Arsenic and Old Mines

When I first found out I would be spending my summer researching arsenic contamination in Thailand, I couldn’t help but think of the 1940’s classic film, “Arsenic and Old Lace,” which was my first introduction to arsenic and its poisonous characteristics. In the dark comedy, Cary Grant’s character discovers his two sweet elderly aunts are actually serial killers that poison unsuspecting lonely old men with a deadly concoction of homemade wine and arsenic. While the circumstances here in Ronphibun, Thailand are entirely different, it highlights the dangers the heavy metal poses. Arsenic is known as the “silent killer”; it has no taste, no smell, no color, and can easily leach into surface and ground water without detection. While acute large doses lead to death within a few hours, arsenic is actually of greater public health concern in chronic low doses.

Arsenic-contaminated shallow well

Arsenic-contaminated shallow well

Chronic arsenic exposure is a major global environmental health concern and is estimated by the WHO to effect over 200 million people worldwide.1 Arsenic is found naturally in the environment, with some specific geographic areas like Bangladesh, India, China, and Taiwan having naturally arsenic-rich groundwater. However anthropogenic activities, primarily mining-related activities, have contributed to arsenic enrichment in certain areas of the world. Ronphibun Subdistrict, in Nakhon Si Thammarat Province of Southern Thailand, is one such area of high arsenic contamination.

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Remains of a tin mine in Ronphibun

Ronphibun literally translates into “rich in metals” because the area lies along the Southeast Asian tin belt and was heavily mined over the course of a hundred years. The tin-mining process left behind huge waste piles of arsenic-containing residue, primarily arsenopyrite. Usually arsenopyrite is underground, but when unearthed and exposed to oxygen the compound oxidizes and inorganic arsenic leaches into the surrounding environment. Here in Ronphibun, the arsenic leached into the local groundwater, surface water, and inhabitants’ shallow wells. To put the severity of the contamination into perspective, the WHO-recommended “safe” level of arsenic in drinking water is 10 μg/L and some of the shallow wells in Ronphibun contained over 1000 μg/L. The Thai government halted mining after over 1000 cases of arsenicosis were officially diagnosed in Ronphibun in 1987, and interventions like piped-in water from other areas and rain collection pots were distributed. Despite these interventions, the environmental and health impacts still persist today.

Arsenic-contaminated stream and pipe for non-contaminated water

Arsenic-contaminated stream and pipe for non-contaminated water

We are studying arsenicosis, the diseases associated with chronic ingestion of arsenic-contaminated water. Our focus is on one of the most common health effects that develop within years of exposure: arsenical skin lesions. These include:

  • spotty or diffuse hyperpigmentation= dark spots
  • depigmentation (or hypopigmentation)= white spots
  • spotty or diffuse hyperkeratosis= thickened skin
IMG_1996

Hyperpigmentation and excised Bowen’s disease

Depigmentation

Depigmentation

These lesions can be precursors to Bowen’s disease and basal and squamous cell carcinomas. Keratosis is usually found on the palms or soles of feet, while hyperpigmentation and depigmentation are usually found on the arms, legs, and trunk. However, skin lesions type, pattern, and severity are extremely different among individuals, even those from the same household, and the reason is unclear. It is known that arsenic is excreted from the body through skin, hair, nails, and urine, but the mechanism that causes these arsenical skin lesions is not well understood.

Bowen's disease

Bowen’s disease

Our study focuses on epigenetics, as it is likely that epigenetic changes to genes involved in melanin or keratin production have a role in producing these skin lesions. Led by Dr. Alan Geater and PhD student Witchaya (Morn) Phetliap of Prince of Songkla University (PSU) and Dr. Laura Rozek of UM SPH, the study investigates the role epigenetics plays in arsenical skin lesion manifestation and severity. We are comparing the epigenetics of Ronphibun residents with skin lesions and those without; Morn and I are collecting saliva samples for DNA analysis, and toenail and urine samples for long-term and short-term arsenic concentration analysis. Once we collect all the samples in Ronphibun, they will be brought back to Dr. Rozek’s lab for analysis.

