Injury Prevention for Marathon Runners

With the Boston Marathon just a few weeks away, Kristen Stivers and I worked on a slideshow which teaches runners some vital stretches necessary to prevent injuries while running. The slideshow was posted on Commonhealth, WBUR’s health blog on March 15, 2011.  Click here to view the tutorial


Background to the Boston Marathon

My classmate and friend, Kristen Stivers is working with me on some blog pieces for an online journalism class. This is a podcast we did for marathon training. It’s an interview with seasoned marathon runners Saif Pathan and Molly Minah.

Click here to hear the story.

Pictures and better stuff to follow.


Medford- mapping main street

A sneak peak into a lazy Saturday autumn afternoon in Medford, MA.

Main Street, Medford, MA by Anne-Marie Singh, BU from BU Narrative Radio B on Vimeo.

 


Benign Factors and War Stress- on PTSD

“Happy Veterans Day! Coming up now is Kings of Leeeeeon!!” screeched the shrill, young voice at 10 am on the radio on Nov 11, 2010. Lounging in the comfort of a centrally air conditioned home, with hot drip coffee in the pot and pancakes for breakfast, the Average American enjoys his public holiday with very little understanding of what the American soldier’s day was like before he became a veteran.

Sleeplessness, fatigue, aching muscles, unfamiliar food, no cell phones, very little internet, water and electricity on good days, heat and stress on bad ones- that’s what every American soldier has had to live with while fighting for his country in the two recent wars of Iraq and Afghanistan. At the tender average high-school graduating age of 18-20 years, these former Dunkin Donut and video game junkies are now subject to an isolated life in conditions they would have only earlier seen in post-apocalyptic movies.

War is no bed of roses. It’s depressing and it brings with it death, loss, more death and more loss. Post Traumatic Stress Disorder or PTSD is defined by the ‘Wounded Warriors Project’ as “an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening”. This definition encompasses what most psychologists, psychiatrists and trauma specialists are trained to deal with in war zones. Symptoms of PTSD among soldiers in war zones, include agitation, anger outbursts, tunnel vision and the inability to solve problems and agonizing mental suffering. They talk to military men and women treated about the trauma they might have encountered and provide them skills to deal with it. But how often are these specialists trained to identify and cure symptoms arising out of the benign factors of war?

Psychologist Craig Bryan, Lead Consultant to the US Air Force for Psychological Health Promotion Initiatives and US Marines Suicide Prevention Programme describes his observations of mental anxiety among soldiers during his deployment to Iraq in 2009. “Most of the (psychological) attention given up to this point is to killing, seeing dead bodies, accidents and injuries. The other factors are taken for granted and don’t seem like a big deal but they add up over time. “ Limited food options, no laundry facilities, no internet access, 12-16 hours of military exercise every day, dehydration, no recreation and no days off, are some of these factors Dr Bryan identified as serious catalysts to PTSD in war zones. “It’s constantly unrelenting. When something big happens, you don’t have the psychological resources to deal with it.”

How do soldiers deal with this new life? “No one ever quits,” says Veteran Boyd Parker from his tenure in Iraq. “There were times when people overemphasized an injury to get out, but they never quit. The experiences are one thing but being dead tired, dealing with malnutrition, no sleep and the heat is pissing off and gets to you real bad.”

The military code of conduct teaches soldiers to toughen up. Admitting to their need for medical help is often viewed as weakness and invites stigma and insults from fellow soldiers. Without a specific ‘trauma’ or incident to identify their anxiety with, soldiers allow their stress to fester and unleash in sporadic bursts of anger or depression. Most lunch-room brawls have been allocated to this reasoning. Psychologist Craig Bryan says, “by definition a soldier would not have experienced PTSD if he did not see a threat to his life, or was exposed to trauma.” This limiting definition is the reason why soldiers refrain from therapy unless their mental health has deteriorated considerably. “Average soldiers generally wait till it’s so bad that they are in trouble, before they go in,” adds Dr Bryan.

