Life on the Mississippi: Tale of the Lost River Shrimp

Yale Environment 360 - June 24, 2014
The 20th-century re-engineering of the Mississippi River wreaked havoc on natural systems and devastated once-abundant populations of native river shrimp. Biologist Paul Hartfield has focused his work on studying these creatures, which were known for making one of the world’s great migrations. BY PAUL GREENBERG
Categories: Environment, Health

Citizen Scientists: Using the How Citizen Scientists Are Using the Web to Track the Natural WorldWeb To Keep Track of the Environment

Yale Environment 360 - June 23, 2014


By making the recording and sharing of environmental data easier than ever, web-based technology has fostered the rapid growth of so-called citizen scientists — volunteers who collaborate with scientists to collect and interpret data. Numerous Internet-based projects now make use of citizen scientists to monitor environmental health and to track sensitive plant and wildlife populations. From counting butterflies, frogs, and bats across the globe, to piloting personal drones capable of high-definition infrared imaging, citizen scientists are playing a crucial role in collecting data that will help researchers understand the environment. Here is a sampling of some of these projects.
View the gallery.
Categories: Environment, Health

Citizen Scientists: Using the Web To Keep Track of the Environment

Yale Environment 360 - June 23, 2014


By making the recording and sharing of environmental data easier than ever, web-based technology has fostered the rapid growth of so-called citizen scientists — volunteers who collaborate with scientists to collect and interpret data. Numerous Internet-based projects now make use of citizen scientists to monitor environmental health and to track sensitive plant and wildlife populations. From counting butterflies, frogs, and bats across the globe, to piloting personal drones capable of high-definition infrared imaging, citizen scientists are playing a crucial role in collecting data that will help researchers understand the environment. Here is a sampling of some of these projects.
View the gallery.
Categories: Environment, Health

Assistant fatally burned in UCLA professor’s lab, not an obstacle in receiving NIH grants

Pump Handle - June 23, 2014

The June 2014 news on UCLA chemistry professor Patrick G. Harran’s website announces his lab’s award of an NIH grant. I wonder if it will be updated with his other news for the month?

Last week, Harran settled criminal charges with the Los Angeles County district attorney (DA) for the work-related death of Sheri Sangji, 23. Sangji was a research assistant in Harran’s lab. She’d only been on the job a few months. She was hired primarily to set up lab equipment, but on Dec. 29, 2008 she was assigned to use tert-butyllithium (tBuLi). The highly reactive liquid ignites spontaneously when exposed to air. The flash fire seriously injured Sangji. She suffered the intense medical treatment for the burns, but succumb to her injuries on January 16, 2009.

After an investigation by the California Bureau of Investigations (BOI) and Cal/OSHA, the DA issued an arrest warrant in December 2011 for Harran (and the Regents of UCLA) for willfully violating worker safety standards. (Details from previous posts here and here.)

Now, two and a half years later, the legal proceedings seem to be coming to a close. On June 21, the DA and Harran signed a non-prosecution agreement to settle the case. Chemical & Engineering News (CEN) reports on the terms of the agreement:

  • Harran must develop and teach an organic chemistry preparatory course for the South Central Scholars, a volunteer organization that helps prepare Los Angeles inner-city high school students for college and graduate school. … Harran must teach this course each summer of the five-year term of the agreement.
  • Harran must complete 800 hours of community service in the UCLA hospital system…[performing]  jobs such as delivering food to patients.
  • Harran must pay a $10,000 fine which will be given to the Grossman Burn Centers.
  • Harran must talk with all incoming UCLA chemistry and biology students about laboratory safety.
  • Harran must not violate California labor code over the five-year term.

Over the next five years, if Harran violates the terms of the agreement, the charges against him will proceed to a trial. According to the CEN reporter, the presiding judge said Harran’s compliance would be monitored at regular court appearances. The judge added:

“[Harran] will be given one chance to get this right.”

UCLA’s press offered released a statement following the announcement of the settlement. It notes that both Harran and UCLA

“have agreed not to deny responsibility for the conditions under which the laboratory was operated at the time of the accident.”

