By Larry Fox
What, us worry?
Yes indeed.
When the Advisory Board of To Your Good Health, A Health Care Newsletter, convened for its most recent quarterly meeting at the Four Points by Sheraton Resort in Hyannis, the topic on the agenda was, "What do you perceive as the major health threat facing Cape Codders today?"
As moderator, I anticipated the discussion to range all over the lot. Not so. The conversation almost immediately concentrated on two discrete paths, fascinating in their difference.
The first was the headline grabber: The Cape's apparent failure to prepare for a catastrophic EVENT, our emphasis. Whether it be a bird flu pandemic, a hurricane or some form of terrorist attack (up to and including nuclear), the challenges will be the same: communicating when the phone lines are down, hospital beds for the victims, how to get medicine and food supplies in and people out if the bridges fail.
The second cause for concern seems totally mundane. Obesity. A national epidemic that the Cape has not escaped. Just check out the aisles of any supermarket and you'll see "effect" pushing too many shopping carts of "cause."
Obesity is a driving force behind a textbook full of diseases and it has become a recent factor with younger and younger Americans; affecting us, one might say, from the cradle to a premature grave.
In companion articles listed below we will deal with each of these problems separately and also reference related pieces by our regular expert contributors.
Many of these will even strike a note of optimism. The Cape is working on a disaster preparedness plan…and you don't have to be fat!
Aside from the accident of geography, which links us to the mainland by two slender threads of steel, "progress" may be most responsible for many of the health problems Cape Codders will face in the event of a major catastrophe, natural or man-made.
Yet, as members of the Advisory Board of To Your Good Health, A Health Care Newsletter, agreed at their most recent meeting at the Four Points by Sheraton Resort in Hyannis, "progress" also may provide an eventual solution.
Two aspects of modern life were singled out. One is obvious-our total dependence on wired power, for communication or to run appliances.
"What happens if the telephone wires aren't connected?" asked Dr. Arthur Bickford, founder of the Duffy Community Health Center. "What happens in a worst-case scenario, a hurricane that closes both bridges and knocks out the power?"
Less obvious, but also an outgrowth of modern technology, is a change in marketing strategy by the nation's retailers. Thanks to the computer's ability to track inventory, stores no longer use precious floor space to warehousing extra product. So supplies on-site are limited.
Again, Dr. Bickford: "We've become a nation where you sell it today, order (new) this afternoon and it's delivered the day after tomorrow. Whether it's aspirin or oxygen, you've got this small supply that isn't going to last through a hurricane. We've checked this out. The hospital has something like six days of oxygen."
There's another change from the old days before help was just 911 away.
Andrew Young, a former trustee of the Cape Cod Hospital Foundation, recalled, "Years ago, folks on the Cape understood that they had to be self-sufficient. When those '50s hurricanes and storms came through, everybody had kerosene lamps, everybody had kerosene, and everybody had food and water put by. They understood that they could not necessarily communicate with their neighbor. That's all gone by for a variety of reasons so we have to bring back the ethos that we need to be self-sufficient…for at least five to seven days."
One added problem with stockpiling concerns prescription medications. Most insurance programs will not provide reimbursement for more than a 30-day supply.
The answer to a potential communications vacuum is not being ignored and this is where "progress" comes into play.
Dr. Kathleen Schatzberg, president of Cape Cod Community College, reported on a recent preparedness summit sponsored in part by the Cape Cod Technology Council.
The goal was to figure out how best to build a communications network that will work in a hurricane. "They talked about wireless systems, they talked about satellites. Their whole thing was seeing that communications work in case of an emergency," she said.
"Cape Cod Healthcare is helping to lobby for a Cape-wide wireless network," said Dr. Herbert Mathewson, medical director for the VNA of Cape Cod. "Cape Cod Hospital will be the first and largest responder for any kind of emergency and I would expect them to take a major role in this wireless responder network"
Finally, what kind of disasters might we face...and where do we treat the victims?
Hurricanes have long been a way of life on the Cape. A bird flu pandemic and terrorist attack are risks of a more recent vintage.
"It's only a matter of time before all the birds of the world have it," Dr. Bickford warned, "and so it's only a matter of time before the thing will begin to spread human-to-human. Whether a vaccine comes first is another matter…but nobody knows how long that interval is. As we learned from the 1918 flu epidemic, pandemics come and go quickly-like a hurricane-but during the surge period demand for help is high."
Dr. William McDermott, a retired Navy admiral, is former president and current treasurer of the Massachusetts Medical Society.