Staff Sergeant Mike Fitz recalls his time spent in Iraq in 2003. “I went in as a boy and came out a man. Back home, trash gets taken every Tuesday, clean water comes out of the faucet, grandfathers die of old age. Normal Americans don’t get to see the life we lead. I felt like I was prisoner there.” Fitz identifies isolation from significant others as one of the main causes of stress among soldiers at war. He said that 30 percent of people deployed in his unit lost or divorced their relationships by the time they finished their term. “We had a lot of people committing suicide because of this.”

Minor steps are being taken to help soldiers deal with these stresses. Video games, movies and exercise are a common means of recreation. Soldiers with musical skills congregate and entertain themselves and the others. “What else can they do?” says Dr Bryan who is trying to promote strategic and customizable programmes which could target different military sub-cultures separately. His strategies are aimed at improving resilience in mental health and providing preventive methods as opposed to curative. “Mental health prevention is abysmal. Buying doctors in clinics is not enough. They need to live with warriors everyday to foster mental toughness so that when trauma hits, they are in better shape to deal with it.” He states that these strategies could not be demonstrated as funding for them was turned down, since they do not qualify as treatment for PTSD.

“We have failed our warriors cause we expect them to think like us, but truly we need to think like them,” says Dr Bryan.

 

 

 

“Despite all the publicity, combat stress and PTSD are just clinical words. For those of us who have served in a combat environment, our experiences never seem to fit into those tiny categories. All we know is nothing seems quite right since we came home.”

– John Melia-Executive Director WWP

 


Profile- She’s not just a doctor

Dressed in scrubs, slightly tight around her second-trimester-pregnant belly, Julie Herlihy, walked briskly down the corridor of the pediatrics unit of the Boston Medical Centre to room number 10. Her first patients for the day, a Somalian family waited for her in the room with two of their ten children. The wife was dressed in a burkha while cradling the infant and the husband stared blankly at the wall in front of him. Their elder boy, not older than four, sat in a chair swinging his legs violently. The family broke out in a nervous smile when Julie entered unable to say anything because they can’t speak English. Julie returned their smile with a bigger one, a motherly tap on the little boy’s back and lots of welcoming words, which the family didn’t understand but responded to with an obvious sense of comfort and trust. Few minutes later, with help from a telephone translator, the children were thoroughly examined, their medical needs met, the family’s insurance sorted out, a breast pump was ordered and the family left with a look of satisfaction on their face.

This was one of many cases Julie tended to on that day. All her cases were met with the same smile and warmth on a bespectacled face adorned with a pair of simple silver hoops. She eased her way through every case without being limited by cultural, racial and language challenges presented by her patients. They all left smiling as though she had magically banished their illnesses away.

In her third year of residency, Julie Herlihy now 33 years old, has already spent several years in Africa teaching and volunteering with communities in Zimbabwe and Zambia. An east coast girl, Julie first left for Africa at the young age of 20 on a teacher exchange programme teaching Biology to high school students, only to discover a pleasant surprise. “The teachers there were way better than me”, she said with a laugh. Her journey then took her to the local public health clinic where she found herself learning and teaching women and children about primary care. All the while she lived with the village chief and his family, who wanted her to be under their wing due to their suspicions about foreigners. At the end of her six months, the chief, father to 14 and grandfather to over a 100, held a formal ceremony adopting Julie as his Manini, his last born.

Julie returned from Africa and spent the next decade designing curriculum for public health workers in refugee communities, joining Medical School at University of Massachusetts, obtaining a Masters from the Harvard School of Public Health and travelling back and forth to Zambia. Her love for the country and its people continued to grow as she involved herself in care for people with HIV. She worked with local communities and women to help empower their abilities to provide primary care in areas such as infant and child care, women’s health and nutrition. At a young age Julie had developed cross-cultural skills which taught her how to work and appreciate foreign customs while working with the community. This white American girl also learnt how to cook on a fire, live without water and electricity and bathe out of a well.

When asked how she first developed her passion for Africa, Julie confesses that there isn’t any one particular reason. Fascinated by the thought of going to the continent, she called up the Peace Corps at the age of nine begging them to enroll her. Today she is clearly satisfied with herself for living out her childhood dream.

