Charlotte Brody, a registered nurse, is a founder and executive director of Health Care Without Harm, an international coalition of 416 organizations in 44 countries working to make health care more environmentally responsible and sustainable.
Monday, 12 May 2003
A sunny, breezy morning. So I walked across Washington instead of taking the Metro. The azaleas are fading but there are new roses and peonies.
On the way, I passed three pesticide trucks outside of office buildings and apartment houses. Would they be there if the workers and the occupants knew what I know?
I am one of eight people who got their body burden of chemicals tested as part of a Commonweal and Environmental Working Group study. So I know about the pesticides and other pollution in me. My tests showed that my body was carrying 85 contaminants, including 45 carcinogens and 56 chemicals that can impact the brain and nervous system. My blood and urine contained two organochlorine insecticides and four organophosphate pesticides, including the now banned Dursban, made by Dow Chemical.
How did these chemicals get into me? I never use pesticides in my house or garden and I try to buy organic. But the pesticides still could have been on something that I ate or the chemicals may have been sprayed in a room that I walked through. I don’t know. What I do know is that no one knows what the combination of pesticides and dioxins and furans and PCBs and phthalates and metals and volatile organic compounds that I am carrying around is doing to my health.
The chemical industry issues press releases assuring the public that these levels are too low to be dangerous. But the testing that these press releases are based on does not look for the effects from combinations of chemicals or for the subtle or long-term health effects of chemicals on people and the environment.
As a nurse who has spent many hours going over informed consent forms, I get riled up thinking about how the chemical industry enrolled all of us in this giant experiment on our health without having to get our permission. I never got the form.
The chemical industry would say that the body burden we all carry is a small cost to pay for the benefits of modern society. But pollution doesn’t need to be the payment for progress.
That’s been the experience of Health Care Without Harm: The Campaign for Environmentally Responsible Health Care. When we started in 1996, hospitals in the United States were major sources of dioxin and mercury pollution. Today, hospitals are reducing the volume and toxicity of their waste through environmentally responsible purchasing, reuse, and recycling. The waste that remains is decontaminated using non-incineration technologies that do not produce dioxin.
Thousands of hospitals have phased out the use of mercury fever thermometers and blood-pressure devices. All of the major retail pharmacies in the United States have stopped selling mercury fever thermometers and now offer cost-comparable, safer alternatives.
Instead of debating how much mercury is necessary to impact the brain of a developing child or how much dioxin a person can bear before the chance of cancer increases, hospitals are figuring out how to decrease the amount of toxic chemicals that come in the front door and go out the back. Leaders in the health care industry are teaching each other how to use and emit less mercury, less dioxin, less pesticides, and less phthalates. These lessons are finding their way around the globe, as best practices and successful case studies get shared and refined.
The day-to-day work of Health Care Without Harm asks and answers the question, How can we reduce everyone’s body burden of toxic chemicals? I feel lighter for being part of it.
Tuesday, 13 May 2003
NEW YORK, N.Y.
To New York today to talk about working more closely with church groups on combining efforts to move markets and move policy. The Health Care Without Harm campaign, for example, found that the first bans on the sale of mercury fever thermometers in Minnesota and Michigan helped convince Wal-Mart, Albertson’s, and the other big retail chains to take mercury fever thermometers off their shelves. Those market changes in turn encouraged other cities and states to ban the sale of mercury-containing products.
But I drive my son and two friends to school first. My riders sleep and I listen to the morning news. Car bombs in Saudi Arabia intermixed with appeals for new members for public radio. NPR could make a lot more money if, after you made your pledge, you got access to a version of Morning Edition without any more cutesy appeals. I arrive late at the airport and jog to the gate in my heels, feeling ridiculous. But I make the plane in time.
I love flying into New York. You come out of the clouds and there is the harbor, the boats, the bridges, the Statue of Liberty. Then the feeling in the pit of your stomach when you see the space where the World Trade Center is supposed to be.
Yesterday, after ending my diary entry, I went off to a rally in support of the survivors of the Bhopal chemical disaster. Two women survivors, Rasheeda Bee and Champa Devi Shukla, along with activist Satinath Sarangi, were ending their 12-day fast for justice in Bhopal at a noontime event at the Gandhi statue across from the Indian Embassy in Washington, D.C.