It seems pretty much business as usual  if you look at the website for Harran’s lab. There are announcements of students completing their doctoral theses, and others receiving post-doc fellowships. The two most recent entries publicize the lab’s recent award, in April and June, of two NIH grants. Sheri Sangji’s work-related death is clearly not obstacle to the lab receipt of federal research funding.

Harran offered a public statement of remorse. Sheri Sangji’s sister, Naveen Sangji, MD noted that his remarks were a condition of the settlement.

I hope Harran begins each of his community-service teaching gigs by telling the students why he’s in their classroom.  It could be something like:

I’m here because a young research assistant in my lab was fatally burned. I failed to ensure my lab was safe and provide the appropriate training and protective gear. She died because of my actions.

Categories: Health

Study: Safe Routes to School investments save millions and improve quality of life

Pump Handle - June 20, 2014

Building safe ways for children to bike and walk to school is more than just a way of encouraging kids to go outside and get active. According to a new study, it’s also an investment that reaps millions of dollars in societal gains. In other words, smart walking and biking infrastructures for kids make good economic sense.

Published in the July issue of the American Journal of Public Health, the study examined the cost-effectiveness of Safe Routes to School (SRTS) infrastructure in just one city — New York City. SRTS was initially enacted in 2005 as part of a massive federal transportation bill known as the Safe, Accountable, Flexible and Efficient Transportation Equity Act and was supported with more than $600 million that states could use to build new sidewalks and bike lanes and enhance road safety features. In New York City alone, the study found that SRTS is linked with an overall net societal benefit of $230 million as well as 2,055 quality-adjusted life years gained, which measures the quality and quantity of life gained through a health intervention. And like many such public health ROI (that’s return on investment) studies, that’s a conservative estimate.

“To be honest, I wasn’t really sure what we would find,” said study co-author Peter Muennig, an associate professor of health policy and management at Columbia University Mailman School of Public Health. “Changes to intersections are not that expensive and they last a really long time, but on the other hand, the chance of any one person getting killed at an intersection is fairly tiny. So we went into it not really knowing what would happen. But when you look across the whole city, the effect was pretty big.”

To conduct the study, which examined the impact of SRTS on everyone and not just schoolchildren, Muennig and his study colleagues focused on intersections with histories of high injury rates and estimated the long-term impact of SRTS improvements on injury and its associated economic and quality-of-life costs. They found that SRTS saves $5,500 per user and results in a net gain of about 0.02 quality-adjusted life years per user, noting that “in the parlance of cost-effectiveness analysis, SRTS is said to ‘dominate’ a no investment strategy, indicating that every dollar spent on SRTS saves both money and lives.” When all users of SRTS improvements are taken into account over 50 years, it comes to a net benefit of $230 million and more than 2,000 quality-adjusted life years gained. The study also found that even if the gains are isolated to just school-age children, SRTS still saves money over the long run.

Muennig told me that this is a conservative estimate, as it doesn’t account for other ways SRTS may impact health, such as the impact that increased physical activity can have chronic diseases such as obesity. Noting that SRTS has been found to increase walking and biking among children (click here for a wealth of evidence on inclusive transportation planning, physical activity and child health from the Safe Routes To School National Partnership), Muennig and co-authors Michael Epstein, Guohua Li, and Charles DiMaggio write:

About one third of obese children become obese adults, and obese adults accrue many additional costs, such as lost productivity costs, and obesity accounts for upwards of 10% of all medical costs. Moreover, the rise in obesity expenditures outstrips the medical portion of the consumer price index in part because obesity rates are increasing and in part because, as the population ages, the obese incur disproportionate costs.Were SRTS to prevent a small number of cases of obesity in each cohort, this benefit alone would likely pay for the entire program over time.

Muennig said the SRTS benefits that he and his colleagues found would likely be even greater in communities that don’t already have the extensive pedestrian networks that New York City does. In the context of a serious obesity epidemic in the United States, he added that smarter transportation and urban planning that supports safe walking and biking could be a key component to creating healthier populations.