"Bird flu has to be on the table," he said, "but there are an awful lot of experts who say one of the biggest threats is some sort of nuclear attack against this country, on our grounds, within 10 years. That's what we've got to be concerned about. These guys are experts who look at national security and they know what they're talking about. This is what they're hearing…nuclear, nuclear, nuclear."
Dr. Bickford then posed the next question, "Whether it's the bird flu, a hurricane or the nuclear thing, what happens when there's a surge of sick people trying to get into the hospital that's already stretched to the limits? The system just hasn't got the capacity to absorb 500 new cases."
Dr. David Penfield, an emergency room physician at Cape Cod Hospital, agreed. "The hospital is already at capacity," he said, adding that given the Cape's demographics, "We have the highest number of really sick people in those beds (who can't be safely moved)."
The Rehabilitation Hospital of the Cape and Islands does present partial relief.
"We don't have an emergency room," explained Carole Stasiowski, RHCI director of marketing, "But we certainly could send some of our patients home to make room so some of the less acute cases could be moved from the hospitals."
Diane Kolb, president of the VNA of Cape Cod, pointed out that "the VNA has historically always done emergency care and we have at any given time 1,200 to 1,500 really elderly patients in a home environment. We are moving toward making these people more independent and to prepare the home so they can stay there safely if nobody can get to them. Not everybody has a generator, but our focus has been making them aware of what can happen to them. We're dealing now with preparations for a pandemic and what we can do with all these people in their home setting where they'll be safer."
Even Cape Cod Community College is preparing to play a role.
According to John Lebica, director of facilities management, the college has been preparing to serve as a distribution point for vaccines and also as a triage center.
The college actually has a large in-house contingent of nursing students and their instructors to lend an expert hand. And Mr. Lebica noted, "We have a place to store stuff, a loading dock, easy access to the Mid-Cape and a place for helicopters to land. Also, the way our buildings are set (in a circular pattern surrounding an open space) and a driveway that's one way in and one way out really lends itself to be able to triage folks as they come onto the grounds."
Sue Rohrbach, an aide to Senator Rob O'Leary, did sound one optimistic note. "A lot of things are going on that people don't know about," she said. "There is a state Regional Emergency Planning Committee. And here on Cape, we have a regional organization."
And Mr. Lebica added, "I've been to state-wide conferences and could see where other people are at. Barnstable County is ahead of curve on all of this stuff. The challenge is to get people to pay attention."
"Obesity is responsible for more deaths on Cape Cod in one year than any hurricane."
--Dr. David Penfield
"My definition of junk food: Anything wrapped in cellophane that comes from a vending machine."
--Dr. Herbert O. Mathewson
When you mention a rehabilitation hospital, the first thought that generally comes to mind is treatment of trauma. Auto accidents, broken hips, war wounds.
Yet, according to Carole Stasiowski, director of marketing for the Rehabilitation Hospital of the Cape and Islands, one of the major factors that brings people to their Sandwich facility is obesity.
Oh, not directly, but as a "co-morbidity" of the effects of diseases that can trace their origins in large measure to obesity: heart disease, stroke, diabetes, respiratory disease, depression, incontinence and arthritis. Patients come in with these problems, but they're so obese they're immobile and RHCI has been forced to set up rooms with special equipment to treat them.
"Particularly, there's a growing epidemic in childhood obesity," Ms. Stasiowski said at the recent meeting of the Advisory Board of To Your Good Health, A Health Care Newsletter, at the Four Points by Sheraton Hyannis Resort. "It's such a huge problem that we've even started a special program for overweight kids."
"A significant issue," she concluded, citing national figures that show obesity has passed smoking as the number one preventable risk factor for disease.
How to deal with this growing epidemic, especially among overweight children before they become overweight adults, at which time their bodies, according to studies, are growing 20 years older than their calendar age from the strains of excess poundage?
"A big thing is to get some parental involvement in physical activity," said Diane Kolb, president of the VNA of Cape Cod, who came here from Iowa where "our number one priority was childhood obesity."
"Park as far away as you can from the entrance of the place you're going to. Try that for a change," suggested Dr. David Penfield, an emergency room physician at Cape Cod Hospital. "And if you watch TV-as some people do-put your remote away for a week. Think about all these little things that you don't do."
Following the statement by Ms. Stasiowski "that obesity is a very serious problem related to our lifestyle; everything is so abundant," Dr. William McDermott, treasurer of the Massachusetts Medical Society, closed with an ironic note:
"Yet, despite all this abundance, we continue to struggle with the problem of the number of kids who still come to school hungry."