Almost 20 years ago, 40 tons of lethal gases from a pesticide factory owned by Union Carbide poisoned the community of Bhopal, India. More than 8,000 people died in the three days following the disaster. About 150,000 people, including children born to parents who were injured by the gas, suffer serious health effects from the Union Carbide poisoning, and 380 more gas-affected people die every year.
In 1989, Union Carbide negotiated a secret settlement with the government of India for $470 million, about one-sixth of the amount originally claimed for disaster-related damages. Most of the Bhopal survivors got between $300 and $500 for the death of relatives or to pay for lifelong injuries. Union Carbide did not clean up the site before Dow Chemical acquired the company in 2001.
Dow buying Union Carbide never sounded like a great deal to me. I mean, who would want to buy a company responsible for the suffering of so many people? The answer is Dow Chemical. Dow’s purchase of Union Carbide has to be premised on the bet that Dow can continue to put chemicals into the environment and into people’s bodies without factoring in the costs for the harm their products have done or will do.
My body burden testing showed that Dow has its Dursban in me. That puts me in the list of Dow subjects along with the people of Vietnam and Vietnam veterans hurt by Dow’s Agent Orange, and the residents of Dow’s hometown of Midland, Mich., whose land has been contaminated with dioxin. By externalizing the costs of contamination, Dow and the other chemical companies lower the price of their products. The real costs show up elsewhere — in the medical bills of Vietnam veterans with non-Hodgkin’s lymphoma and the clinic fees for treating cataracts and menstrual disorders in the people of Bhopal.
Would Union Carbide have built the Bhopal factory the way it was built if they had factored in the full potential costs of an accident? Would they have ignored the many warnings that the plant was unsafe? Would Dow’s price for Agent Orange have been too high for the Pentagon if it had factored in the future medical bills for heart disease, cancer, diabetes, and birth defects?
These days, economic freedom is being defined as freedom from the regulatory burden of health, safety, and environmental rules. But we can change that definition. With freedom comes responsibility, right? In a free society, honest people can’t stay honest for long if crime goes unpunished. And corporations that want to produce safer products can’t compete fairly when other companies are allowed to pollute the environment and contaminate people’s bodies.
So when Bhopal survivors demand that Dow provide safe drinking water and pay for health monitoring in India, they’re helping all of us. Making Dow accountable today moves us toward safer products tomorrow. You can join the worldwide relay hunger strike for justice in Bhopal by going to bhopal.net.
Wednesday, 14 May 2003
NEW YORK, N.Y.
Today I fly first to Paris and then on to Geneva. I’m not great at long airplane rides and the jetlag can get to me. But I know how lucky I am to have a job where I can complain about things like going to Geneva.
I’m going to Geneva for the World Health Assembly and the meetings leading up to it. The WHA is the governing body of the World Health Organization, or WHO. Health Care Without Harm, in consultation with WHO, just sponsored a contest to come up with innovative, environmentally sound health care waste disposal technologies that would work in rural areas around the globe. Next Wednesday, we’ll honor the contest’s winners at a reception cosponsored by the International Council of Nurses and the World Federation of Public Health Associations.
The contest is meant to truly solve a health problem instead of moving the problem around. In brief:
Bill and Melinda Gates and the Gates Foundation decide to give a whole lot of money to stop the spread of preventable diseases through immunization. This is a very good thing.
So, the Gates Foundation funds buy billions of syringes. Once they are used for vaccination, they have to be kept from being reused, because the reuse of syringes is a major contributor to the spread of hepatitis B and HIV. How do you stop a good thing such as immunization from creating a bad thing such as the spread of two very deadly diseases?
The proposed solution was the burning of the immunization waste. But incineration of waste creates dioxin and other dangerous byproducts. Dioxin, one of the most potent carcinogens and an endocrine-disrupting chemical, already contaminates the breast milk of mothers around the world. So does the price of immunizing children have to be the pollution of mother’s milk?
We wanted the answer to be, “No.” So Health Care Without Harm, led by engineer Jorge Emmanuel, came up with the idea for a contest: “MedWaste Treatment — Minimizing Harm, Maximizing Health: An International Competition for Innovative Technologies for the Treatment of Medical Waste in Rural Areas.” The designs needed to be built using local materials and they must be able to be operated with little or no electricity and without highly skilled labor. Applicants had to agree to transfer their intellectual property rights to Health Care Without Harm so the designs would be held in the public domain.
