A year later there is widespread complaints of nosebleeds, GI pain, memory loss, persistent coughing, skin lesions and other serious conditions. But where's the help?
By Brad Jacobson,
AlterNet
Posted on May 8, 2011
Contrary to many national stories covering the one-year anniversary of the BP oil spill in the Gulf of Mexico,
a health crisis in the region has developed among exposed workers and residents. And it's
not so "mysterious."
In recent meetings with public health, medical and chemical experts in Louisiana -- the Gulf state hardest hit by the worst offshore oil spill in history --
AlterNet found a striking symmetry between debilitating chronic symptoms being reported among those sickened and the known effects of chemicals in the toxic brew of oil, dispersant and burned crude to which they were exposed.
One year later,
persistent coughing, wheezing, headaches, fatigue, loss of balance, dry itchy eyes, runny nose, nosebleeds, rectal bleeding, skin lesions, gastrointestinal pain, cardiac arrhythmia and
memory loss are common complaints -- all consistent with exposure to chemicals released in the water and air since the explosion of the Deepwater Horizon rig off the Louisiana coast.
In addition to these physical heath issues, mental health experts are finding an increase in associated
psychological distress, including
depression, anxiety and
post-traumatic stress disorder, which are fueled by converging concerns over health, loss of livelihood and general insecurity about the future.
While long-term studies are underway, such as the National Institute of Health's projected 10-year monitoring of
55,000 cleanup workers, experts stressed both the need for those affected to be assessed for chemical exposure immediately and lamented the lack of access to medical doctors trained to diagnose and treat such exposure.
Nearly every source
AlterNet interviewed in Louisiana called the health situation "a mess" and said it is not being adequately addressed.
Current Manifestations of Physical and Psychological Impacts
Dr. Mike Robichaux, a highly regarded ear, nose and throat doctor in Raceland, Louisiana, is seeing many of the most commonly reported physical symptoms, and some more unique, in scores of patients he's treated pro bono at night, working nearly round the clock after regular office hours.
On average, Robichaux, who's also a former state senator, said he sees four or five new patients a week with health complaints that manifested after the oil spill.
Recently, he's found a
spike in "absolutely fantastic" amounts of
memory loss. He said it took him awhile to figure it out because many of his patients we're forgetting to mention the problem until their wives asked Robichaux if they'd discussed it.
University of Maryland School of Medicine neurologist Lynn Grattan, who was in Raceland to begin a study on Robichaux's patients, said of their memory loss, "It's nothing we've ever seen before."
Additionally, Robichaux is detecting
a pattern of extremes in blood sugar levels that he hasn't observed in his thirty-seven years of practicing medicine.
"People are coming in with
dizziness and they're having these
bizarre symptoms of heart rates racing up and down," he said. "Their blood sugars are shooting way up and then screeching down in a much more exaggerated fashion than anything I've ever seen."
He believes "there's no question" these symptoms and others he's treating are
attributable to the oil and dispersant because "it's such an exaggerated thing" and virtually all of his patients say they had none of these health problems before the spill.
James Diaz, director of environmental and occupational health sciences at Louisiana State University Health Sciences Center in New Orleans, said he's "not surprised at all" by many of the current chronic symptoms being reported --
respiratory, dermatologic, ocular and
neurological -- because they are consistent with
exposure to polycyclic aromatic hydrocarbons and
volatile organic compounds, chemicals in crude oil and dispersants.
Diaz, who worked for 16 years as an occupational medical doctor on an emergency flight team that treated injured offshore oil workers and is an expert on chronic and carcinogenic effects of chemical exposure, believes the "most serious" early phase chronic illnesses will be
neurological.
"These agents are water soluble, attack the
irritative membranes," he explained, "Then when they get into the body, they're
lipophilac, which means they love to concentrate in tissues that have a lot of fat --
the brain, the covering of nerves."
Diaz said that, as opposed to respiratory, skin and ocular disorders, there are few options for treating neurological disorders, which include reported symptoms such as
balance issues and
memory loss.
"
Once we get into central nervous system disorders, there's not a lot we can do," he said grimly.
