Archive for June, 2011

From the front lines of public health

Rashida is a Peace Corps volunteer in Uganda teaching “teaching life skills/health/whatever at a local secondary school,” as well as a blogger. She also happens to be in the same Hopkins global health Masters program as me (but a year or two ahead, so we’ve never met). Her latest post starts with this:

Since the kids are often shy around the muzungu (and in front of their classmates), I thought it would better to set up an anonymous questions box, where students can ask questions about health, etc. without having to ask them in front of everyone. Well, no one else seemed as excited about this idea as I was, so I thought the box would just be forgotten about, or maybe even stolen by a trouble-making student. Imagine my surprise when I came back to the school two days after setting up the box to find it overstuffed with questions. I was a bit overwhelmed by the volume of questions posed to me, so I told the students to let me take them home and prepare my answers for next week. Well, here are some of the questions that I got:
  • If you have sex during your menstruation, do you get pregnant?
  • Is it true that if you kiss someone who has HIV, you’ll also get HIV?
  • There are some boys who disturb me during my leisure time, but if I see them I feel like vomiting. What can I do, please help me?
  • Is it true that if young people play sex before menstruation begins you can still get pregnant?
  • How can I know when playing sex that sperm is coming through the penis?
  • Is it true that if you delay having sex you become an abnormal person?
  • Is it bad to practice homosexuality?
  • People usually tell us to have sex when we are still young in order to become perfect in sex. What is the meaning of perfect in sex?

There are quite a few more in the rest of the post,  and they just get more disturbing. Personally I wouldn’t know where to start, and I greatly admire those who have the patience, courage, and tact to do this badly needed work. It must be especially difficult to do this sort of work as a foreigner.  Alas, I described this post — and the sample questions — to a friend who does sex ed in New York City and was told that the questions are remarkably similar to what you get asked here.

28

06 2011

Advice not to trust

Yesterday morning I came across the gentleman pictured below in New York’s Union Square. I’ve been meaning to take more pictures of “things you only see in NYC” — a category which generally consists of extremes of pets and fashion — but I think this deserves its own post:

He was either selling or trying to give away copies of a book titled Uropathy: The Most Powerful Holistic Therapy by one Martin Lara. Since the review of Uropathy on Amazon.com is from the Village Voice, I assume that the evangelist was either Lara or one of his disciples. The review:

Vitamin Pee! Urine is a natural remedy, so raise a glass! That’s what alternative therapist Martin Lara wants everyone to do. In his Uropathy: The Most Powerful Holistic Therapy, pee’s the ultimate cure-all. Gagging aside, it’s not so unconventional: former Indian prime minister Morarji Desai guzzled ounces each morning, observing an ancient Hindu practice. Lara learned about it 11 years ago, when the self-taught therapist he’s never studied traditional medicine became disenchanted with science’s inability to cure his ailments. Since then he’s lectured to thousands. Not any pee will do it must be your own, which Lara says is a nontoxic biofeedback stimulator that boosts immunity by activating the lymphatic system, thus restoring the body to an internally balanced state of health. Dosages range from a few drops of Lara’s “Ultimate Universal Remedy” an elixir of water, urine, and white rum to several ounces for serious conditions like cancer, dysentery, or Alzheimer’s. Of course, not everyone is ready for this leap of faith. On his Web site Lara argues against obsessing over taste and smell: “Urine is a sample of what is flowing through your veins and repulsive urine should be a motivation to improve the internal conditions, rather than an excuse for not using Uropathy.” — The Village Voice

He was quite earnest. I didn’t engage him in conversation because two other passersby were already talking to him. A girl was explaining that urine is what your kidneys decide your body doesn’t need. But she wasn’t just explaining it, she was disgusted, and angry. His response was similar to a major defense of homeopathic medicine, that the “toxin makes the remedy” (or something like that). The girl got exasperated and left with her friend, and you could hear her ranting as she walked away. I chose not to continue the conversation because I was on my way to meet friends, but in hindsight I wish I had stayed because there are some questions I don’t have the answers to:

  • How often does he talk publicly about this? What does he do for a living? Ie, is this it, or does he have a boring day job and this is his true passion?
  • Does he feel that drinking urine has cured whatever health problems that he originally sought help for? (I would guess so.)
  • Why does he think drinking urine has not been more widely adopted?
  • Does he think that his approach (especially the t-shirt and public ‘evangelism’) is the most effective way to spread his message? I would guess he enjoys the attention on some level, but also promotes his beliefs through other, more effective channels.
  • What are the typical reactions he gets? How many people stay and talk with him at length, and of those how many eventually adopt his therapy?
  • I’d like to talk a bit about Western medicine. Not necessarily the biomedical interventions we favor, but the scientific process by which we (ideally) establish that a practice is beneficial. Does he think urine therapy could be tested by a randomized controlled trial? If not, why not?
  • If the passerby had stuck around: why did she choose to argue with him? Did she really think that a guy wearing a bright yellow “Drink Urine” t-shirt in Union Square was likely to change his mind? And for the man himself: how common is her argumentative reaction?