Collecting samples at home visits

Collecting samples at home visits

This study has been a great collaboration between Thailand’s PSU and the University of Michigan; both schools recently signed an MOU to continue research collaborations together. I’ve had a great time interning in Thailand, so I am excited to for Morn to fly over and spend a couple months in Ann Arbor doing lab analysis for the project. I am sure he will receive a warm Michigan welcome (well… just a warm welcome from the people, not sure about the weather)!

Thanks to Marc-Grégor Campredon (http://www.marc-gregor.com) for providing the photographs.

1WHO (World Health Organization). Guidelines for drinking-water quality: incorporating first and second addenda to third edition. Vol. 1, Recommendations, Geneva: World Health Organization, 2008.

 

 

 

 

 

10 Things I’ve learned in Peru

1. Peruvians are very proud of their heritage. The country has had a tumultuous past, but people are so proud to be from Lima (they are called limeños) or from Cuzco or wherever they live. They celebrate their culture through art, music, dance, textiles, etc and are excited to talk about it. Their independence days are July 28 and 29 and they celebrate them for about two weeks.

Church in Arequipa, Peru in the Monasterio de Santa Catalina

Church in Arequipa, Peru in the Monasterio de Santa Catalina

2. Peruvians in general are short. At 5’5″, I tower over most people. The women wear heels most of the time to appear taller.

3. A lot of Peruvians are also overweight, so their BMI must be out of control. They drink a lot of soda such as Inca Cola, this highlighter yellow beverage that tastes like bubble gum to me. They eat a lot of sugar and bread. On the other hand, the abundance of fresh fruits and vegetables here is incredible. Every street corner store and often street carts sell bananas, oranges, avocados, potatoes, etc.

4. It’s ok to get on the bus even if it looks like one more person won’t fit without the whole vehicle bursting. Eventually people will get out and you can get a seat. There might be a metaphor in here about doing things that seem impossible because they will most likely work out.

Combi bus, one of the "joys" of travel

Combi bus, one of the “joys” of travel

5. You have to get out of the city and go smell the fresh country air, see the stars, and get out of the chaos. It is cleansing for your mind, lungs, and soul.

Me at the Canon de Colca, the second deepest canyon in the world. There were 9 condors (a large bird that the Incas worshipped) flying in the canyon that day.

Me at the Canon de Colca, the second deepest canyon in the world. There were 9 condors (a large bird that the Incas worshipped) flying in the canyon that day.

6. The colonial buildings here are incredible. The old churches, monasteries, government buildings, and restaurants are beautiful. It’s amazing to see all the detail they put into these old buildings. The new buildings are very modern, with plain walls and no detail. People don’t necessarily like the colonial look anymore, which I think is a shame.

Colonial church in Miraflores, Lima, Peru

Colonial church in Miraflores, Lima, Peru

7. Living near the coast and eating fresh seafood is great. I normally don’t like or eat much seafood, but when it’s fish or shellfish right out of the ocean, it’s delicious. I have learned to eat ceviche (fish or shellfish cooked with lemon and the acid in the lemon breaks down the proteins in the fish, therefore cooking it) and fried fish called chicharrones. Both are delicious.

8. Peru has thousands of varieties of potatoes. I’ve only tried a handful, but they are delicious. Unfortunately, I tried to make mashed potatoes with one variety and it didn’t work out too well.