“(Efforts such as SRTS) get people out and moving around in ways that don’t require a lot of volition on their part,” he told me. “Urban redesign to reduce dependence on motor vehicles has great promise. From a theoretical standpoint, it holds much greater promise than hoping people will diet and exercise on their own.”

Muennig said he hopes advocates will use his findings to justify continued investments in pedestrian and bicycling infrastructure and enhancement, though he knows it can be a tough sell. In the latest iteration of the federal transportation funding bill, now known as Moving Ahead for Progress in the 21st Century Act, or MAP-21, SRTS was combined with other biking and walking programs and funding was cut by more than 30 percent.

“It’s a tough funding environment in general,” Muennig said. “There’s a strong movement toward across-the-board budget cuts and we’re not thinking carefully enough about which cuts are targeting investments that will produce monetary returns and which are needed to address the deficit. …If you don’t have functioning roads, you don’t have a functioning economy. If you have a sick and obese population, you can’t have a functioning economy. We need to think carefully, on both the left and the right, about which kinds of investments will produce returns over the long run.”

To request a full copy of the latest SRTS study, visit the American Journal of Public Health. To learn more about Safe Routes to School, visit Safe Routes to School National Partnership. And to read more about why transportation design matters to community health and how inadequate public transportation disproportionately affects low-income workers, read Liz Borkowski’s recent post here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health

Average Summer Temperatures in U.S. Have Risen Up To 5 Degrees Since 1970

Yale Environment 360 - June 20, 2014
Summer temperatures in the U.S. have been rising on average 0.4 degrees F per decade since 1970, or about

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Average summertime temperature increases 2 degrees F overall, but the Southwest and West regions have borne the brunt of those increases, according to an analysis by Climate Central. In the Southwest, temperatures have risen an average of 0.6 degrees per decade, with a few localized areas warming as much as 0.9 degrees per decade. In the West, some parts of California and Nevada have warmed 1.32 degrees F per decade, or more than 5 degrees total since 1970. On the other end of the spectrum, the Upper Midwest has seen the lowest increases. Temperatures in that region have increased only 0.1 degree F per decade on average. The National Climate Assessment, released last month, found that annual average temperatures in the U.S. could increase by 10 degrees F before the end of the century if the rate of greenhouse gas emissions doesn't slow.
Categories: Environment, Health

It feels good to be cheered down a mountain by a throng of friends, supporters and family members

Breast Cancer Fund - June 19, 2014
Our Climb Against the Odds 2014 team made it back to civilization today in high spirits. Twenty of the 25 climbers made it to the top of the 14,179-foot Mount Shasta. The remaining five climbers made it to at least...
Categories: Health

Rerouting Flights to Avoid Contrails Would Slow Climate Change

Yale Environment 360 - June 19, 2014
Rerouting the flight paths of commercial aircraft to minimize the condensation trails, or contrails, they leave behind would help slow global warming, even if

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Alternate flight paths to avoid contrail formation the new flight path is longer, according to research published today. Contrails, thin clouds composed of ice crystals condensed from an aircraft's exhaust, can persist for 17 hours or more and are likely the single largest contributor to climate change associated with aviation. They form when a plane passes through parts of the atmosphere that are very cold and moist, usually near high pressure systems. The new research shows that avoiding contrail formation has greater climate benefits than avoiding additional carbon dioxide emissions associated with slightly longer flight routes. For example, for a small aircraft that is predicted to form a contrail 20 miles long, an alternative path that adds less than 200 miles will have a smaller climate impact than the contrail. For a larger aircraft, which emits more CO2 per mile than a smaller plane, the alternative route is preferable if it adds less than 60 miles, according to researchers from the University of Reading.
Categories: Environment, Health

Peak Coal: Why the Industry’s Dominance May Soon Be Over

Yale Environment 360 - June 19, 2014
The coal industry has achieved stunning growth in the last decade, largely due to increased demand in China. But big changes in China’s economy and its policies are expected to put an end to coal’s big boom. BY FRED PEARCE
Categories: Environment, Health

“Decide to be safe” is not an answer to workplace hazards

Pump Handle - June 19, 2014

Motivational speaker Kina Repp shares a dramatic story when she addresses audiences at occupational health and safety conferences. In 1990, Repp lost her arm in a piece of machinery when she was working at a seafood canning plant in Alaska. She was a college student trying to earn money for college tuition. It was Repp’s first day on the job—-only 40 minutes into her shift—-when the machine caught her arm. Repp not only lost her arm, her shoulder blade was torn off, she had a broken collarbone, a severe neck injury and a collapsed lung.