I thought the submissions were amazing. A solar-powered autoclave designed by a group of Australian engineering students won first place. Second place was awarded to a designer in the United Kingdom for a system that combines mechanical grinding with boiling water to treat medical waste. Third place was awarded to a team in Mississippi for a proposal to treat waste through the heat generated by a chemical reaction involving lime and subsequent hardening of the waste into a cement-like material. You can read more about the contest, the winners, and the winning designs on the contest website.
I loved the idea of the contest and the image of engineering students all over the world thinking creatively about non-burn alternatives for the treatment of medical waste. Even more, I love being part of an effort to find solutions instead of arguing about whether immunizing children is more important than preventing HIV. Or is preventing HIV more important than stopping the contamination of breast milk? Obviously, they’re all important and they all need to be addressed, and the more time and energy we put into figuring out solutions rather than arguing about the problems, the better off we’ll all be. Right?
Thursday, 15 May 2003
What an odd thing it is to be asked to write a diary for a website. How personal am I supposed to get? Shall I tell you how I love my husband? Do I talk about my fierce love for my sons? My deep affection and respect for my fabulous coworkers? Maybe I’ll just talk about this airplane ride.
So here I am on this flying 777 box together with a couple of hundred other human beings. First class, business, premier economy, and economy. Four pseudo-classes of people crossing the Atlantic together. I am in the third class, in the premier section of coach, a.k.a. economy. I sit in row 18, my father’s favorite number. Next to me at the window is a French man who never gets up. I admire his bladder and worry about his risk of blood clots. Diagonally in front of me is a young woman with a baby girl. She is self conscious about what others may think about having to sit so near a baby. But she is a loving mother, caressing her baby’s hands and toes and looking into her eyes.
Sometimes, especially when a flight is delayed on the ground, I fantasize about a group discussion among the people on the airplane. I want everyone to take out their ticket and stand up in the aisle and tell the rest of us the price of their ticket. Then I want to hear how they came to be on this airplane on this day and this time. Interspersed with the passengers’ stories would come the pilot telling the tale of how he or she became a pilot and how each flight attendant came to work on this specific flight.
I love the map that you can follow that they project on a screen on 777s. Now we are just about halfway across the Atlantic. We are east of the tip of Greenland at an altitude of 38,000 feet. We have traveled 2,150 miles and have 1,807 miles to go. Somehow, this is all very reassuring. It is 68 degrees below Fahrenheit outside. I am glad I brought my sweatshirt.
We land in Paris early but I still miss my connection to Geneva. So I get to spend five hours in the Charles De Gaulle airport. I walk inside and outside. I drink coffee. I look at faces. I read the International Herald Tribune, the European edition of the Wall Street Journal, the Financial Times, and USA Today.
In each paper, I read stories about the downturn in the U.S. economy, the ongoing U.S. presence in Iraq, the waning chance of peace between the Palestinians and the Israelis. The most disturbing story, however, is on the editorial page of the International Herald Tribune. It is a commentary by William Pfaff on Leo Strauss, the mentor of neoconservatives like Richard Perle, Paul Wolfowitz, and William Kristol. These are the men that brought us the war in Iraq, and here is Pfaff on Strauss:
He also argued that Platonic truth is too hard for people to bear, and that the classical appeal to “virtue” as the object of human endeavor is unattainable. Hence it has been necessary to tell lies to people about the nature of political reality. An elite recognizes the truth, however, and keeps it to itself.
Weapons of mass destruction? Links between the tragedies of Sept. 11, 2001, and Saddam Hussein?
We need to turn the U.S. government around. But first, I’m going to bed.
Friday, 16 May 2003
Is there a better place to put a city than where a lake becomes a river? You locate the central functions where you can build a bridge across the narrow part of the river and then you build out from there. Julius Caesar visited Geneva. Now I’m here.
Geneva is in the French-speaking part of Switzerland, so I try hard to conjure up the French I learned in high school. I can order in a restaurant and buy a newspaper without embarrassing myself too much, but the political posters are harder. There is an election on Sunday and the people of Geneva are voting on whether to phase out nuclear power and rent control and there are posters advocating both sides all around town. When I ask, my colleague Susan Wilburn explains the politics of each poster, but I don’t really understand yet.