9. Peru (or any developing country for that matter) is a really hard place to live for sensitive people. Sensitive in the sense of emotional sensitivity, yes, but also someone with heightened 5 senses of the body. I have a keen sense of smell and it goes wild here. Walking down the street, I’m confronted with a range of smells: fish cooking, potatoes frying, urine, trash, cigarette smoke, diesel exhaust, and every once in a while fresh cut grass. My sense of taste is elevated with the different foods I taste, as mentioned above. Sense of sight: Very hard to describe everything I’ve seen here because I’m incredibly observant. I’ve seen colorful buildings and houses, lots of signs advertising the upcoming elections, a bare naked man changing in the street, dogs searching for food, indigenous people in their full traditional dress dancing and/or trying to make a bit of money selling handmade goods on the street. I’ve seen fights, love, smiles, families embracing, people saying goodbye. Sense of sound is heightened because the city of Lima is never quiet. There’s always people talking, cars zooming past, car alarms going off, horns honking, babies crying, people cutting the grass, water running, etc. Sense of touch: well, I try not to touch more than I have to. I always have to touch the bus railings to hold on, but I’m sure I encounter lots of germs that way. Touching money also always makes me nervous. I wonder who sneezed on this money at one point…

Peruvian money- the Nuevo Sol. There are 5, 2, 1, 0.50, 0.20, 0.10, and 0.05 sol pieces.

Peruvian money- the Nuevo Sol. There are 5, 2, 1, 0.50, 0.20, 0.10, and 0.05 sol pieces.

10. Peru actually has a really good public health awareness and advertising system. On every bottle of alcohol, it says that drinking in excess can cause harm. On cigarettes, advertisements say that smoking causes cancer. I’ve seen posters that talk about staying home from work when you’re sick. Tuberculosis warnings are all over the buses. Plus, casinos talk about how gambling can cause problems. It’s really nice to see all of these advertisements.

Chao for now!

Up, Up and A- Way Over to Mongolia

This summer I am living and interning in Mongolia and I must say it has been the experience of a lifetime. Now, I know that phrase is extremely vague so I will explain why this experience has been so enjoyable, challenging and valuable for me.

I arrived in Mongolia not knowing exactly what to expect. I did not know what the infrastructure would be like, how developed the city would be, how I would be perceived, what I would have access to (food, internet, water, etc.) or what my experience would be like. I was pleased to find that Ulaanbaatar, Mongolia’s capital city, is very well developed. There are paved roads with lots of traffic, huge malls, restaurants, universities and many places to see and enjoy! The rest of the country varies culturally and geographically which, I have been able to witness through my travels. I have been here for a while so I think it is best to recap. My experience is best broken into 4 parts.

1) Ulaanbaatar- arriving in Mongolia, adjusting to the 12 hour time difference, planning for the study, exploring

2) The Gobi Desert- collecting samples for the study, no running water, enjoying simple pleasures

3) Erdent City- visiting a copper mine, getting to know 35 amazing students from Mongolia’s School of Public Health, fun times

4) Back in UB- data entry, making new friends, Naadam festival, teaching English, “never can say good-bye”

I will elaborate on each of these experiences separately in the upcoming blog posts.

Overall, I will say that I am very glad that I opened myself up to this experience. I have never been to an Asian country before and I was nervous about applying to spend 3 months in Mongolia. However, I did it and it has been very rewarding.

My word of advice: Opening yourself up and welcoming new and even possibly uncomfortable experiences is very important because you may find something in that experience that you did not expect and gain invaluable insight.

 

P.S: Here is a sneak peak; I’ve posted one picture from each of the four parts!

1)

welcome to Mongolia

This is the very first picture that I took in Mongolia. I had no idea of what was in store.

2)

This shot is from the Gobi desert, where we conducted our study. I spent a lot of time hanging with camels while collecting water samples!

This shot is from the Gobi desert, where we conducted our study. I spent a lot of time hanging with camels while collecting water samples!

3)

This is where they mine for copper. We toured the entire copper mine.

This is where they mine for copper. We toured the entire copper mine.

4)

Naadam is the Mongolia cultural festival. This is just one of many outtings during the last part of my Mongolian experience.

Naadam is the Mongolia cultural festival. This is just one of many outtings during the last part of my Mongolian experience.