The value she adds to the pediatric clinic is clearly notable. “If I could spend a day observing her, I would learn quite a bit myself,” said Dr Jose-Alberto Betances, Clinic Director of the Pediatric Primary Care Unit at BMC. Dr Megan Sandel, one of the preceptors at the clinic adds that Julie’s patients are very loyal to her. “We get a lot of patients from refugee and immigrant communities with different medical issues, especially trauma being a big issue. Julie  asks questions sensitively. She has both, skill sets of a scientific mind and a social perspective.” Dr Sandel further comments that “She (Julie) is laser-focussed on what she wants. That makes her very unusual.”

This is not the end of the road for Julie. Sitting in her office, one can tell that her mind is exploring the next place she wants to visit. “Ethiopia” she says, “they have different history from the rest of Africa.” One can tell that her mind is already travelling across the Atlantic.


Zoonotic Diseases

Think Swine Flu, Avian Influenza, Hantavirus and Lyme Disease and what immediately pops into one’s mind are images of squalor, dirty, plague-infested rats, pig and tics and all the menacing pathogens they bring with them. Labeled as ‘zoonotic diseases’, they have grown in number and impact in the last decade affecting human populations across the globe. But can these diseases and their rapid growth in the last couple of years be blamed on the animals themselves?

WHO defines zoonoses as “diseases and infections that are naturally transmitted between vertebrate animals and humans. A zoonotic agent may be a bacterium, a virus, a fungus or other communicable disease agent. At least 61% of all human pathogens are zoonotic, and have represented 75% of all emerging pathogens during the past decade.” According to a study by the Washington Department of Health, nine new human pathogens have emerged from 2000-2010 of which six are zoonotic in nature.

While these figures may appear alarming, there are those whose expertise leaves them unperturbed. “I do not think that’s terribly surprising,” said Dr Aaron Bernstein from the Harvard School of Public Health. “Infectious diseases in humans have similar cousins in other animals. It’s a pool of disease-agents which are closely related to each other and can be closely transmitted.” Some scientists are still debating over the figures. Dr Walter J. Tabachnick, Director of the Florida Medical Entomology Laboratory, University of Florida, says that there is “no data” to prove an overall increase in zoonotic diseases. “Few like dengue have increased, but that’s just a personal opinion,” he adds.

Studies have proven several factors leading to the sharp increase in zoonotic and vector-borne diseases in the last few years. While most point towards climate change being the largest contributing factor, many experts have opposing opinions. A widely expressed opinion states that climate change can only affect vector-borne diseases i.e. diseases transferred by arthropods or insects, as they are cold-blooded hosts. Since zoonoses specifically relates to diseases transmitted between vertebrate animals and humans, the climate change argument fails to apply to the entire gamut of zoonotic diseases. However, some scientists argue that warmer temperatures are not good enough to even explain the increase in vector-borne diseases alone.  “In order to have something happen, a lot of factors contribute to it. Temperature alone cannot make a difference. Malaria epidemics have decreased over the last 100 years, but the earth’s temperature has gotten warmer,” argues Dr Aaron Bernstein. Echoing a similar thought Dr Tabachnick feels that most studies “glibly offer assurances.” He adds that “climate change will have an effect, just like any environmental factor, but no one can predict specific consequences with assurance.”

With globalization of food, growth of cities and populations and spread of industry, came the excessive desire to constantly meddle with the earth’s environment and to alter its face. “We are reconstructing nature and causing humans to come into contact with animals in new ways,” says Dr Bernstein. He supports his claim providing examples from the live and wild animal markets in China stating how animals which would normally coexist in nature would be brought together in constrained conditions. The deadly Severe Acute Respiratory Syndrome (SARS) virus which claimed hundreds of lives in 2003-2004 can trace its origins to civet cats, which were held captive to feed the exotic food market, in China. Butchers of these cats were the first to be infected with the SARS virus.