Repp was the keynote speaker at a recent conference organized by the State of Oregon’s Occupational Safety and Health Administration (Oregon OSHA) and its S&H Achievement Recognition Program (SHARP).  The Associated Press (AP) covered the event and reported:

“Another worker didn’t notice she was working on the underside of the belt and flipped the machine to high speed. Her left arm disappeared underneath a 24-inch-diameter roller in an instant. She held tight to a bar with her right arm until someone shut off the conveyor belt. Then she lost consciousness. ‘To this day, I wish I could forget the sound the machine made, the sound of my arm breaking, the sheer panic.’”

Setting aside the gruesomeness of her injuries, something else caught my attention in the AP story.

“‘I knew what I was doing was dangerous. I didn’t understand that machine. I gave away my safety that day. It was 100 percent preventable. It absolutely didn’t have to happen.’” She ticked off reasons why people have accidents at work. Fatigue. Complacency. Lack of training. Losing focus. Indifference. Attitude. Anger.”

It sounds like Kina Repp blames herself for the life-changing injury she sustained. That message—given at a safety conference—troubles me. The suggestion that workers are injured because they are “complacent,” “lose focus,” are “fatigued,” etc. leaves out the crux of workplace safety: fixing the hazards. Having a safety guard in place, or de-energizing equipment when it’s being repaired, will take care of the problem. Those fixes will protect workers’ lives—-whether or not workers are fatigued or lose focus.  Afterall, we’re not robots—many of us do get fatigued and we do lose focus. That’s not our fault. That’s because we’re human.

Repp’s experience is particularly interesting because she was only 40 minutes into her first day on the job. Forty minutes into the job, in one of the most hazardous industries in Alaska, and it’s her fault?  And it’s hard for me to believe that a college student eager for money was “indifferent” or “complacent.”  More likely, whatever training (if any) she received in those first 40 minutes had little to do with safety.  I cringed when I heard Repp say:

“I didn’t understand that machine,” and “No one knew how to turn off the machine.”

Repp’s wrong to blame herself for not understanding the machine—-apparently no one else did. A “you be safe out there” message won’t cut it when nobody even knows how to turn off a machine that can mangle a worker’s arm.

I realize the AP story did not cover her entire speech. I was curious what else she mentions in her safety speeches. Does she mention the responsibility of employers to ensure their workplaces are safe? When she addresses audiences with young workers, does she explain that there are certain tasks that workers under age 18 are prohibited from doing?

I checked out Kina Repp’s website and found several of her previous talks posted on YouTube. There’s no doubt she is inspiring and embraces life. She now has four children. She’s run 13 marathons and has a black belt in karate. Her family and friends are amazed at her determination (and success) at overcoming the physical challenges of having only one arm.

I don’t mean to diminish those accomplishments or her inspirational message. But the bulk of her safety message misses the mark. She places much too much emphasis on how workers are responsible for keeping themselves safe.

“I just feel so passionate about wanting for people to understand this is about you.  Making choices and making decisions to keep yourself safe. Repp holds up her prosthetic arm and says ‘this is what I traded my safety for that day.’”

She goes on:

“No matter your safety program, it all comes down to us. We make those minute-to-minute, second to second decisions, that dictate our personal safety. You are your last line of defense in safety. It boils down to you and the choices you make.”

The stage on which Kina Repp addressed the audience had a banner overhead. It was probably posted by the company hosting the event and likely referred to their record without a work-related injury. It read:

“5 million hours: Decide to be safe.”