I think a natural first reaction to something this out of the ordinary is laughter or mockery, or the assumption that he’s clinically insane. On further thought, what he believes — in factual support and argumentative method, if not in substance — isn’t that different from much of alternative medicine, and his methods have been widely adopted by many mainstream religions and social movements as well as less-respected ‘fringe’ beliefs. If those are both true, why isn’t his belief more widely adopted? Is it just too taboo?

I think I could have learned valuable things about the mixture of reason and emotion and belief that guide human choices if I had stayed and asked some of these questions. I don’t think I’ll change his mind, but I plan to look for him if I’m ever strolling through Union Square on a weekend again.

(Note: evidently “urine therapy” is a thing. The Wikipedia page starts with “In alternative medicine…” — never a good sign.)

26

06 2011

Measles is big this year

The CDC just put out a Health Advisory describing measles’ big comeback. Though endemic transmission is the US has been interrupted, but importations keep happening when the unvaccinated population travels or come into contact with travelers:

The United States is experiencing a high number of reported measles cases in 2011, many of which were acquired during international travel. From January 1 through June 17 this year, 156 confirmed cases of measles were reported to CDC. This is the highest reported number since 1996. Most cases (136) were associated with importations from measles-endemic countries or countries where large outbreaks are occurring. The imported cases involved unvaccinated U.S. residents who recently traveled abroad, unvaccinated visitors to the United States, and people linked to these imported cases. To date, 12 outbreaks (3 or more linked cases) have occurred, accounting for 47% of the 156 cases. Of the total case-patients, 133 (85%) were unvaccinated or had undocumented vaccination status. Of the 139 case-patients who were U.S. residents, 86 (62%) were unvaccinated, 30 (22%) had undocumented vaccination status, 11 (8%) had received 1 dose of measles-mumps-rubella (MMR) vaccine, 11 (8%) had received 2 doses, and 1 (1%) had received 3 (documented) doses.

Measles was declared eliminated in the United States in 2000 due to our high 2-dose measles vaccine coverage, but it is still endemic or large outbreaks are occurring in countries in Europe (including France, the United Kingdom, Spain, and Switzerland), Africa, and Asia (including India). The increase in measles cases and outbreaks in the United States this year underscores the ongoing risk of importations, the need for high measles vaccine coverage, and the importance of prompt and appropriate public health response to measles cases and outbreaks.

Measles is a highly contagious, acute viral illness that is transmitted by contact with an infected person through coughing and sneezing. After an infected person leaves a location, the virus remains contagious for up to 2 hours on surfaces and in the air. Measles can cause severe health complications, including pneumonia, encephalitis, and death.

The message is simple: parents should vaccinate their children because not doing so has serious health effects not only on those children, but also on those who are unable to be vaccinated because they are either too young or have medical contraindications. If everyone who believed (wrongly) that vaccines are unsafe would move to one country (let’s call it Unvaccinstan) then the choice would have fewer ethical pitfalls: you make a bad choice, and your kids might get sick. But as it is there are many people who simply can’t get vaccinated — kids with cancer for example, or kids in the window between when your maternal antibodies aren’t that effective against measles but still interfere with the vaccine — so the choice has much broader societal impact. I imagine that many of the parents who choose not to vaccinate — who are often of higher educational status and more liberal politics — view themselves  as virtuous; the reality is sadly the opposite.

23

06 2011

Monday Miscellany: NYC edition

Two weeks ago I moved to New York City for the summer, so today’s links from around the interwebs are focused on the Big Apple:

21

06 2011

Lead poisoning in China

It’s a huge problem — the Times calls it a Hidden Scourge:

Here, Chinese leaders have acknowledged that lead contamination is a grave issue and have raised the priority of reducing heavy-metal pollution in the government’s latest five-year plan, presented in March. But despite efforts to step up enforcement, including suspending production last month at a number of battery factories, the government’s response remains faltering.

At a meeting last month of China’s State Council, after yet another disclosure of mass poisoning, Prime Minister Wen Jiabao scolded Environmental Minister Zhou Shengxian for the lack of progress, according to an individual with high-level government ties who spoke on the condition of anonymity.

The government has not ordered a nationwide survey of children’s blood lead levels, so the number of children who are at risk is purely a matter of guesswork. Mass poisonings like that at the Haijiu factory typically come to light only after suspicious parents seek hospital tests, then alert neighbors or co-workers to the alarming results.

And relevant to my current work, which I hope to write about more soon.

15

06 2011

"A baby was born in my Land Rover today"

….so writes my friend Bobby Garner, a missionary in Uganda. Worth a read.

10

06 2011