The Social Medicine Portal

Agent Orange and the Vietnamese Community In the Bronx

Nestled amidst the McDonalds, Duncan Donuts and various Latin eateries of Jerome Avenue in the Bronx, sits the World of Taste Deli/Restaurant (formerly the Phung Hung Market), a cheery Vietnamese restaurant serving authentic sandwiches and various noodle soups.  It is one of many signs of our local Vietnamese community.

One of the health concerns of the Vietnamese patients who visit our clinic has been the possible health sequelae of the use of Agent Orange by US forces during the Vietnam War.  On Friday, September 19, 2008 we had the pleasure of meeting Mr. Ngô Thanh Nhàn, a Vietnamese activist in the Agent Orange campaign.  He spoke at a forum organized by the South East Asian community in the Bronx entitled “Justice is Healing.”  [We will be discussing this forum in a future post.].  Mr. Nhàn’s presentation follows that of Dr. Nguyen Thi Ngoc Phuong, one of the leading Vietnamese obstetrician-gynecologists, who spoke at our Social Medicine Rounds in November of 2007.  Both are members of the Vietnam Agent Orange Relief & Responsibility Campaign. This campaign is a joint initiative by US veterans and Vietnamese living in the US.

Agent Orange was one of several defoliants sprayed by the US Army during the Vietnam War. Defoliants kill plants and were intended to deprive guerilla fighters of hiding places and destroy crops that might feed them.  In addition, the Army sought to make entire regions “uninhabitable” forcing their population into controlled villages (called strategic hamlets).

These defoliants were contaminated with dioxin, considered one of the most toxic substances known to man.  The health impacts of dioxin were succinctly summarized in a 2007 American Public Health Association statement on Agent Orange:

“Dioxins are known to be risk factors for cancer, immune deficiency, reproductive and developmental disorders, and central nervous system and peripheral nervous system effects.

Studies conducted by the international scientific community have shown the association between exposure to the herbicides and health outcomes, including cancer, reproductive illnesses, immune deficiency, endocrine deficiencies, nervous system damage, and other ill effects and possible developmental disabilities and emotional problems in children.

Those negatively affected may include children born to parents who were sprayed directly. Current conditions recognized by the US Veterans Administration as service connected to Agent Orange exposure include the following: soft tissue sarcoma, chloracne, Hodgkins Disease, multiple myeloma, non-Hodgkin’s lymphoma, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers, chronic lymphocytic leukemia, diabetes (type 2), and spina bifida in the children of veterans.”

About 1/10^th of Vietnam is estimated to have been sprayed with some 20 million gallons of Agent Orange.  Dioxin hot spots remain today around US air bases.   Upwards of 2.1 million people may have been exposed to Agent Orange.

There is a strong case that the use of Agent Orange and other herbicides is illegal under various international agreements.  In addition, there is evidence that the US military knew that Agent Orange was contaminated with dioxin.

In September of 2004 a group of Vietnamese filed a law suit in New York Federal Court against 36 chemical companies. The suit sought to hold the companies “accountable for their actions when they knew they were providing a poison in orangebanded barrels to the United States government which was to be sprayed on millions of people and vast areas of land in South Viet Nam.” The suit was thrown out of court by Judge Jack Weinstein.  The judge’s decision stated in part: “Defendants moved in those cases for summary judgment based on the government contractor defense-in essence, the claim that the government told us to do it and knew at least as much as we did about the dangers. The court granted defendants’ motion to dismiss those tort-based claims on the grounds that the contractor defense applied.” This lawsuit has been appealed.

There is a need to clean up the dioxin that remains in Vietnam and to care for and compensate the victims of this toxin.  There is also an interest in doing a comprehensive survey of the effects of Agent Orange in the Vietnamese community in the US.  Agent Orange-related damage is also an ongoing problem for US Veterans. The Veterans’ Administration has lots of information on Agent Orange, sprayed “to remove unwanted plant life and leaves which otherwise provided cover for enemy forces during the Vietnam Conflict.”

Sadly, we are likely witnessing a replay of this story today in Iraq.  Please see our September 12, 2008 posting on the impact of the war on health conditions in Fallujah.

Posted by Matt Anderson,  MD

Reports from Iraq on the Health Impact of the War

Dr. Dahlia Wasfi has passed on to us several Iraqi reports about the dramatic health problems caused by the US invasion and occupation of their country.  The materials sent by Dr. Wasfi are important because they provide an Iraqi perspective.

Two concern the use of chemical weapons in Fallujah.  Fallujah, once known as the City of Mosques, was the subject of two major U.S. assaults in April 2004 and November 2004.  Fallujah had also been subject to bombings during the first Gulf War.  Italian RAI News has produced a documentary entitled Fallujah: The Hidden Massacre which shows scenes from the November 2004 attacks.

