Podcast Transcription

Steve:           Welcome to the Scientific American podcast Science Talk posted on April 26th, 2012.  I am Steve Mirsky.  On this episode:

Gorman:           He's the most famous latrine builder in the world.

Steve:           That's Scientific American editor Christine Gorman. She recently attended the Association of Health Care Journalists Conference in Atlanta.  Be warned, some of what you're about to hear is not for the squeamish.  We spoke at the Scientific American offices.

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Steve:           So at this conference, Jimmy Carter and his wife, Rosalynn Carter were, sort of, headliners.

Gorman:           That's correct.  Former president Jimmy Carter and his wife, Rosalynn, were headliners at the Association of Health Care Journalists Conference, which took place in Atlanta;  of course, you know, prime stomping grounds for the Carters—the Carter Center is there. And it was very interesting because I hadn't really thought very much about the Carters, well, in a very long time. And I was surprised, and pleasantly so, just to hear the way they talked about global health issues—that was, of course, Jimmy Carter's focus, and the way Rosalynn Carter talked about mental health,  of course, she's been known to be a champion of mental health issues for a very long time,—but hearing them in person, I was just struck by their dedication.

Steve:           And Jimmy Carter has been specifically involved in this battle to eradicate a particular tropical disease.

Gorman:           That's right.  Jimmy Carter has been involved in the battle to eradicate what's called Guinea worm. It's a parasitic worm that burrows into people and is found in contaminated water.  Technologically speaking, the way to get rid of it is to filter water and make sure everybody strains the water that the eggs are laid in, but easier said than done, shall we say. And so, 30 some years ago, when the Carter Center got involved in this they were looking for projects where they could have an impact, but in which other organizations like the World Health Organization and others maybe weren't trying to do anything because it seemed too difficult, even though the solutions were straightforward.  And Guinea worm is one of those because it affects people in, you know, in the back of the beyond, in the rural areas where you basically end up having to walk to.  You can't even always drive in a four by four. And they were able to do such a terrific job that now Guinea worm is practically on the cusp of being eradicated.  I think one of the things that I was most impressed by—I mean, you hear a lot of people doing good deeds and so you can get a little do-gooder fatigue—but one thing that Jimmy Carter talked about that rang a bell with me was, they didn't call it the Carter Initiative to Eradicate Guinea Worm; they talked about, Global 2000, I think is the name they've given it.  So that when they go into different countries, they can get buy in from the leadership of that country and the local president or whomever can say, my program to eradicate Guinea worm. And as a result it's the old adage, you can get a lot done if you don't care who takes credit for it; and so Guinea worm has nearly been eradicated and quite possibly will be eradicated before polio is, making it the second human disease after small pox, infectious disease that's been eradicated in the world.

Steve:           Did we talk about what specific areas the Guinea worm efforts took place in?

Gorman:           The biggest area is sub-Saharan Africa for Guinea worm eradication, but there are other places as well.

Steve:           Let's take just a moment; people might not fully appreciate the horror of this Guinea worm infection.  It's right out of a sci-fi movie.  I mean, the Guinea worm is special.

Gorman:           So, maybe if you're particularly sensitive, you don't want to listen to this part of the podcast, but Guinea worm truly is one of those horrific parasites.  At some point they have to get out of the body, and as they're emerging from the body—a process that can take upwards of 30 days—that can be quite painful. And so,  Jimmy Carter talked about one of the first times he ever saw this in real life many years ago, they were in a small village in sub-Saharan Africa, and he went over to a woman, who was carrying what he thought was a baby—you know, I guess all politicians have to check out the babies for the photo op or whatever—and when he got over to the woman, he realized that it wasn't a baby she was carrying it, it was one of her breasts and out of the nipple was coming a Guinea worm, and she was in excruciating pain.  In fact, over the course of the next several months, 11 different worms came out of her body.

Steve:           These things are like as thick as a finger.

Gorman:           That's about the right size, just a little narrower than that and…

Steve:           Feet long maybe…

Gorman:           Oh yes, absolutely feet long, feet long. And in fact so much so that a lot of people are malnourished because the worm is taking so much of whatever vitamins and calories that they consume.  Interesting—and I haven't had a chance to check this yet—but Mr. Carter was talking about, you know, the snakes in Caduceus, the sign for a pharmacy or medicine since ancient times.  Those aren't actually snakes around that staff; he says that the origin of that image is Guinea worms around a stick because that's the way that—as I mentioned, naturally the worms it will take about 30 days for them to come completely out of the body—but if by taking the head of one of these worms or the end that comes out and then putting it around a stick, you can in essence pull the worm out, you can't pull it out all at once, but you can pull it out and you might shave at least a week off the time it takes to get the worm out, and that's the origin of that medical sign that we're all so familiar with.

Steve:           Well, that is truly grisibly horrible.

Gorman:           So, now you can come back to listening to the podcast.  It really is [horrible] though.

Steve:           So, they also discussed a public health technique that's really good at getting rid of trachoma, which is this infection spread by flies that causes blindness.

Gorman:           It's digging pit latrines and so forth, and making sure that people have a place to go to the bathroom, [so] they don't have to go out in the open; that's called open defecation. And in fact, former president Carter made a joke about being famous as, more famous nowadays for having built, I think he said something like over 500,000 latrines or something like that, I don't know if that was per year or in total.  He was more famous for being, he's the most famous latrine builder in the world and maybe more famous for building latrines than he was for the Camp David accords.