Like Dr Bernstein, most scientists believe that people are misled into believing that the issue is climate change. The main problem is the constant and repetitive transformation of ecosystems on a large scale which breaks down ecological barriers. The way people interact with their live stock, their hunting practices, and their dependence on the land for their needs and their interaction within their own communities all add to the development of an epidemic. Dr Kenneth Gage, Chief of the Flea-borne Disease Activity Unit of the Centre of Disease Control (CDC), said “vector-borne disease cycles are very complicated. Land-use patterns and human behavior vastly add to these systems.”

Alterations in land-use can be singled out for older zoonotic diseases too.  Some studies demonstrate a correlation between the growth of the Atlantic seafood fishing industry and the introduction of the HIV AIDS virus in Western Africa. Rapidly increasing industrial fishing practices in the 1950s brought the fish population down to 10 percent of its original catchment a decade later. This made coastal tribes of Western Africa turn to bush meat to supplement their protein intake. The virus, once inside the human genome, mutated and became the Human Immunodeficiency Virus which became globally pandemic, nested within its travelling human host. “Twenty years ago people would have laughed at this reasoning,” said Dr Bernstein.

Human behavior within different societies, sharing the same environment, can show contrasting results in the spread of zoonotic diseases. Hantavirus, a lung disorder spread by rodents, spread wildly in Mexico in 1993-94 but was hardly significant on the other side of the Rio Grande River in the state of Texas. Dr Gage from the CDC points out that most Americans stay indoors on hot evenings in the comfort of their air-conditioned homes, while Mexicans would go outside on their porches to cool off. “These little things are very important,” he added.

In the case of zoonotic diseases, the factors are several and the impact is always the result of their cumulative effect. Understanding them is extremely complex as it involves a host of organisms from the pathogen, to the host to the infected organism, as well as the mutations which occur in this process. Dr Donald Thea from Boston University’s School of Public Health states that “it’s hard to talk about zoonotic diseases generically as they are a complex heterogenous body of biological beings.” He specifies that each disease needs to be studied and understood locally taking into consideration the environment, animal and human populations, industrial development and climate of the area. Moreover, scientists commonly agree that there is a lack of understanding the specifics of any particular episystem and the complexity of the interacting environment on vector-pathogen-host interaction. Due to these complexities, scientists seem to falter in their predictions for the future of these diseases. Even those confident in their climate models are questioned by the rest of the scientific community. “Predicting the impact of climate change in the future is like trying to predict how the stock market will behave in three years based on the conditions and information we have today,” said Dr Tabachinick.

While uncertainty may taint the understanding of the future of these diseases, resolution can be found in simple steps like educating local and medical communities globally. Dr Gage from the CDC notes that 14 percent of all fatal plague cases in the US, in the last 30 years, have been due to delayed medical attention or misdiagnosis. He states that the CDC focuses most of its efforts on educating people on managing their pets, livestock and disposing garbage in their neighbourhoods. Awareness and surveillance is the key to controlling the outbreak and spread of these diseases. He adds that with Remote Sensing and satellite imagery, scientists have access to land use, precipitation and pollution figures across the world which could help determine the possible epidemics in certain regions. “Theoretically we could reach a point for predicting zoonoses,” he adds. “But these diseases are very hard to predict and penetrate, “ he concludes soon after.


Bhopal- not forgotten

Accidents happen, people die, the offenders pay and the public forgets. But what if the accident continued to add victims to its list year after year and decade after decade and like the Ghost of Christmas Past, it kept returning in the form of disease and mutilation? Bhopal, a city in central India, may not be the perfect setting for a Dickens novel but it carries the stamp of a haunted past.

The night of Dec 3rd, 1984, a powerful gas leak from the American-run Union Carbide Industries Limited (UCIL) pesticide factory, in Bhopal drowned the city in 27 tonnes of methyl isocyanate (MIC). The pungent odour of the gas drove people out of their homes and into streets filled with even more frenzied people. The result was a bloodbath which statistics quantify as a death toll of 25,000 people at the end of the week which followed. City municipalities struggled to deal with the overwhelming number of bodies which even mass burials and cremations could not address. Half a million people had been exposed.