• A 9 minute video, Iraq Deformities, produced by Journeyman Pictures reports an increase in birth defects among children born since the assault. The local population attributes these defects to the use of white phosphorus by the US Army.

• Dr. Dr. Muhamad T. A. Al-Darraji is an embryologist who is President of the Conservation Center of Environmental and Reserves in Fallujah (CCERF) and Director of Monitoring Net of Human Rights in Iraq (MHRI net). In March of 2008 he prepared a report for the High Commissioner for human Rights of United Nations entitled Prohibited weapons Crisis: The effects of pollution on the public health in Fallujah. He notes in his report that the medical records of Fallujah General Hospital were destroyed in the assaults, making it difficult to establish a comparison before and after 2004. This problem is compounded because the population in Fallujah has been greatly decreased. His document points to increased numbers of pediatric illnesses:

The main civilian victims of most illnesses were the children, and the rate of them represents 72% of total illness cases of 2006, most of them between the ages of 1 month and 12 years. While in 2007 was not very difference because many illnesses accounted the children with another ages.

Many new types and terrible amounts of illnesses started to appear since 2006 until now, such as Congenital Spinal cord abnormalities, Congenital Renal Abnormalities, Septicemia, Meningitis, Thalassemia, as well as a significant number of undiagnosed cases at different ages.

He also reports an increased incidence of cancer.

MPT [Muslim Peacekeeper Teams]  report refer Starting in 2004 when the political situation and devastation of the health care infrastructure were at their worst, there were 251 reported cases of cancer. By 2006, when the numbers more accurately reflected the real situation, that figure had risen to 688. Already in 2007, 801 cancer cases have been reported. Those figures portray an incidence rate of 28.21 by 2006, even after screening out cases that came into the Najaf Hospital from outside the governate, a number which contrasts with the normal rate of 8-12 cases of cancer per 100,000 people.

Dr. Wasfi also sent us a report from Dr. Souad N. Al‐Azzawi, an Associate Professor in Environmental Engineering, Iraq which focuses on the use of depleted uranium (DU) during the war.  She concludes:

“Continuous use of Depleted Uranium weapons since 1991 against the population and the environment of Iraq is an act of crime. The occupation’s total denial of the problem and refusing to allow international agencies to conduct any exploration programs to define the risk associated with this contamination, has resulted in more exposure to these radioactive pollutants, and more health damages.

Ignoring DU related health damages and the ongoing occupation of Iraq have proved to the world how desperate the American Administration is to control oil resources of the Middle East. Occupation of Iraq is a catastrophic criminal act that resulted in the death of over two million people and forced about five million of the population to leave their living areas inside and outside Iraq.

The occupying forces intentionally created a state of chaos during the invasion in 2003 to facilitate committing genocide against the Arab majority who refused the occupation of Iraq, ultimately changing Iraq’s demography and national identity in favor of the occupation’s new constitution and the minorities who helped them during the invasion and occupation of Iraq.

The occupation forces and allies failed to comply with Article 2 of the four Geneva Conventions of 1949, and articles (42-56) of the Hague Regulations that addresses obligations imposed on occupying powers towards occupied people. The occupation forces and its assigned governments failed to ensure basic human needs like potable water, food, medical care, education, sanitation, and security. The excessive use of power, besieging whole cities, illegal imprisonment of civilians and even children, and occupation induced poverty have all turned Iraq into a death camp.

The international community is urged to help Iraqis gain back their independence and sovernity through getting the occupation forces out of Iraq and through refusing any shape of colonial, long term security treaties that would facilitate taking over the country and control the oil of Iraq through permanent foreign army bases.”

Commentary

This situation is not a new story.  There is an active campaign in the US to address the long-term health consequences (particularly in terms of congenital abnormalities) amongst Vietnamese exposed to dioxin during the Vietnam War. This campaign resulted from years of collaborative work between Vietnamese and international researchers.

It would seem fitting that US health personnel build relationships with our Iraqi colleagues to take their concerns seriously, to work collaboratively to document the health impact of the invasion/occupation, and to repair the damage caused by the war.

Posted  by Matt Anderson

Health Activism in the UK

A very partial listing…

Medact: formed from the Medical Campaign Against Nuclear Weapons and the Medical Association for the Prevention of War, Medact “speaks out for countless people across the globe whose health, wellbeing and access to proper health care are severely compromised by the effects of war, poverty and environmental damage.” We are particularly grateful to Medact for their consistent attention to the health effects of the war against Iraq. Their work, however, involves a broad set of social issues including development, environment and refugees.