 

Mid-Summer Epi Character Tome

Even though I’ve only ever created one character for a Dungeons & Dragons role-playing game, I tend to make daily use of the phrase “leveling up.” Sometimes it’s a sarcastic remark utter in referring to another person – when the (now ex-) Japanese Prime Minister Junichiro headed an official apology to former comfort women, I muttered that the event was a leveling up 60 years in the making. On a happier note, however, I also consider the routes through which I, friends, family, and colleagues can and do level up. I think about what can make us better at what we do – as friends and partners, as healthy individuals, and, in my case, as an epidemiologist with relatively little real world experience to-date.

I might be addicted to learning, and seeking out new self-education opportunities, in the way that some people are die-hard players of Candy Crush.

I am always trying to pursue what I see as new Epi-related skills, to flesh out my current knowledge of nodes and connections, and (AND) I have kept a list. Think of it as a character sheet.

In adapting my list for this post, I’ve stuck to concepts and softwares/hardwares that are on the technical side of epidemiology learning and omitted personal wellbeing fields that, I am certain, are just as crucial to my professional path. I have rated each skill on my own subjective, anecdotal, and yet logical 1 to 10 scale, where 1 is equivalent to a recent subject introduction that calls for further practice and 10’s adroitness is performed without hesitation, with months of experience, but includes the tenet that there is always more to learn. (If anything, I am likely to be too hard on myself.) I grouped each skill roughly by type and, because it is summer, I have placed an asterisk (*) by the skills I have used so far in my internship.

Coding Languages and Programs with Coding
*Python +1
*Microsoft SQL/VBA +7
Matlab +4
HTML5 and XHTML +8
JavaScript +8
*ArcGIS 10.1 +2
*SAS 9.2 and 9.3 +5
STATA 12 +3
NetLogo +2
JMP +1
*Access +8

Software Without UErCoding
*Word +10
*Excel +9
*Publisher +7
PowerPoint +10
InDesign +5
Illustrator +4
Photoshop +2
Google Productivity Tools +9
Atlas.ti + 7

Tasks and Skill Areas
*Coding/Computer Interaction +7
*Data Analysis +7
Statistical Regression +5
*Writing Reports +8
*Workplace Communication +6
*Multitasking/Prioritizing +8
*Self-Motivation +7
*Proofing +10

Large Database Experience
*eHARS +5
NHANES +7

I think my next steps consist of improving my SAS and GIS knowledge, learn R, incorporate more regression into practice, and not let my anxiety cloud my love to write in both personal and professional forms (and oh, do those two interact). I think, too, that I may start including my ability/flexibility to pick up new traits fast and remember/add to them with depth.

Oh. Hello, by the by. My name is Jamaica and my apologies for being late to the party. It has been a weird/hard summer, but I have looked forward to meeting you. I am an epidemiology student currently working with the HIV Surveillance Unit in Southfield, MI. I get giddy at all things data.

More soon. Truly.

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Healthy Messages

For your viewing pleasure, a few of the public health messages I’ve run across this summer:

IMAG0069

Paris, France: Notice about influenza and other respiratory diseases posted in a restroom

“Wash your hands multiple times per day”

“When you sneeze or cough, cover your mouth & nose with your sleeve”

“If you have flu symptoms, call your doctor”

 

IMG_5722

Hatyai, Thailand: Handwashing signs (notice the germ-monsters) posted outside the public restroom near our favorite market (Photo courtesy of MG)

(Sorry, can’t translate these for you!)

Sook Library Advertisement

Bangkok, Thailand: Advertisement for a new application designed to bring health materials and lifestyle tips to the masses of Thai people who rely heavily on mobile technology.  

Sook Library : Open source health and wellness materials distributed through a free app, advertised in partnership with the local public transit authorities.

Download for Android

iTunes download

 

What kind of messages have you seen?  What seem to be the talked-about public health concerns where you are?

