Is there really a difference between NCDs and Infectious Diseases?

I am, with two of my favorite fellow Peace Corps volunteers, working on a mass media campaign to address health beliefs and hopefully change poor health behaviors. The other day, one of them and I had a conversation about whether we should focus on the “preventable” non-communicable diseases(NCDs or lifestyle diseases) solely or to also include infectious disease(malaria, STIs etc). At the time I was thinking we should only focus on the one’s the people have control over right? Then I started thinking about it and realized that NCD vs infectious disease is really a false dichotomy.

Diabetes, hypertension, some cancers, and chronic pain are all non-communicable diseases though to be preventable. But so isn’t malaria right? I mean, get an insecticide treated bug net can reduce childhood deaths from malaria by 20%(1). Add in intermittent prevention treatment during infancy, and indoor residual spraying combined with utilizing bug spray, wearing light colored clothing and medication as needed and the risk is significantly reduced. How about STI’s? Don’t cheat on your partner and wear protection and you should be good.

But not everyone has access to the means to these medications and tools and therefore cannot really be considerable preventable. Well, by that argument, neither should any of the NCDs. Put a person in a high-stress environment with poor air quality, no safe areas to exercise in a food desert(2) and see how well they do. For example, one study of Chicago neighborhoods found the death rate from diabetes in food deserts to be twice that of areas offering access to grocery stores(3). Or look at children experiencing high level of trauma as children, they face higher risks of everything from suicide to heart disease later in life(4).

Okay. But maybe we are thinking about it incorrectly. Maybe all diseases are preventable in ideal situations. But regardless the difference lies in the fact that one group is contagious while the other group is not(hence, non-communicable).

Errr. Not so fast. Let’s go back to diabetes. A mother who is obese, greatly increases her child’s risk of developing metabolic syndrome which is the precursor to heart disease and diabetes(5).  Same goes for smoking(6). And we all know the risk of lung cancer from second hand smoking, but did you know that it has been estimated that exposure has  caused 379,000 deaths from ischaemic heart disease, 165,000 from lower respiratory infections, 36,900 from asthma, and 21,400 from lung cancer. A total 603,000 deaths were attributable to second-hand smoke in 2004, which was about 1.0% of worldwide mortality(7)! Smoking sounds contagious to me! 

But that’s not all. Suicide is contagious, both related to media exposure(8) and clustering(9). Chronic pain has been shown to be communicable(11) in that a positive family history of pain was associated with increased reports of pain over the previous month and poorer general health as well as enhanced sensitivity to experimental pain stimuli(11). Additionally studies have found that not only is chronic pain associated with problems in the marital relationship but increases the distress and physical symptoms is previously non-chronic pain spouses as well. However, it is important to note, that these effects appeared to be related less to the existence of a chronic pain problem per se but rather to patients' and spouses' manner of coping with the situation(12).

Bad News? It seems like almost everything we can die from is potentially communicable.

Good News? There is already evidence suggesting that pain-related beliefs, attitudes and behaviour could positively be influenced by media campaigns(10). We have control some over who we hang out with, how we manage stress, what we do for exercise, choosing the most nutritious options available to us, developing positive coping strategies and utilizing preventive measures(i.e bug nets, condoms etc) to reduce risk of infectious disease transmission. For sure, there are things that will always be out of our control, but if we can successfully manage the ones that we do have control over and not stress over the ones we don’t, I think we can all live happier and healthier lives.

Until next time,

Danny

REFERENCES

1. Insecticide-Treated Bed Nets. http://www.cdc.gov/malaria/malaria_worldwide/reduction/itn.html
2. USADA Defines Food Desert. http://americannutritionassociation.org/newsletter/usda-defines-food-deserts
3. Curry, Andrew. “Bringing Healthy Fare to Big-City ‘Food Deserts.'” Diabetes Forecast. December 2009. http://forecast.diabetes.org/magazine/your-ada/bringing-healthy-fare-big-city-food-deserts (4/17/11)
4. The Adverse Childhood Experiences (ACE) Study. Centers for Disease Control and Prevention.
5. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005 Mar 1;115(3):e290-6.
6. Oken E, Levitan EB, Gillman MW. Maternal smoking during pregnancy and child overweight: systematic review and meta-analysis. International journal of obesity. 2008 Feb 1;32(2):201-10.
7. Öberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. The Lancet. 2011 Jan 14;377(9760):139-46.
8. Gould MS. Suicide and the media. Annals of the New York Academy of Sciences. 2001 Apr 1;932(1):200-24.
9. Joiner TE. The clustering and contagion of suicide. Current Directions in Psychological Science. 1999 Jun 1;8(3):89-92.
10. Raspe H, Hueppe A, Neuhauser H. Back pain, a communicable disease?. International journal of epidemiology. 2008 Feb 1;37(1):69-74.
11. Fillingim RB, Edwards RR, Powell T. Sex-dependent effects of reported familial pain history on recent pain complaints and experimental pain responses. Pain. 2000 May 1;86(1):87-94.
12. Flor H, Turk DC, Scholz OB. Impact of chronic pain on the spouse: marital, emotional and physical consequences. Journal of psychosomatic research. 1987 Dec 31;31(1):63-71.