Since late last year, Wilma Subra, a chemist and microbiologist in New Iberia, Louisiana, has analyzed approximately 150 blood samples of sickened workers and residents across the Gulf Coast -- from New Iberia to the Florida Panhandle -- and has found
alarming elevated levels of toxic chemicals consistent with those in BP crude, including
benzene,
ethylbenzene,
toluene and
xylene.
Subra, a McArthur Genius Award-winning environmental scientist and former consultant to the Environmental Protection Agency, analyzed these samples serving as technical advisor to the Louisiana Environmental Action Network (LEAN).
She and Marylee Orr, executive director of LEAN, continue to receive calls daily from cleanup workers, divers and coastal residents whose list of ailments continues to grow but mirror most of the
respiratory, dermatological, ocular and
neurological disorders repeatedly reported to
AlterNet in its meetings with sources in Louisiana.
"Marylee and I have been the voice of the fishers [who volunteered in the cleanup] from the very beginning, when they weren't protected, they weren't trained," said Subra. "Now we're the voice of the sick people."
A recently published health survey of 954 Louisiana residents living in seven oil-impacted coastal communities found that nearly three-quarters of those who believed they were exposed to crude oil or dispersant reported feeling symptoms. Nearly half of all respondents reported an "unusual increase in health symptoms" consistent with exposure, including
coughing, skin and eye irritation, and
headaches.
Tulane University's Disaster Resilience Leadership Academy and the environmental justice group Louisiana Bucket Brigade, both based in New Orleans, jointly conducted the on-the-ground survey.
Sophia Curdumi, the program manager of Tulane's Disaster Resilience Leadership Academy and a public health researcher at the university who took part in the survey, said that the symptoms the residents described to her and her colleagues were remarkably consistent with what she's hearing elsewhere.
"
Skin rashes, a lot of
upper respiratory issues, increased mucous, coughing, perpetual runny nose," Curdumi said. "I've had folks say that they've had to start using inhalers were they didn't have to before. And
eye problems -- itchy, runny eyes.
Headaches. And
fatigue."
She continued, "Fatigue is the one thing that keeps coming up. People are just saying, 'I'm so tired, my husband's so tired, everyone's so exhausted all the time.'"
Curdumi then noted that such fatigue might be attributable to a combination of chemicals in the environment and also the increased stress because their livelihoods are in jeopardy.
Howard Osofsky, head of the psychiatry department at Louisiana State University School of Medicine in New Orleans, supported Curdumi's insight.
Regarding attendant psychological manifestations from the disaster, Osofsky said that it's difficult to pinpoint how much is related to stress and how much is related to environment.
"But certainly there are symptoms which can be related to stress," he said. "We're seeing high percentages of people reporting
fatigue, difficulty sleeping, headaches, stomach aches, back aches, pains in their legs."
Osofsky, who is a co-author of the April
New England Journal of Medicine report on the effects of the Gulf oil spill, also pointed out that he's finding expected "elevated quantities" of
post-traumatic stress, generalized anxiety disorders, symptoms of depression, increase in use of alcohol and
family difficulties, such as a
spike in domestic violence.
"These symptoms seem to be greater the more the family was disrupted by the oil spill," he said, adding, "We see
irritability, we see
anger, we see the tremendous
uncertainty of what's going to happen with their lives."
Elmore Rigamer, a psychiatrist who is director for Catholic Charities in New Orleans, which is performing ongoing mental health outreach to the most oil-affected coastal communities in Louisiana, is witnessing this firsthand.
He said anxiety over livelihood is a primary concern of these residents, who have one main skill: fishing. The astonishing number of them who've yet to return to the only work they've ever known supports his assessment.
As of March 31, out of 466 heads of household interviewed by Catholic Charities during outreach in the parishes of St. Bernard, Plaquemine, Jefferson and Lafayette, nearly 80 percent said they have not been able to return to fishing.
"When your income is gone and you don't have a lot of reserves or flexibility in working in other places, a lot of anxiety and depression come with that," Rigamer said.
"If that continues," he noted, "then naturally that spills over into the family -- problems with
substance abuse, alcohol primarily, and
family fractiousness and quarrels and it ripples through to the children."
Rigamer said he's also witnessed the convergence of psychological and physical impacts in these communities, in which many have reported
upper respiratory problems they say they've never had prior to the spill or preexisting conditions, such as
asthma, which have grown
much worse since.