Established in 1970, the pesticide plant was UCIL’s effort to tap into India’s agricultural market. As farmers were unable to afford the pesticides due to increasing floods and droughts and resulting drop in crop yield, the factory went into slow decline, as did its security systems, finally ceasing production. Three tanks full of methyl isocyanate continued to loom in its dark corners till a corroded pipe allowed water to come in contact with the deadly chemical unleashing a volatile reaction. The concrete tanks exploded and spat plumes of MIC and hydrogen cyanide into the atmosphere, which cleared up after a while, and into the groundwater and soil, which never did. Generations have been poisoned since. Even today in 2010, an abnormally high number of children are diagnosed with birth defects like cerebral palsy, tumours, webbed feet, deformed or twisted limbs and sensory disabilities. Periodic testing over the decades has shown the presence of heavy metals like lead and mercury and organochlorines in the soil and water near the plant. Lactating women living in the vicinity have tested positive for the presence of these pollutants in their breast milk.

The plant lies still like a fossil, untouched, in the middle of the city. Union Carbide never cleaned up after itself. The offenders got away unscathed leaving a trail of stained corporate liability in their lee.

The people of Bhopal have learned to live with a fate which kills fetuses before they are born and maims those which make it, but their quest for justice has not concluded. The Indian Government and Dow have each outwitted the other in the classic blame-game, oblivious to the growing numbers of disabled children in Bhopal. Citizen groups around the country have been lobbying with UCIL, now Dow Chemicals, to clean up the plant. The thirst for justice has become so contagious that now America has stepped in to ensure that justice is served to the Bhopalis. American youth and students have formed support groups under the International Campaign for Justice in Bhopal (ICJB) to raise awareness and rally with the American government. Heading the Boston Coalition for this campaign, Leonid Chindelevitch, a PhD student at MIT says “awareness and strength of the campaign has increased with time though things don’t change quickly.” He adds that media coverage has helped them estimate the growing awareness of this dated incident with “over 500 articles appearing in American and European Press on the 25th Anniversary of the tragedy”. He further adds that the added pressure from the home country has restricted Dow’s ability to carry out business in India.

Leonid is not the only one who feels this way. In the year 2000, passionate youth around the America formed themselves into an organized group called ‘Students for Bhopal’. US Campaigner and representative, Claire Rosenfield says that “the group was formed in response to the fact that an American company was responsible for the disaster.” Working to raise awareness, motivation and funds, the group is present in major cities across the country including New York, Chicago, Boston and Northern California. They work in close conjunction with the local campaign in India to further the demand for justice. Commenting on the progress of the campaign in the past decade, Rosenfield says, “We make it such that Dow has to make notice of us once in a while. Andrew Liveris (present Chairman and CEO, Dow Chemicals) had to address Bhopal when he took office.”

The demands are simple- compensation for victims, cleaning up the site and water sources around it, and Dow admitting to its crime. Global justice is the mantra. “It is important to create international pressure,” says Somnath Mukherji from Associate for India’s Development (AID), “we work to confront Dow in several ways in the US.” Working with Students for Bhopal, AID conducts activities around the US targeting youth in major universities to recognize the true face of Dow and to remember the tragedy that was. Though embedded 26 years ago in time, Mukherji points out that Bhopal is not history, “How can it be dated if babies are still born deformed? Is colonialism a dated issue?” When asked how all this affects Dow, Mukherji’s response is brief “Dow is offended. It’s not as if we can let them forget it.”

Mukherji was right. In 2004, 20 years after the disaster, Congressman Frank Pallone introduced a bill in the House of Representatives marking the 20th anniversary of the tragedy and expressing Congress’s commitment to working with the government of India to ensure that Union Carbide is held responsible. In a prepared statement Pallone expressed solidarity with the movement- “our countries should come together to recognize the gravity of the Bhopal disaster and the ongoing environmental problems in Bhopal caused by Union Carbide’s policies and practices.”

Across the border in Toronto, Ellen Shifrin a volunteer with Amnesty International mentions that Bhopal is an important issue for Amnesty under their larger aegis of corporate liability. “We do not believe in burning effigies,” she said, “ but we want medical clinics, clean water and justice.” She adds that “Bhopal is one the biggest examples of what can go wrong in the world”.