Steve:           I would imagine you also get a cascade of positive health benefits by having the sanitary conditions installed.  Is there any evidence that they've also improved other conditions there?

Gorman:           Well, yes, there's plenty of evidence that by building latrines, you can have other positive impacts. But one that a lot of people wouldn't have thought of is the amazing ability of having latrines, really helps with women's education  girl's education, which you'd say, "Well what do latrines have to do with girl's staying in school or doing well in school?" That's because we're used to going to the bathroom inside. But if you can imagine a young girl, if the only place to go to the bathroom is outside, and you're living in an area where there are a lot of people and, you know, kids or older men see you going to the bathroom, you're much more vulnerable; there's the whole issue, you're family might not want you to go away to school if there isn't a bathroom. And this has been shown up until about menstruation: Girls will go to, you know, elementary school and so forth and so on, but then once they start menstruating, then that's a whole another layer; in addition to having to relieve themselves or having to deal with their monthly blood flow and it's embarrassing, it makes them vulnerable to attack. And so having latrines is one of the essential ingredients to increasing a girl's education.

Steve:           It's amazing; so it just initiates a whole social order in a society.  

Gorman:           Having latrines, there's a positive virtuous cycle there that happens. And it's, you know, it's we talk about bathroom humor because talking about bathrooms and relieving yourself is sort of embarrassing and yucky, but it's really the foundation of a lot of civilization.

Steve:           And Rosalynn Carter has long been associated with mental health efforts.

Gorman:           Yes.  So, Rosalynn Carter has been linked to mental health efforts for decades.  At the meeting at the Association of Health Care Journalists in Atlanta, she talked about the beginnings of that. And that dates back to when her husband, Jimmy Carter, was running for governor in the State of Georgia. And as Rosalyn was going around, you know, campaigning for her husband, she kept hearing people coming up and saying, "Well what are you going to do about mental health?"  And the reason they were asking was because the governor at the time had just signed into law, a law that opened up all the state psychiatric hospitals. And as it turned out there was no place for the former state psychiatric patients to go. And it was a huge need, and a lot of people—families of those who were in the hospitals and others—were very upset. There was a law to shut down of the hospitals, which was good, because horrible things were happening there, but there was no provision for what to do with the people who came out. And that was the beginning of her interest in mental health.

Steve:           She was discussing specifically, some of the problems with getting mental health appreciated, mental health treatment appreciated, on the same level as what we just take for granted, for example, insurance coverage of physical ailments. But if you're suffering from depression or anything else that, you know—schizophrenia—and you need mental health coverage, it can be a whole different story.

Gorman:           That's right.  So, the code words for what you're talking about, it's a phrase called "mental health parity."  The idea that there should be equivalent coverage, that if you have a mental health problem or issue or mental health disease really, that it should be covered just as if you broke a bone or, you know, had cancer or something like that, treatment should be covered.  And so when you think about some of the big mental health disorders—depression, anxiety, schizophrenia, bipolar disease—it's interesting, Rosalynn Carter was talking about how you try to educate people about them. And what they have found, and there have been a few studies now—  this I wasn't aware of—that the more people learn about anxiety and depression, not necessarily that they have it, but they learn about these conditions, they're more sympathetic to folks with anxiety and depression. But something different happens; the more people learn about schizophrenia and bipolar disease, they actually become more fearful of those conditions and people with those conditions.  So it makes it very hard to figure out how to educate folks about schizophrenia and bipolar.  There was one other thing that Rosalynn Carter talked about and that's after a lot of advocacy work on her part and the part of many others, a law was passed in 2008, providing mental health parity so that there would be coverage for serious mental disorders the way there is for serious physical conditions, and as you know, I mean, in some ways passing a law is just the first step, because then you need certain rules and regulations to put the law into effect, and none of that has happened.  Those rules have not been promulgated since 2008, so she seemed very discouraged about that and didn't know really what else to do.  She, you know, has been calling the White House and has not gotten the response that she would have hoped for and the interviewer at the conference was very funny.  He looked, kind of, to former president Jimmy Carter, and said, "Well you know, you used to be president. Can't you call the White House and say, 'look you got to do something,'" and Jimmy Carter laughed, and he said, "They'll take my wife's calls," he was saying, and so implying they wouldn't take his.  So, I think, a lot of us were quite surprised to learn that, which, you know—in a room full of journalists in general and health journalists in particular, the fact that you could surprise several hundred people about such a huge issue that a law that was passed in 2008 still hasn't been implemented on mental health, says something about us and the audience as well: that we have not been paying as much attention to mental health issues as we probably should have been.

Steve:           We'll be back right after this word from Kerri Smith at the Nature Podcast.  

Kerri Smith:  On the Nature Podcast this week, organic and inorganic farming battle it out, a long-running study of development comes of age, and experiments on the edge of acceptability.

Steve:           Just go to http://www.Nature.com/podcast.  Our editors try to get to as many scientific conferences as they can.  Tune back in tomorrow for a briefing from Kate Wong, who's back from the Annual Meeting of the American Association of Physical Anthropologists in Portland, Oregon.  We'll talk about killer chimps, and funny feet.  For Scientific American's Science Talk, I'm Steve Mirsky.  Thanks for clicking on us.