering an area of expertise.

wish me luck!

APHA conference reflection

My day yesterday was filled with lectures, debating and a great movie.

I went to the APHA (American Public Health Association) conference, whose theme this year was WATER. How convenient for me, as this is one of my favorite topics, and hopefully an option for my masters research and thesis.

I was able to attend presentations on everything from hand washing programs in Africa, bottled water in the US and sanitation and safe water access in El Salvador. It was inspiring, frustrating and informative. Most global health lectures mentioned how great the Peace Corps is and how everyone interested in working in global health should consider joining.

Most also talked about how desperate the need is for safe water and proper sanitation in developing nations, and the programs that have made a difference so far.

A few points that stuck out to me, some of which are opinions of the presenters:

- Chlorine water treatment (point of use and for storage) is the cheapest immediate solution for providing safe water. But how sustainable is it? It appears better for the long run to invest in potable water systems.

- Bottled water is not regulated nearly as much as tap water, and has been found to have levels of contaminants above what is regulated for tap water. It is also bad for the environment, as plastic water bottles cannot be recycled back into another plastic water bottle, they are used for fillers, chairs, etc. Bottled water though in vogue right now, is not sustainable nor is it as safe as drinking tap water.

- In regards to global health outreach: don't go into a community where you are not invited. The people you are helping should always be willing and enthusiastic about working alongside of you, not expecting a mere handout. Otherwise, the solutions will not sustain when you leave.

- Charity, or handouts, though good for the short term, is not sustainable long term. Justice, or teaching and developing programs where people have the opportunity to develop their community and meet their own needs, on the other hand, is a much more effective means of short term and long term volunteer work in a community.

Finally, at my last lecture, a women in the audience made a comment basically stating that young people these days were going into health care for the money (she used the exact # of $45 an hour), not for the good will or desire to help people. I found this a bit of an insult, especially since I work and go to school with so many young people who are passionate and excited about what they are doing, and not at all making that kind of money (myself included). If they were in it just for the money, why not just go to business school and work in corporate America? So, I spoke up, and said that I was a health care work and I was getting my MPH, and my reasons were not for the money. I also noted that I was not making $45 an hour, nor did any of the young people I knew in the field. Needless to say, I was respectful to her, but still noted my concern for her unfair blanket statement. A few people clapped, and I was thanked for my comments by one girl my age after the lecture.

The movie was on a water organization in Malawi that is founded and run by a native. They are doing a great job in the country, drilling bore hole wells and bringing safe water access to hundreds of communities. I was very impressed with the founder, who was able to be there to present the film, all the way from Malawi.

Consider it: donating your time or money to an organization who takes a justice approach to their work, training locals to sustain their community.

Unlearn it: buying bottled water