December 14, 2015

CHW LogoToday I watched a boy bleed to death.

I watched as a dozen doctors and nurses poked him, ventilated him, poured blood into his veins, sliced open his grotesquely swollen limbs to prevent gangrene.  I watched as, despite their efforts, despite two operations in a few hours, his teenage body continued to hemorrhage beyond repair.  I watched his parents standing outside the room, anxious and tearful. I watched his extended family gathered outside the hospital, holding one another, waiting for word.

This is what guns do.

Yesterday he was just another teenager worrying about all the usual adolescent things.  This morning he got in an argument with another teenager over a phone.  We all know how stupid teenagers can be, and we’ve all done something like that at some point in our lives.  But this time one of them had a gun, and one body lies cold and blue in the morgue, while another is in detention. Two lives destroyed, two families shattered.

This is what guns do.

I am not here to make a political argument, because this isn’t a political problem.  It’s a public health problem: a public health crisis.  If that boy, and the tens of thousands of others that meet a similar fate every year in this country, had bled to death from Ebola no one would hesitate to acknowledge that.  It’s made out to be a political problem because a few truly evil people (I’m talking to you, NRA leader Wayne LaPierre), cynically manipulate genuine concerns about the balance between public well being and constitutional rights.  But facing public health threats always requires such a balance.  Tobacco, automobile crashes, polio – all of these were addressed by reasonable, common sense restrictions on rights, in the form of requirements (you must wear a seat belt, you must get immunized) and prohibitions (you may not buy cigarettes if you are under 16, you may not drive above the speed limit), which have been readily accepted by the public.

We will continue to see thousands of people die by murder or suicide, and many thousands more wounded, until gun violence is seen as a health crisis.  More people need to see what I did this morning.  We need to stop letting Wayne LaPierre set the agenda.  Instead, we need a Mamie Till.

When Mamie’s son Emmett was brutally tortured and lynched in Mississippi in 1955, she insisted that the world needed to see what she saw.  His battered corpse was on view in an open casket funeral attended by hundreds and shown in newspapers around the world.  Racial violence was no longer an abstraction that could be glossed over.  It was a raw, ugly reality not only to its victims, but to the entire public.  It was a key moment in spurring the civil rights movement.

Sadly, the death I watched didn’t even make the news.  After all, there isn’t enough room in the papers to report on every person felled by a gun.  But crime still sells, and there are plenty of media items about gun violence.  In the wake of recent mass shootings, the New York Times ran its first front page editorial in almost a century.  That won’t do it.  People don’t need to be convinced, they need to be shocked out of complacency.  We need to stop showing photos of the perpetrators, or grainy high school yearbook pictures of the victims.  We need to show graphic, gruesome images.  Family survivors need to do what Mamie Till did – make everyone share your horror and grief.  Everyone needs to see what guns really do.


Public Enemy?

December 4, 2015

CHW LogoIn 1882, Norwegian playwright Henrik Ibsen wrote An Enemy of the People.  It tells the story of a doctor who becomes concerned about contamination of the water supply for his town.  When he speaks out publicly, he is condemned by the political and business leaders – who know about and profit from the tainted water – and eventually run out of town.  He, rather than those who are poisoning the water, is branded an enemy of the people.  Abandoned by family and friends, the doctor stays true to his principles and refuses to back down.

It sounds (and in fact is) a bit melodramatic; Ibsen himself wasn’t sure whether to label it a tragedy or a comedy.  Either way, it is fiction. Or is it?  Fast forward to 21st century America and you can find a similar, and true, story.  In October 2015, the water supply in Flint, Michigan was determined unfit to drink and a public health emergency was declared.  While the ending is happier for the public than in Ibsen’s play, it followed vigorous denials by the authorities.  As in the play, it was a physician – a Flint pediatrician – who first raised the concerns and was dismissed and criticized.

Dr. Mona Hanna-Attisha had been hearing complaints about the smell and taste of the Flint water since 2014, when the supply was changed from Lake Huron to the Flint River.  Many of her patients’ families suspected the water was making their children ill.  After learning of a similar problem in Washington DC in the early 2000s that resulted in high levels of lead toxicity, Dr. Hanna-Attisha reviewed the results of lead testing in Flint and found that the rate of lead poisoning had more than doubled after the change in water supply. Working with an environmental toxicologist from Virginia Tech, who had discovered the lead problem in DC, she learned that the new water supply was more caustic, allowing lead to leach out of the aging pipes in Flint’s water distribution system.

State officials responded with criticism, calling the findings “unfortunate” and accusing Dr. Hanna-Attisha of “near hysteria.”  Like the doctor in Ibsen’s play, she refused to back down.  She convinced the state to re-analyze their data, which demonstrated that the rate of lead poisoning had in fact increased.  At that point, the state conceded and declared the water emergency.  The Flint water supply has now reverted to Lake Huron, with anticorrosion measures in place to prevent the lead leaching.

It’s a thin line between advocacy and subversion.  Pediatricians and other pediatric professionals, as advocates for children, are often skating along that line.  Lead in the water in DC or Flint, injuries and deaths from gun incidents both intentional and accidental, climate change that threatens the health of this next generation and the ones that follow: all of these and many others are issue on which we must, and do, stick out our necks.  At times, that means being an enemy of the powerful.


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