The City of Eternal Spring

When I first learned that I would be placed in Cuernavaca, Mexico, I immediately googled (that’s a word now, right?) the city and learned briefly of its history. Located 40 miles due south of Mexico City, Cuernavaca is a relatively small city that houses El Palacio de Cortés (the oldest preserved colonial-era structure in the Americas, which housed Hernan Cortés, the Spanish conquistador who led the Spaniards in an expedition that caused the fall of the Aztec Empire, and his wife) and beautiful market places. It rains nearly every evening and is shining and bright by mid-morning. The temperature rarely gets above 90 degrees or below 60, hence the nickname City of Eternal Spring. The city is also home to the Instituto Nacional de Salud Publica (INSP), a world-renowned research institution housed within the Secretaria de Salud and the premier public health institution in Latin America. With a month under my belt and about a month-and-a-half to go, I have grown quite fond of the city, the food and culture, and people.

I should note: I am NOT fluent in Spanish. Far from it, in fact. I took a few classes in high school and when I realized I couldn’t roll my ‘R’s, I kinda sorta just gave up formal learning of the language all together. Over the years, I’ve listened to my fair share of Latin music and I have picked up words and phrases, here and there. That being said, I was relieved that Catherine, the person I was paired to go to Cuernavaca with, spoke fluent Spanish. AND to top it off, while her parents are from Colombia (making my companion Colombian-American) and she spoke Spanish in her home pretty often, she could not role her ‘R’s either. Needless to say, we bonded over our shortcoming (shout out to Catherine!! Hey girl heeeey!). Well no, that’s shallow. We actually bonded over our interest in community-based participatory research, life as a 20-something, and our general love for crime shows. Having a companion who not only speaks both English and Spanish, but who is kind, open and hard working has made this experience just wonderful. All and all, I’ve made it my business to improve my Spanish. After all, it is one of the most widely spoken languages in the world. I may not be fluent once I leave, but I will certainly keep learning during my spare time.

Here are a few photos taken during our first few weeks in the city. We’ve successfully navigated downtown, toured museums, eaten tacos and churros (alllllll of the churros) off street trucks, and taken public transportation in the form of Mercedes-Benz vans-turned-buses to and from our home.

El Palacio de Cortes

El Palacio de Cortes, a majestic structure turned museum. Pretty provocative history, if you’re interested in that kind of stuff.

El Mercado

The colors. I was captivated, seriously. There were at least 40 stalls in this particular marketplace and needless to say, I was overwhelmed. I did manage to make a few necessary purchases despite my transfixion.

El Centro

El Centro. The place to be any day of the week. Mariachi bands, food, shopping, people, bubbles and more. A lovely place to bring the family and explore…and it’s right across from El Palacio. Perfecto.

La iglesia

All gold EVERYTHING. Literally. The churches in Mexico are insanely ornate. This church alone, while small, contained three alters made entirely of gold.

Catedral de Cuernavaca

Admiring the view from the Catedral de Cuernavaca. I felt like I’d been ushered back to the 16th century.

In my next post, I’ll update you all on the research I’m conducting at INSP, what it’s like to be in Mexico during the World Cup (¡mi deporte favorito!) and my trip to Mexico City.

Saludos,

Michelle

Peruvian Adventures

Greetings from Lima, Peru! I’m Michelle Long, an EHS student in Environmental Quality and Health doing my internship at DIGESA in Lima, Peru. DIGESA is a sector of the Ministry of Health here that deals with envionmental issues, primarily water and food samples. I will write another blog post about my internship work, but for now I will explain the cultural experiences here in Peru.  I have been here a month now and every time I open my eyes in the morning, adventure awaits. No, I don’t go mountain climbing and scuba diving every day, but everything else here is almost as adventurous.