Too Few Doctors Trained to Diagnose and Treat Exposure
A dearth of doctors with the proper medical background to diagnose and treat patients for chemical exposure, experts roundly cited, is another critical factor in the Gulf health crisis.
Private physicians like Dr. Robichaux in Raceland and those in Gulf area clinics and hospitals might be treating people who complain of symptoms they attribute to chemicals from the oil spill. But most of these doctors are only treating the symptoms, primarily with antibiotics and corticosteroids, which, if they have any effect, often merely
alleviate symptoms temporarily without addressing the underlying cause of illness.
"Things that are carrying me are just corticosteroids," said Robichaux. "I mean that's about all I can give to these guys with their respiratory problems. I'll give them a shot of cortisone and put them on antibiotics."
If he administers cortisones by mouth it could cause
G.I. tract problems, which some of them have as well, so he's forced to give them injections instead.
Robichaux said he regularly observes patients "getting better and worse, better and worse, better and worse" and openly acknowledges the limitations of what he can provide.
Studies of the long-term effects on people exposed to oil and dispersants from the Gulf oil spill, which have only just begun recently, are cold comfort to Robichaux, his patients and others suffering or seeking relief for those who are.
"We're worried about treating people that are sick today," he said.
To date, however,
no major funding -- whether from BP or the federal government -- has addressed the needs of those sickened by the oil spill in the immediate term.
James Diaz of LSU, who recently published a report in the peer-reviewed
Journal of Disaster Medicine that predicts potential chronic health effects from the Gulf oil spill, stressed that everyone exposed,
heavily or lightly, should be screened by physicians trained to treat chemical exposure.
He said this is necessary not only for their immediate health but also to prevent potential catastrophic illnesses in the future.
Diaz pointed out that studies of two prior oil spills, the
1989 Exxon-Valdez oil spill off the coast of
Alaska and the
2002 Prestige oil spill off the coast of
Spain, provide peer-reviewed, evidence-based results on some of the long-term health effects of exposure to these chemicals. He cited these studies in his
Journal of Disaster Medicine report.
One study, for example, found that 14 years after the Exxon-Valdez spill, workers with high exposure to weathered crude oil and dispersants had a significant increase in
respiratory disease, neurological disorders and
multiple chemical sensitivities.
A study of fishermen exposed to crude oil and dispersants during the Prestige oil spill found significantly increased levels of persistent
lower respiratory tract problems, biomarkers of chronic airway injury and
DNA damage two years after the spill.
"We ought to be looking at
molecular biomarkers that could alert us to the potential for chronic disease, whether it's an inflammatory disease or a malignant disease," said Diaz, who also lamented the scarcity of physicians trained to treat chemical exposure.
"In other words," he emphasized, "we ought to be practicing secondary prevention...to see if there is an indicator, a warning sign, for the develop of the disease process."
The primary long-term danger of exposure to chemicals in the crude oil and dispersants, he explained, is DNA damage, which could result in
chronic inflammation and
multiple forms of cancer over time, including
cancer of the lungs, liver, kidney, blood and
colon.
Citing chemist Wilma Subra's analysis of blood samples for chemical markers related to the oil spill, Diaz said that such analyses are only helpful in aggregate with assessing immunological, molecular biomarkers, which provide the only definitive window into what is actually occurring inside the body.
He added, "What we really want to do is diagnose disease early when we can do something about it."
These tests are also crucial, he noted, to identify which people are more genetically predisposed to illness from these chemicals.
This should especially concern public health authorities in Louisiana, Diaz said, because his research has found that many regional southeastern coastal residents in the state -- those in areas who also tended to be more heavily exposed to the oil and dispersants -- do exhibit increased
genetic predispositions that make them more vulnerable than the general population.
Such people have less of an ability to metabolize
polycyclic aromatic hydrocarbons in petrochemicals and glycols in dispersants, he explained, which puts them at much greater risk for various kinds of
cancer; lung, liver and
kidney diseases; mental health disorders and
fetal alcohol syndrome.
Insufficient Funding, Budget Cuts and Lack of Political Will Cited
Subra acknowledged the limitations of her blood sample analyses and would applaud an army of occupational doctors diagnosing and treating people across the Gulf for chemical exposure.
Unfortunately, she said, "That's not happening," and blames both a lack of money and political resolve.