Bhopal is alive. It’s breathing through choked lungs and limping its way into the twenty first century but it’s still alive. 26-year-old Andrew David Simpson left for India on Nov 1, 2010 to walk from the Pakistan border in the West to the Bay of Bengal in the East covering a distance of 2000 miles on foot. His motivation is to raise money for the Bhopal Medical Appeal. While waiting at the airport to board his flight to India, Andrew contemplates the journey ahead, “people hope that it’s going to go away but it obviously hasn’t. As time goes on it has just gotten worse.”


The wrath of Alzheimer’s

If you’re on the less-desirable side of 60 and you’re reading this, you probably have a strong chance of delaying the onset of Alzheimer’s and dementia.  But that’s where the good news ends.  A team of researchers from Chicago have discovered that mentally engaging activities may prolong the arrival of this dreaded old-age curse, but if the disease does set in, it will devour an enlightened brain at a much faster rate than an uninitiated one.

Almost a hundred years after the discovery of Alzheimer’s, Robert Wilson’s team from the Rush Alzheimer’s Disease Centre of Chicago has presented a study which demonstrates the vengeful nature of this disease. Starting in the early 1990s, Wilson and his colleagues monitored 1157 participants over the age of 65, in four neighbourhoods of Chicago. Their findings revealed a much greater rate of decline in mentally stimulated seniors who contracted Alzheimer’s Disease as compared to those who remain relatively unengaged in mental exercise, before being affected by AD. But what really happens is that cognitively-charged brains were able to mask the onset of age-related dementia, which once discovered would hastily progress due to the pathological burden already present on the individual’s mind.

The team conducted its survey by asking each participant to rate their involvement in seven information-processing activities. These included watching television, listening to radio, reading newspapers, reading magazines, reading books, playing cards and games and visiting museums. The seniors had to rate them on a scale of 1 to 5, with 5 representing a daily engagement with the activity and 1 representing very little or no involvement at all. The individuals were also analysed for symptoms of AD and dementia. This exercise was repeated in the same neighbourhood every three years completing five whole cycles. Data revealed that for those without AD, the rate of decline on the activity scale was 52 percent per point, but for those with AD, the decline was 42 percent higher for each point, than the rate of normal decline.  These results may offer bleak consolation to senior citizens who are paying attention to ward of mental decline and inactivity, but as Wilson says, “cognitively stimulated individuals with AD lived their lives (before AD) always getting a little bit more out of what they had.”

This study shows that Alzheimer’s tends to ‘catch up’ and make up for lost time, but it definitely raises certain questions about its ability to represent a larger group of people.  Can results from a small population in southern Chicago establish a generalization for all of America or, for that matter, the world? Srikant Sarangi, a biomedical researcher at Boston University points out this very limitation, “the study is a good start but it’s not valid enough based on this sample set. It should, perhaps, even consider individuals younger than 65 as there are increasing cases of AD from people in their 50s.”

Sources:

Wilson, R.S. PhD; Barnes, L.L. PhD; Aggarwal, N.T. MD; Boyle, P.A. PhD; Hebert, L.E. ScD; Mendes de Leon, C.F. PhD; Evans, D.A. MD, Cognitive Activity and the Cognitive Morbidity of Alzheimer’s Disease, Neurology, Vol 75(11), Pg 990-996


The Harmonica and Jazz Music- Interview with Hatrack Gallagher

In the new age of pop culture and electronica, acoustic instruments are being kept alive by connoisseurs of the art. Local musicians have a very special role to play in embalming traditional music and instruments like the harmonica. ‘Hatrack’ Gallagher, from Massachusetts, is one such musician who has been playing the harmonica for over fifty years in various jazz and blues performances.

Click here to hear the story.


The war in Afghanistan- Interview with Robert Zelnick, Boston University

As the US decides to withdraw troops in Afghanistan and hand over charge to President Hamid Karzai, leading political journalist and Boston University Professor, Robert Zelnick, speaks to me about the fatalities of this move.

Click here to hear the story.