A worker can decide all she wants to be safe, but if there are hazards that haven’t been addressed—-from poor ventilation and exposure to carcinogens, to disengaged safety devices on machines or blocked fire exits—she can be injured, made ill or killed by her job. Kina Repp should not blame herself. The finger pointing should not be directed at the victim, but at the employer who allowed the hazard to go unaddressed.

Categories: Health

Climbers slide back in to base camp

Breast Cancer Fund - June 18, 2014
Many of the climbers glissaded, or slid, back to base camp as you can see below. Leslie Kelly, Bridget Vanoni, Marlyss Bird, Lucas Parsons, Arthur Morgan, Lindsey Dal Parto, Tessa Montgomery, Cathy Ann Taylor, Frederique Mary, Barbara Winter and Maryann...
Categories: Health

2014 Team members reach personal summits

Breast Cancer Fund - June 18, 2014
It's incredibly rare for a whole Climb Against the Odds team to make it this far, and we are so proud of our whole team. Twenty of the 25 climbers have reached the pinnacle of Mt. Shasta: Arthur Morgan Lindsey...
Categories: Health

Second group of climbers reach Mt. Shasta summit

Breast Cancer Fund - June 18, 2014
Robert Abramowitz, Ruth Walter, Katie Bernell and Cristin Bailey have made it 14,179 feet to the top of Mt. Shasta! Ruth Walter lived only one mile away from Ground Zero on 9/11 and was breast feeding her daughter. After that...
Categories: Health

First climbers reach the summit

Breast Cancer Fund - June 18, 2014
We have confirmation that at least three people have reached the summit and others are close behind. Leslie Kelly, her daughter Bridget Vanoni and the North Face-sponsored climber, Marlyss Bird, have all reached the summit! Leslie Kelly was diagnosed with...
Categories: Health

Base camp volunteers dedicated to climbers

Breast Cancer Fund - June 18, 2014
Past climber and 2014 Sacred Trekker, LaDawn Beardsley, one of our dedicated volunteers working at base camp needs to stand on one foot and reach as high as she can to get cell phone service so she can remain in...
Categories: Health

Global Energy Sector Must Prepare for Climate Change, Report Says

Yale Environment 360 - June 18, 2014
Power plants and energy systems around the world will experience potentially disastrous effects from climate change and should develop plans for dealing with those effects, according to a report released today by the World Energy Council and European researchers. Long-term droughts, for example, could threaten water supplies needed to cool large power plants as they produce electricity, the report notes. Many energy facilities are also lacking protection from floods, rising seas, and severe weather events — a problem highlighted by the 2011 Fukushima nuclear disaster. Strong global political action could have major impacts on the energy sector, the report says, especially if governments make a coordinated effort to invest in renewable and low-carbon energy and upgrades to power distribution grids.
Categories: Environment, Health

Global Energy Sector Must Prepare for Climate Change, Report Says

Yale Environment 360 - June 18, 2014
Power plants and energy systems around the world will experience potentially disastrous effects from climate change and should develop plans for dealing with those effects, according to a report released today by the World Energy Council and European researchers. Long-term droughts, for example, could threaten water supplies needed to cool large power plants as they produce electricity, the report notes. Many energy facilities are also lacking protection from floods, rising seas, and severe weather events — a problem highlighted by the 2011 Fukushima nuclear disaster. Strong global political action could have major impacts on the energy sector, the report says, especially if governments make a coordinated effort to invest in renewable and low-carbon energy and upgrades to power distribution grids. Making energy systems resilient to climate change in the coming decade will require hundreds of billions of dollars from governments and industries around the globe, but most of that money is already slated to be spent keeping the current systems running, the report says.
Categories: Environment, Health

Climbers reach 12,400 feet

Breast Cancer Fund - June 18, 2014
The following climbers are at the top of the West Face (~12,400 feet) and the rest are close behind: Arthur Morgan Frederique Mary Marlyss Bird Leslie Kelly Bridget Vanoni Lindsey Dal Porto Robert Abramowitz Ruth Walter Katie Bernell Cristin Bailey...
Categories: Health

