It was 10 p.m. and I had just stepped off the airplane and into the congested luggage collection area at Delhi International Airport. The airport had dramatically changed since I had last visited. The walls were now covered with bright, digital ads and it was clean with a crisp, pacific appearance to it. Western stores stood adjacent to traditional Indian stores. The degree of assimilation to the westernized culture was quite notable.
With heavy, sleepy eyes, but obvious enthusiasm, Meredith and I were ready for our Indian journey. I stepped out into the sweltering heat with luggage in both hands. What a difference from the rainy, cloudy Columbus weather I had left behind! A few moments after I stepped outside the airport and into the Delhi streets, I somehow found myself chanting the Bernie Sander’s slogan: “Feel the Bern!” Oh, I was definitely feeling the burn!
My eyes started to gently water. There was a tingling feeling in my nose, and my throat felt like what it does after sipping on steaming hot coffee. The faint taste of acid on my tongue soon became evident. At dawn, a thick blanket of brown, heavy fog engulfed the city. Desolate, clean areas of the city stood next to towns filled with factories with large smoke stacks. Outdated tractors and buses emitting dark, thick smoke infiltrated the busy streets of Delhi.
One thing became pretty evident: the air was terrible. It was clear that pollution knew no boundaries. The tree hugger and future oncologist in me became panicked by the implications the environmental condition of Delhi had on its inhabitants. I also began to channel my inner Dr. Snyder (my preceptor back home) and thought about what the rate of asthma was. Intrigued by this topic, I began to research in this area of Indian health and the statistics and facts I came across were unsettling.
One particularly interesting study I came across was titled Air Pollution and its Effects On Health: Case Studies, India. This project was conducted by the Chittaranjan National Cancer Institute in Kolkata. According to this study, Delhi was noted to have “critical levels” of air pollution (PM10> 10ug/m3). Pune—which is the city Meredith and I are going to work in for 15 days—and Shimla, which was one of the cities we visited, were noted to have “high levels of air pollution.” Vehicular emission accounted for 70% of the pollutant load, which was not surprising judging from the vehicles that we had seen in Delhi.
Asthma rates were higher by a factor of 2 in the urban Indian areas as compared to the rural areas. Upper and lower respiratory tract symptoms such as cough, wheezing, shortness of breath, and pneumonia were 2-3 times higher in the urban setting. 41.2% of participants in the urban research group were found to have reduced lung function as compared to the 18% in the rural group. Lung function was measured using pulmonary function tests.
The urban population was also noted to have increased levels of inflammatory cytokines. Platelet-P-selectin function was higher in the urban population as well. This correlated with a two-fold increase in platelet aggregation and ATP-release. The researchers deduced that inflammation and increased formation of leukocyte-platelet aggregates partially contributed to an increase in thrombotic disorders, cardiovascular disease/congestive heart failure.
Electron microscopy studies suggested that DNA samples from the urban population had an excess of comet formation, suggesting an increased rate of DNA damage. Up- regulation of AKt signal transduction and increased rates of metaplasia and dysplasia were noted in cellular samples collected from the urban study group. This seemed to correlate with an increased rate of malignancies such as leukemia and lung cancer in the urban population.
The research was demonstrating that poor environmental health meant poor physical and mental health. I could only imagine what types of implications it posed on child health. Simply put, this data was terrifying!
So, what does all of this have to do with our little, big fighters? Well, it’s pretty obvious that children who live in healthier environments typically do better in terms of disease process. For example, development and nutrition tend to be better in kids who live in environments with cleaner air and water. Air health correlates particularly with respiratory function. Water conditions have a significant effect on gastrointestinal function. Solutions to the environmental crises need to be developed on the individual, national, and international levels. Solutions are not easy, nor are they fast. However, actions need to be taken now. A nation’s and a world’s health depend on these actions!
As I end this rant and wordy post (congratulations to those who have not fallen asleep reading this), I leave you with more words (sorry):
“For what I’ve done, I start again. And whatever pain may come, today this ends. I’m forgiving what I’ve done. I face myself, to cross out what I’ve become…” What I’ve Done by Linkin Park.