Dr. Sushrut Jan: I'm not used to seeing public health stories about India in American newspapers - but last week, the tragic deaths of 23 North Indian children after they ate tainted school lunches in the agricultural state of Bihar was prominently featured in the New York Times, CNN, the Washington Post, NPR, and the Boston Globe. Such extensive American media coverage about a health tragedy in a poor, rural state in India surprised me. Obviously, the death of children arouses our compassion, but unfortunately, such events occur so regularly throughout the developing world that most end up receiving notably less attention.
Consider an event in Nigeria three years ago: a medical team belonging to Doctors without Borders ventured into northwest Nigeria to conduct an immunization campaign for children but instead found farming towns mysteriously devoid of children altogether. The team found families engaged in subsistence gold mining, a process that released dust laden with unbelievably high concentrations of lead. Partnering with local agencies, the Centers for Disease Control, and the World Health Organization, researchers determined that the lead exposures were among the highest in the world - and that such exposure had killed more than 400 children under age 5 and left more than 2,000 children with permanent disabilities.
But when I asked some colleagues about these two stories - the 23 dead in India, and more than 400 dead and 2,000 disabled in Nigeria - most were very aware of the school-lunch story but had no familiarity with the second. The reason for this discrepancy, I suspect, rests on the speed of the two tragedies. Moments after the Indian children noticed a funny taste in their food - apparently from a potent insecticide -- many developed stomach cramps and vomited; within hours, some were critically ill or had died, even before reaching the hospital. Within a day, news agencies around the world were alerted to the crisis.
On the other hand, in Nigeria, the lead poisoning epidemic has evolved over months to years, and the consequences of lead poisoning - brain damage, paralysis, deformity - have taken a long time to reveal themselves. Consequently, the Nigerian story, although tragically important, has been more difficult to tell in our current rapid pace of media coverage. Without reminders, the slow-moving public health crisis tends to slip under our radar. Even in the recent news about the poisoned schoolchildren in India, a slower story hides in its shadow.
"You've heard about the cancer train?" asks Amit Khurana, head of the Food Safety and Toxins Program at the Center for Science and Environment in New Delhi, India. Nightly, he says, a train departs from a farming district in Punjab, taking passengers to a hospital in the bordering state of Rajasthan. The train is nicknamed "marizon ki train" or "train of the ill": its seats routinely fill with cancer patients, both young and old, afflicted with all manner of malignancies. The reason for high cancer rates in this rural farming community?
"We found that people living in this district and the surrounding areas had high levels of pesticides in the blood, the breast milk, and in other body tissues," Khurana says. Researchers discovered farmers were spraying crops with abnormally high concentrations of pesticides and rarely wore protective masks. And, just like at the school in Bihar, empty pesticide containers were frequently used for storing food. But the doses of pesticides were not high enough to kill, as they did in the schoolchildren. Instead, people living in these farming communities developed disease slowly, over months to years.
And here, again, is the crux of the problem in a slow-moving disease process: the longer the time-lag between a potential exposure and its health consequence, the harder it is to track, to prove, and to report. "So a lot of people in India remain unaware of chronic pesticide exposures," Khurana explains. "A few years before I took this job, I didn't know about it either."
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