Likely to Glissade

Breast Cancer Fund - June 18, 2014
We hear from our guides that the winds are low and at about 40 degrees the conditions are good for glissading. Follow weather on the mountain at http://forecast.weather.gov/ What is glissading? Glissading is the act of descending a steep snow-covered...
Categories: Health

What would Ciro do now? Learning from a public health hero

Pump Handle - June 18, 2014

by Phyllis Freeman and Anthony Robbins, MD, MPA

One of our public health heroes, Ciro de Quadros, a public health physician from Brazil died on May 28, 2014. We need his attitude, skills, and persistence more than ever today. Ciro was a master of innovation, particularly in his efforts to prevent infectious diseases with vaccines. It seems especially timely today to review highlights of his career.

And why now? For one, because just now efforts to eliminate polio are foundering in the wake of the US CIA’s disastrous and hugely counterproductive scheme to identify Osama bin Laden’s children through a phony immunization program. The CIA’s ruse confirmed all the worst claims of vaccination opponents.

And why else? Because if we can assemble lessons from his career, they may benefit efforts to prepare public health workers to solve many other sorts of problems.

Ciro faced what seemed to most observers and colleagues to be insurmountable challenges as he tried to eliminate smallpox in Brazil and then Ethiopia.  But he always found an effective way forward. Later, when directing the Pan American Health Organization’s Division of Vaccines and Immunizations, he pioneered in broadening protection against many more vaccine-preventable diseases.  His career was one of problem solving – he never conceived of public health as a ‘discipline’ – to be defined in academic terms that might narrow his scope of activity.  Instead he learned on the go – any skill or information from any source available – redefining his role as he sized up challenge after challenge.

As we look to find a way forward after the CIA-initiated immunization reversal, and to increase commitment and urgency of public health workers – the newly arriving to public health work of any description and those continuing – we look at Ciro’s career for glimpses of what made him so effective, so relentlessly committed to solving problems, and so able to shape novel approaches and renew his own energy.

Ciro’s education and career

Ciro de Quadros lived in Brazil from his birth in 1940 until the early 1970s when his early successes caused his boss, WHO’s smallpox eradication program director, DA Henderson, to transfer Ciro to Ethiopia.  Just after medical school, Ciro had worked as chief medical officer of a public health center in the Amazon rainforest, in Altamira, a town of 5000. There he and his team (a nurse, a sanitarian, a lab technician, and a health educator) did every kind of task. Ciro, did more. He kept detailed records of everything—and by the end of that year the team knew they had vaccinated every man, woman, and child, even as they treated every sort of malady, performed surgery, dug latrines, etc. After that year he went back to school, also in Brazil, for an MPH. Then in 1969, Ciro headed back to the field, to the state of Paraná in southeastern Brazil, to be its smallpox surveillance officer.

He began earning respect for his ways of getting things done – ways that assure him a special place in public health history.  Although everyone was committed to mass vaccination against smallpox, there was no budget to do so in Paraná. Thus, Ciro tried a new and untested strategy–surveillance and containment. It was heretical, as at that time almost everyone believed that the only way to eradicate smallpox would be with mass immunization: vaccinate everyone. His experiment helped to topple ‘common wisdom’.  With a car and a nurse vaccinator, this little team chased reports of outbreaks or single cases – using local radio, a megaphone mounted on the car. They identified cases and vaccinated more than 38,000 people, anyone who may have had contact with a ‘case.’ When the mass campaign finally did go door to door later, they found not one case of smallpox.

DA Henderson lured Ciro to greater challenges in Ethiopia –where half the population lived more than a day’s walk from any road. Not only was the territory tough to traverse, but suspicions about vaccinators meant, as Ciro put it:

“You could go walking through those mountains for days and days to find a smallpox case but then you could not vaccinate anybody because nobody wanted the vaccination. They would throw stones. They would set dogs on you.”

After 6 years in Ethiopia, Ciro moved to Washington DC in 1977 – but only after having waited 6 months from when the last case of smallpox was reported in the country.