In fact, Subra said, it has worked like that in some cases, such as with a
Superfund site or a waste site, where she's been able to compel federal agencies to send medical specialists trained to treat issues associated with specific chemicals.
"They come down, they train the doctors, they do grand rounds and they're there for consulting," she explained, adding, "In this case, none of that is happening."
Edward Trapido, associate dean for research and professor of epidemiology at Louisiana State University Health Sciences Center, said that people who feel they've been exposed to something "not of their own doing" might have reason to believe they would be able to receive either low-cost or no-cost treatment.
"It ought to be a priority," he said, "but at this point it hasn't been set up and I don't really expect that it will."
He cited state and federal budget cuts as at least one reason.
Trapido is currently leading an LSU study on the physical and mental health of 2,000 wives and female partners of the most heavily oil-and-dispersant exposed male cleanup workers, which has received initial funding by the National Institute of Health (NIH).
But even long-term studies such as this and the NIH oft-referenced "10-year" study of cleanup workers have no guarantee they'll be sufficiently funded and carried to completion.
In fact, Trapido revealed to
AlterNet that at a recent meeting at the Institute of Medicine, he addressed the issue directly with Francis Collins, the head of the NIH, whom Trapido said had justified the projected 10-year study "on the basis that we don't have any long-term results."
Yet Trapido, who has worked at the NIH and knows intimately its vulnerability to transient -- and potentially partisan -- political appointees, as well as budgetary limitations, said that when he asked Collins if he could guarantee the NIH study will last more than five years, he replied, "No."
Diaz also disclosed to
AlterNet that the NIH-funded LSU study that Trapido is leading up has thus far only received enough money to collect specimens.
"They're paying for us to collect samples from people exposed, but they're not paying for the laboratory tests," he explained. "So we're just stockpiling the blood in a repository."
Supplemental funding is needed, he said, in order to actually test any of these samples.
Many public health experts, including Trapido, also expressed frustration over the fact that the NIH has only recently begun its study, forever losing the ability to collect crucial biomarker data in the interim. On a more optimistic note, Trapido said, "I think that one of the goals of the community is to get BP to fund a clinic in the area that will treat health problems."
But he added, "Unless BP decides to fund it, there's no money."
Elmore Rigamer of Catholic Charities echoed this hope, expressing frustration with the poor physical health of the people in the coastal communities he's treating that existed even before the oil spill happened.
"I feel at a loss because the people in these communities don't have access to total healthcare," said Rigamer, which complicates his task of adequately addressing their mental health issues.
"We would still have all these horses of the apocalypse we're talking about," he continued, "but it's unthinkable to me that we have people down there who have diabetes and -- even before BP, even before they lost all their ways -- they couldn't go to a doctor because they didn't have the $70 bucks for a visit."
He continued, "So one of the legacies we would like to have is opening a clinic down there, a federally qualified health center."
But Diaz doesn't expect this anytime soon.
He cited budget cuts, too, but also that
it's not in the interest of BP to provide money that would help properly diagnose and treat illnesses that may have been caused by its oil spill.
"BP doesn't want to address the healthcare impact because they're trying to limit their liability," he said. "They are trying to reach an immediate economic settlement."
Christi Julian, program manager of the Catholic Charities outreach program, said that the state received $15 million in funding from BP and provided $6.7 of that to Catholic Charities.
But the state designated this BP money to Catholic Charities on the condition that all of it is used solely to treat mental health impacts related to the Gulf oil spill, not physical ones, Julian revealed to
AlterNet.
In the meantime, volunteers and outreach employees in the affected coastal communities will continue to do the heavy lifting for those sickened by the spill, with whatever they can provide.
"When somebody comes to a doctor, you are going to treat symptomatically," Rigamer said, in context to the lack of occupational medical doctors. "You're not going to let them walk out without giving them anything, knowing that you're not hitting the root cause."
Dr. Robichaux in Raceland, who is also known in these parts for his doggedness when he served as state senator, looked exhausted before his nighttime interview with
AlterNet even began.
By the end, his eyes red with fatigue and large frame slightly hunched, he appeared to be struggling from crumpling over his bureau.
Beleaguered but unbowed, though, he said, "You just do the best you can do, that's all you can do."