Socialist Health Association: The SHA is affiliated with the British Labour Party and works for a health care system that reduces inequalities and is founded on socialist principles.

Medical Foundation for the Care of Victims of Torture: “Founded in 1985, the Medical Foundation for the Care of Victims of Torture provides care and rehabilitation to survivors of torture and other forms of organized violence.”

Medical Justice “Medical Justice facilitates the provision of independent medical advice and independent legal advice and representation to asylum seekers detained in immigration removal centres. We also seek to negotiate changes to policy and practice within detention centres and publish our findings on the treatment of detainees.”

Action on Smoking and Health: The UK site for this international organization of anti-tobacco activists. The US site is at this link.

Politics of Health Group (UK) POHG’s slogan is: “Healthcare as if people mattered.” (What a radical idea!) PoHG “campaigns for the social, economic and environmental conditions that support health for all people, and against the market-oriented political and economic decisions that are currently being taken in the UK and across the world, and the inequalities, discrimination and poor health they create.” They have a number of thoughtful publications, accessible at this link.

Please attach a comment or send us an email if there are other groups we should include.

Pulse Magazine: My War Story

After a long gestation, Pulse Magazine is finally up and running. The Magazine has just published its fourth piece: My War Story by Marc Tumerman, MD. The story relates a doctor’s response to the health and emotional problems of an Iraqi War vet the author calls Captain America. In publishing this story Pulse is fulfilling its mission of “publishing personal accounts of illness and healing” as well as “fostering the humanistic practice of medicine.”

My War Story begins this way:

My practice is in a small rural Wisconsin town just down the road from a large military base. I see soldiers pretty regularly these days; they stay here for several weeks of pre-deployment training before shipping off to Iraq. They come from all over the country–men and women of various ages, some single, some married and with families. Their health-care needs aren’t too different from those of my civilian patients: maternity care, chronic illness management and the usual scrapes and bruises. I like having them on my schedule; their Boston accents and Georgia drawls make a pleasant change from my neighbors’ familiar, made-for-radio Midwestern monotone. [click here to read the rest]

Drs. Vic Sidel & Barry Levy: War and Public Health

“War has an enormous and tragic impact-both directly and indirectly-on public health. War accounts for more death and disability than many major diseases combined. It destroys families, communities, and sometimes whole cultures. It directs scarce resources away from health and other human services, and often destroys the infrastructure for these services. It limits-and often totally eliminates-human rights. War leads many people to think that violence is the only way to resolve conflicts, a mindset that contributes to domestic violence, street crime, and many other kids of violence in the world. War contributes to the destruction of the environment. In sum, war threatens large elements of the fabric of our civilization.”

- From the Preface to War and Public Health, edited by Barry S. Levy and Victor W. Sidel, Oxford University Press, 1996 (updated January 2000)

War and Public Health (cited above) is considered the classic introduction to the health impacts of war. We were fortunate to have Drs. Levy and Sidel present at our Social Medicine Rounds on April 8, 2008. Dr. Levy presented an outline of the myriad ways in which war impacts on health. Among these:

• Direct injury to both soldiers and civilians resulting in death, physical injury and mental distress/illness. These effects are often long-lasting, as when people are maimed or crippled.
• Damage to the health care infrastructure.
• Damage to the health-supporting infrastructure (water, electricity, etc.).
• Environmental damage resulting in toxic exposures.
• Creation of refugees and internally displaced persons.
• Violations of human rights: These might include violations of medical neutrality, ethnic cleansing, and torture.
• Diversion of human and financial resources to the war effort.
• Promotion of violence as a way of solving social problems.

Dr. Vic Sidel, Distinguished University Professor of Social Medicine at Montefiore Medical Center and Albert Einstein College of Medicine, was one of the founders of Physicians for Social Responsibility (PSR) in 1961 and was its president in 1987-88. In 1980 he was one of the founders of the International Physicians for the Prevention of Nuclear War (IPPNW), the recipient of the 1985 Nobel Prize for Peace, and was its co-president from 1993 to 1998.

Barry S. Levy, M.D., M.P.H., is Immediate Past President of the American Public Health Association. He is also an independent consultant in environmental and occupational health and an Adjunct Professor of Community Health at Tufts University School of Medicine.

Global Health Watch: The Alternative Health Report

Global Health Watch is one of several civil society initiatives set up after the international community failed to reach the goal of “Health for All” in the year 2000. It is a “broad collaboration of public health experts, non-governmental organisations, civil society activists, community groups, health workers and academics” which attempts to produce an alternative health report. GHW was started by the People’s Health Movement, Global Equity Gauge Alliance and Medact.