 

Alpacas

Alpacas

One adventure I experience daily is the food. I’ve been trying native Peruvian dishes and trying to get past my norm of being a picky eater. I learned I have an intolerance to MSG, a food additive used to enhance flavor. Here they call it Ajino Moto and they add it to every food at restaurants. I learned the hard way by eating Lomo Saltado (salted meat with vegetables and rice) and got a terrible migraine. Yesterday, I went to a Chifa restaurant, basically Chinese food with a Peruvian twist, and the only food on the menu without MSG was plain white rice, “diet” chicken, and vegetables. It was tasty. I also have tried ceviche multiple times. Lima is known for its gastronomy so I am trying to embrace it, although a Papa John’s pizza every once in a while is tasty too.
Ceviche Mixto- a typical dish made with seafood cooked in lemon or lime juice. The acid breaks down the proteins in the fish and cooks it.

Ceviche Mixto- a typical dish made with seafood cooked in lemon or lime juice. The acid breaks down the proteins in the fish and cooks it.

Another daily adventure is navigating the bus systems. It’s not the same as the Ann Arbor or University of Michigan buses. The roads here are pure chaos. There aren’t many traffic laws other than “Don’t hit the other cars.”  I have to walk a block to the bus stop, read the side of the bus (or Combi- like a big van) to see if it drives down the street I want, hope it isn’t completely packed so that I can stand and not be pushed up against the door. My “sea legs” have developed so I can stand on the buses. Some days I try different buses and go to different stops, but end up walking around lost for a few miles until I find my destination. One time I walked 3 miles but was right by the ocean, smelling the salt water and hearing the waves crash. I didn’t mind getting completely lost there.
 
I took a lot of Spanish classes throughout middle school, high school, and college. Studied abroad in Ecuador for 4 months. But then, didn’t use Spanish for 4 years. Needless to say, my Spanish is rusty but is good enough to get around, order at restaurants, and ask for help when needed. My understanding and speaking are slowly improving, but the language barrier has been frustrating. Just have to keep improving it and learning more Spanish.
 
Pacific Ocean from Parque de Amor, Miraflores, Lima, Peru

Pacific Ocean from Parque de Amor, Miraflores, Lima, Peru

Exploring Lima has been interesting. I really like Miraflores, the “gringo” area because there are other English speakers and it’s a really nice area. I went to one of the Inca Markets and bought some souveniers. I’ve been to Parque Kennedy and hope to explore that area more. Also, I’ve driven around with the internship to different areas of Lima to collect water samples. I’ll explain this more in my next blog post! I have a lot of items on my list of places to go in Lima and throughout Peru- so much to see in so little time!
 
With all the good comes the bad, too. Every day at SPH, I learned about diarrhea in some way. Of course, within two weeks here, I got the diarrhea after drinking an iced lemonade. Note to self: don’t drink anything here with ice. Ice is often made with tap water, which is not clean and contains many microorganisms because the water treatment process does not kill all of them. My apartment also got infested with fleas after my roommate and her dog left for 10 days on vacation. I had bites from head to toe, but cleaning everything and vacuuming daily has decreased the flea population size. During this time, I could only think of the potential vector-borne diseases I could have contracted. Luckily, no sign of them yet. Public Health knowledge at work! I also have been homesick, a feeling I haven’t really had since I was 10 and went to summer camp. Studying abroad and working abroad are completely different. I don’t have my normal support system here, but have made some friends. It’s definitely a growing experience and all the introspection has been both scary but fulfilling at the same time.
 
This weekend, I went on a trip to Ica, Huacachina and Paracas. These are towns in the south of the country with big sand dunes, islands, and a different sense of Peruvian culture.
 
In the Islas Ballestas near Paracas, Peru. Look closely and you can see a Humboldt Penguin!

In the Islas Ballestas near Paracas, Peru. Look closely and you can see a Humboldt Penguin!

Right now, at 8:30AM, all I want is a Zingerman’s sandwich and big glass of iced tap water.
 
Chao!