Boa Vista -mmm of what?

After my day in Rio with all of its glamour as well as superficiality(number 1 for plastic surgery in the world), I headed to Brazil’s polar opposite: Boa Vista. The funny thing about Boa Vista- it gets a really bad rap. Literally any and every thing I’ve read about it says that it’s a good town to get to to catch a bus to Venezuela, Guyana or Manaus, Brazil. But I think that’s really unfair to it. Now my second time here, I can say that I really like it. Granted it is like a Red Delicious apple. When you call something delicious or good view, it is usually a sign it is anything but. That does apply to Red Delicious(more like red mealy apple), but only kind of applies to Boa Vista.  Yes, it’s small and doesn’t have much in the way of “sights” but it does have a good selection of really good restaurants, everyone is really friendly and hotels can be had for less than a taxi ride to Lethem.

And that last reason is why I am spending the night here in Boa Vista. I arrived via plane, just in time to miss the last bus to Bonfim(the border town to Lethem Guyana). A taxi sets you back AT LEAST 50 Real  but if you’re by yourself and the taxi isn’t in a rush, they can easily charge 4 times that. So instead, I opted to reserve myself the first bus the next morning and got myself a hotel for 80 Real. So that’s 100 Real total for hotel and bus rather than 150 for the taxi ride. Plus this gives me an extra day in Brazil.

So far, it’s been interesting. I mentioned earlier that it is a town that is super friendly. And that is true. I had planned to walk the 5k from airport to bus station, but a friendly person drove me there. Paula and I couldn’t make ourselves understood to the other but luckily she had Google Translator on her smart phone so we were able to communicate. She shaved off about 45 minutes from my trip(and I still didn’t make my bus!). I have also met some nice people while out for a walk, who stopped me because they could tell I “didn’t belong” but only to see if I was okay and then suggested a good place for dinner. I am going to head there in a little bit.

I did have one weird encounter but that was with an English-speaking person living in Venezeula, but coming to Brazil to extend her Visa. I may have said something to the extent that Chavez was so well liked because there was not much opposition or public awareness of alternatives, plus the majority of the older population had still poignant memories of what happens if you have a Right-wing politician in power. And I really thought I was following the conversation. For the most part, I don’t really try to get mixed up in politics and usually with just side with whatever side you are now(if at least SOMEWHAT reasonable). However, in this case, I definitely misread her and this lead to a long diatribe on why Chaves was amazing and Obama is single-handedly trying to destroy Venezeula. 

Whether right or wrong, I wasn’t prepared for that and just sat back and let her go. Haha. I don’t care if you are passionate to the left or right, but if you are so passionate that you can at least hear out an opposing opinion, I think you may have a problem.

Okay well I’m heading out to dinner now and since this is a Catholic state, and this is Easter weekend, things could get crazy ;) But don’t worry about it. I will tell you all about it!

Until next time,

Danny


PS- I then headed up to Lethem for rodeo and my camera battery died so had to take these photos on my crappy camera. Sorry for the poor resolution.

Lethem Rodeo

A giant ant hill in Lethem

Rio in a Day

When I found out that I could extend my trip with an excursion to Rio de Janiero(The erroneously named River of January), I couldn’t pass it up. Especially with all the savings I had in French Guiana, this trip was within my budget. I took a 3am flight from Belem to Rio arriving before 8am. I was on the Metro heading to Copacabana before 9am.

Side Note: It may be just that I haven’t experienced efficient public transportation in a while, but I must say I thoroughly enjoyed how efficient and easy to access Rio’s Metro system was. Everything was clearly marked and a Metro pass costs only $1 per trip(which can be as far as the rail takes you).

Side-Side note:One thing of interest: There are separate women only cars for the metro. Meaning if you are male, you are not welcome. At first, I really liked this idea-allowing women to travel worry-free any time of day. Then I thought of a better option. A DOUCHE-BAG ONLY car. That’s right, if you think it’s appropriate to sexually harass or assault a female, or even condone it, then you get your own separate car. And a nice ankle bracelet and a mandatory mustache. It’s sad we live in a world where we have to separate women from men but after living in Guyana, I certainly understand the need. 