GHW published its first report in 2005-2006 and it is available for free at this link. The report covers a broad variety of topics within contemporary global health. The 360 page report provides essential reading on globalization, health care systems, medications, the crisis in global health care workers, sexual and reproductive health, gene technology, indigenous health, disabled people, climate, water, food, education, war, the WHO, UNICEF, World Bank/IMF, big business, international AID, debt relief, and essential health research.

Work is currently ongoing on the production of GHW 2007-2008. One can also subscribe to the GHW monthly newsletter.

Here is the introduction to GHW 2005-2006:

“Today’s global health crisis reflects widening inequalities within and between countries. As the rich get richer and the poor get poorer, advances in science and technology are securing better health and longer lives for a small fraction of the world’s population. Meanwhile children die of diarrhoea for want of clean water, people with AIDS die for want of affordable medicines, and poor people in all regions are increasingly cut off from the political, social and economic tools they can use to create their own health and well-being.

“The real scandal is that the world lacks neither funds nor expertise to solve most of these problems. Yet the predominance of conservative thinking and neoliberal economics has led the institutions that were established to promote social justice into imposing policies and practices that achieve just the opposite. They police an unjust global trade regime with a doctrinaire insistence on privatization of public services, and preside over the failure to curb disease by tackling the poverty that enables it to flourish. Global Health Watch 2005–2006 is a collaboration of leading popular movements and non-governmental organizations comprising civil society activists, community groups, health workers and academics. It has compiled this alternative world health report – a hard-hitting, evidence-based analysis of the political economy of health and health care – as a challenge to the major global bodies that influence health. Its monitoring of institutions including the World Bank, the World Health Organization and UNICEF reveals that while some important initiatives are being taken, much more needs to be done to have any hope of meeting the UN’s health-related Millennium Development Goals.

“The report also offers a comprehensive survey of current knowledge and thinking in the key areas that influence health, focusing throughout on the health and welfare of poor and vulnerable groups in all countries. These issues range from climate change, water and nutrition to national health services and the brain drain of health professionals from South to North.

“Global Health Watch 2005–2006 is above all a call for action, written in a clear, accessible style to appeal to grass-roots health workers and activists worldwide, as well as to international policy-makers and national decisionmakers. Its resource sections advocate actions everyone can take, while its recommendations show how better global health governance and practice could work for Health for All rather than health for the privileged few.”

The War in Iraq

Health Impact of the War in Iraq

For specific information on the health impact of the current war in Iraq, the MEDACT site offers a number of excellent reports. Information on civilian casualties in Iraq is maintained by Iraq Body Count. Military casualties are logged by the Iraq Casualty Count.

An editorial, entitled “The War Comes to Our Waiting Room,” which discusses the impact of the war on a medical practice in the US was published by Social Medicine in Volume 1, number 2.

Medical Personnel and Torture

In July of 2005, the New England Journal of Medicine published a report by M. Gregg Bloche, M.D., J.D., and Jonathan H. Marks, M.A., B.C.L. on the involvement of medical personnel in the interrogation of Guantanamo detainees. This report is available as a PDF download as well as an audio interview with Jonathan Marks. Similar concerns about the use of psychologists to design “scientific” interrogations were also voiced in July of 2005 in the New Yorker magazine. Medscape General Medicine has compiled a list of recent articles on medical personnel involvement in torture.

Physicians for Human Rights provides a more general discussion of physicians and torture.

Opportunities to Work for Peace

Organizations of physicians such as Physicians for Social Responsibility and International Physicians for the Prevention of Nuclear War have been in the forefront of efforts to prevent violence.

A call to oppose a “medical draft” can be found on the website of Edward Hasbrouck (”the practical nomad”) has set up an interesting page opposing the medical draft. There are a number of interesting links from this page.

Dr. Walter Lear discussed Health personnel who have opposed war throughout the 20^th century in Volume 2, No 3 of Social Medicine.

Sources of Information on War and Health

It is often difficult to get non-corporate news about the current conflicts and particularly the war in Iraq. Here are some sites from the alternative media:

• www.indymedia.org is an activist oriented general news source.
• www.democracynow.org (”the exception to the rulers”) produces a War and Peace report with independent coverage and interesting views.
• www.indybay.org is a San Francisco Bay Area based independent media org.
• For independent news in Spanish, consider Emilio J. Corbière’s Argen Press. “La muerte no es verdad cuando se ha cumplido bien la obra de la vida.” (José Martí)
• www.alternet.org seems to focus more on uncovering lies or ambiguities in current headlining news.
• www.mediachannel.org is a NY-based organization that presents itself as a news-watch news channel. It critiques current news.
• www.informationclearinghouse.info is a one-man website, but it hosts a few health related articles, e.g. “Military mental health workers in Iraq.”