Susan is on sabbatical here working with the International Council of Nurses. Susan and I are both registered nurses; back in the U.S., Susan does occupational and environmental health advocacy work for the American Nurses Association. The ANA and the ICN are both member organizations of Health Care Without Harm. In HCWH, we do our work through workgroups and Susan is the co-chair of the Nurses Work Group.
This morning, Susan and I went to the opening session of the People’s Health Assembly, the pre-World Health Assembly meeting of the People’s Health Movement. The People’s Health Movement is a three-year-old effort to provide health care for all. We heard speakers from Guatemala, India, Iran, Sri Lanka, and El Salvador talk about their efforts to provide primary health care and the political forces that are getting in the way: pharmaceutical companies that only want to make drugs for the diseases that afflict the people who have money to pay for the drugs, Coca Cola buying up water rights, corporations claiming the intellectual property rights or patents for traditional medicinal herbs or for viruses like SARS.
The People’s Health Movement has produced a charter that lays out a vision of a people-centered health sector. The charter also amounts to a call to action to tackle the broad determinants of health: economics, societal arrangements, politics, the environment, war, violence, and natural disasters. You can read about the work of the PHM and sign on to the People’s Health Charter at the group’s website.
As I sat and listened this morning, I thought about how different the PHM is from Health Care Without Harm. We have nothing like the PHM’s nine-page charter. Groups that want to join only need to sign on to our mission and goals. We are much more outcome-based, I guess: focused on winning what can be won now, hoping that what we gain from each victory will help us win something larger. HCWH seems more intuitive while PHM is more declarative.
I think the intuitive, learning-as-we-go, getting-things-done style of Health Care Without Harm is one reason that we’ve enjoyed the strong involvement of nurses and other women health care workers. (Here, I started writing a little apology for not equally praising the involvement of the men in Health Care Without Harm. But I’m not going to do it. They know they’re good.) Twenty years ago Carol Gilligan wrote In a Different Voice, an extraordinary work about women’s psychological development and the difference between male and female moral-decision making.
Gilligan writes about Piaget’s studies of play, in which he found that as they grow up, boys become increasingly fascinated with the legal elaboration of rules and the development of fair procedures to resolve conflicts. Girls, however, do not share this fascination. For girls, rules are pragmatic. Rules only matter if they make the game better. As soon as they don’t, girls are ready to make exceptions. This tendency towards pragmatic tolerance led Piaget to conclude that “the legal sense which is essential to moral development is far less developed in girls than in boys.”
And here’s Freud explaining, “Women show less sense of justice then men, that they are less ready to submit to the great exigencies of life, that they are more often influenced in their judgments by feelings of affection or hostility.”
Kohlberg and Kramer describe six stages of moral judgment from childhood to adulthood. On level three, morality is seen in interpersonal terms — helping others. Beginning at stage four, rules become more important than relationships. At the fifth and sixth, the highest stage, relationships become subordinate to universal principles.
Girl’s morality (the lesser kind) is about relationships and responsibilities. Answering an abstract moral question “Is it moral for a man to steal medicine if it is necessary to save his wife?” with “It depends” is a girl answer. For Piaget and Freud, for Kohlberg and Kramer, objectivity (it doesn’t depend) has the higher moral value. Male morality is about rights and rules. Making things better is for moral weaklings.
Nursing is a level-three profession. Nurses can’t diagnose. But they are allowed to think that information can be put to good use, even if it doesn’t add up to absolute proof. Observations matter. Emotions matter. Intuition matters. Warnings can be listened to if there’s something logical and practical you can do to stop the problem before it gets any bigger.
In Health Care Without Harm, this “thinking like a girl” in nurses and in non-nurses, in women and in men, has allowed us to win many significant victories. Not so much in the industry-made, rule-laden Congress, not in the courts. But in hospitals and clinics and markets and communities around the world.
This week is the celebration of International Nurses Day. The theme this year is “Fighting AIDS Stigma, Caring For All.” For all of you who haven’t celebrated yet, go out and do something “pragmatically tolerant” or “influenced by feelings of affection.” You, and our world, will be better for it.