Exclusivo para mulheres

 Okay! Back to the trip. I arranged a Christ the Redeemer tour via bus that picked up right at Copacabana(Post 2) which was so convenient. Unfortunately for all of my readers, there were no professional photographers, so you are now going to be assaulted by unabashedful and numerous selfies.

How could I not? After all this is one of the modern 7 wonders of the world. Now I’m only 1 down on my brother Matt. We both head to Macchu Pichu in June so he’ll still be ahead.

It's funny most people are taking pictures of the view of the city and not the Redeemer itself

A nicer favela 

After CTR as I like to abbreviate it, I headed to my hotel in Lapa, which is a fun little area within walking distance of the airport and plethora of bars. I changed into my running clothes, stashed some Reals and my Metro card and I was off. I took the Metro back to Copacabana, and instead of heading to the beach, I headed up, up and up. Maybe it’s just because I haven’t seen an inclines for a while, but it certainly seemed like Rio has some of the steepest roads in the world. Either way, my breathing and mind concurred. After doing an up/down/up/down, I headed to the beach and ran the full length of it only singing a little Barry Manilow. I then enjoyed a frosty beverage overlooking Copacabana with CTR going in and out of view(depending on cloud coverage) in the background.

Instead of taking the Metro back, I followed the Walk Rio signs all the way back to my apartment. I wish I had known about it before because I would have definitely run to the beach instead of riding. Either way, it’s a good thing to know about and I would definitely recommend it. Felt safe the entire time and skirted the water almost the entire time.

It's the copa-copacabana

Back at my hotel, I showered(oh hot water, how I am going to miss you!), and headed out for dinner. Not nearly as inexpensive as Belem, but almost as good, I found  a little place where I had Baccliau which always reminds me of my dad and wished he would have been able to join me. Although, I am very much looking forward to meeting them in Barbados within the monthJ While not Portugal, Brazil is a nice alternative with similar meals and culture.

Speaking of culture: you cannot go to Rio and say you’ve been to Brazil. Already Belem and Rio are so different and tomorrow I head up the country to Boa Vista which offers an entirely different side of Brazil.

Until next time,

Danny

Belem- A fun trip into Brazil

From Cayenne, I next headed to Belem, Brazil. I wasn't sure what to expect since the only people that I know who have been there use it as a transit point rather to actually explore. If you want to travel the entire length of the Amazon, you will start or end here. The way everyone made it sound, it seemed like a little frontier town.

Well compared to Cayenne with 150,000 people, Georgetown with 250,000 and Paramaribo somewhere in between, Belem seemed like a huge city even having sky scrapers! And considering it has 1 and a half million residents(2.5 if you include suburbs) it is! Belem is also cool because it means Bethlehem in Portuguese which is one of my favorite towns in NH :)

It had some remnants of when it was a thriving city because of the rubber industry but suffered heavily when that bubble collapsed. The nice thing is that they are now in the process of renovating many of these people which can be seen with a walk through town: Plus so many of the streets are tree lined which definitely beautifies it. Especially when they are mango trees! yum yum!

And then one street over not so much. That's how this city went. I was trying to hit all the historic sites and going from one to the next via foot required traveling through some parts of town that I'm sure the tourist board doesn't put on the website.

However, it was on one of these side streets, that I was able to get those great little snack. Some soup which had been simmering on the burners that the woman brought with her. Each ingredient seemed to have a different pot and weren't added together until she served me. And it was delicious! For 5 Real! that's a little more than $1.

Mine was the Tacaca

And again, one street further over back to well-manicured parks.

I couldn't help taking this photo. 

Again, all those great buildings and then this one so debilitated that a whole tree was growing out of it!

The Amazon!

Belem's Christ the Redeemer. Seriously. That's their name for this statue. Slightly anti-climatic if you were expecting Rio

The vendors!

I kind of wish I was heading right home from Belem because I would definitely loaded up on all their seafood and good amerindian crafts. The picture above are all variations of shrimp... And I had a few types during my time there, and they are all good!

The harbor

Lunch! Spaghetti, rice and beans, and two huge skewers of meat. $10 Real!

The price may have reflected the location ;) 

Supposedly this church was modeled after St Paul's Cathedral

So I had a good day exploring Belem. I was planning on staying out as late as I could because I had a 3am flight and didn't have a hotel. However around 7p it started raining HARD so I headed to the airport. It all worked out well though because I got a chance to write this blog and get more than my share of coffee.

Plus-adventures are really just how you perceive them. I made a fun game where I had to race down one set of stairs, power walk across the entire terminal and back up the other stairs and back. It was surprisingly hard to improve my time... I guess I am a bad walker(that would explain my rapid performance decline in marathons).

Okay that's it for now.

Definitely more fun in store for tomorrow:)


Until next time,


Danny