Working out of the Pan American Health Organization (PAHO) headquarters in Washington DC, but traveling throughout the Americas, Ciro used the smallpox successes to lead an immunization program to cover polio, measles, diphtheria, pertussis, tetanus, tuberculosis; adding additional vaccines as they became available. To make sure that vaccines were on hand when the programs organized in each country were ready to use them, he helped create PAHO’s Revolving Fund (a novel mechanism to assure a ready supply of international currency for purchasing qualified vaccines from reliable vendors anywhere in the world at the lowest prices he could help to negotiate for bulk purchase– allowing each country to replenish the Fund’s supply of US dollars using its local currency).  We have lasting memories of watching Ciro moving in and out of the ministries of health in the Americas – just ahead of the ‘detail men’ trying to cut special deals for direct vaccine sales – to remind everyone he had a better deal for their people – and that he and PAHO would be watching…. should evidence of ‘special deals’ mean higher purchase prices, possibly with ‘unaccounted for benefits’ to any ministry staff.

While at PAHO, Ciro led the successful program to eliminate polio from the Americas, then continued to strategize the global ‘endgame’ for measles from his final professional post at the Sabin Institute, becoming Vice President Emeritus there in 2003.

How did he work?

He defined the problems he aimed to fix—in the long term and all the steps along the way. He took on every issue that blocked his ability to solve the public health problems that needed fixing – making use of every role he could play, all knowledge he could glean, all the teamwork he could promote – with the immense energy he would characteristically muster.  He saw immunization – and immunization of the most vulnerable and hardest to reach children, in remote mountain villages, or caught in war zones during active conflict, or in urban slums that shared some debilitating characteristics of war zones – as the way to engage growing throngs of contributors in improving population health.

He worked from the bottom up; he worked across the top; and he wove through all the layers, following and creating glimpses of opportunity. When working in public health, we hope our colleagues, and our students will call on lessons we learned from Ciro’s education and career.  A quick Ciro list contains these elements:

  • He pursued his education in the setting where he hoped to contribute – for Ciro in Brazil. This meant he was drawing on his local knowledge and growing awareness of the needs of the population as he prepared himself with strategies to improve health – first of villagers, then in a region within his country, then in another country with even greater needs, then for the Americas, and for the world.
  • He went right to work in the field after medical school – where he could learn more about harsh realities undermining health from the perspectives of those living in problematic environments-and from others who had been working there before him.
  • He returned to school in public health – after his village medical officer immersion – to learn more technical skills and to improve his problem solving skills once he had experienced the limits and frustrations of working on the front lines.
  • He took on tough assignments and worked his tail off – all the while nurturing co-workers of every sort and community members.
  • He always looked to learn from everyone around him – in the field or workplace – people at every level because, as he said, the best ideas may not come from those you expect to offer them.
  • He valued his work based on what he actually got done.
  • He avoided becoming isolated in a narrow field of expertise – even while he grew to be so enormously knowledgeable about several aspects of health—for Ciro, infectious diseases, epidemiology, and immunization.
  • He left no assignment without succeeding or planning a logical transition to keep up the efforts to solve whatever the problem–with all the creativity, urgency, and persistence he felt the situation called for.
  • He took the lessons he learned with him everywhere he went.
  • He taught by doing, then articulating his observations and thoughts when he thought others could see their relevance and put them right to work.

He repeated this process throughout his career.

To remind ourselves of these lessons and to provoke strategic and energetic responses to the next public health problems, we who long observed Ciro’s way of working can now simply ask ourselves: What would Ciro do?

For those who did not get to watch him in action, we have offered a small window on years of incredibly effective action. That allows us to also put before readers of this post the question: What would Ciro do now?  Whether the challenge is re-establishing trust in vaccinators (in places where the CIA must have known it put their lives in peril) or charting national strategies to protect workers from avoidable harm – remembering Ciro’s educational and career choices and stunning successes gives us a way to honor his memory.

Phyllis Freeman and Anthony Robbins, MD, MPA are the co-editors of the Journal of Public Health Policy.

 

Categories: Health
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