Black lung is back and nobody knows exactly why. Black lung is a disease afflicting underground coal miners. They breath in coal dust and, over time, miners' lungs are so damaged they stop working. Laws passed in the 1960s helped cut down the number of miners with black lung by controlling the amount of dust in the air. But Carole Bass reports in an online publication that now those gains are starting to erode.
Bass said federal officials have focused on several reasons for the resurgence of black lung disease among underground coal miners. First, the dust standards are still too lenient. There's too much dust in the air and the federal government has refused to lower the standards — to clean up the air in the mines. Also, miners are working longer hours. Instead of a 40 hour week, miners are underground sometimes 60 hours or more. They breath in more dust, and they have less time out of the mines for their lungs to clean themselves.
Finally, researchers believe that as miners dig thinner seams of coal, they are cutting into more rock, mixing silica dust with coal dust. Silica is 20 times more harmful than coal dust and so miners are breathing more toxic air.
Who said living in rural America was easy? Turns out, country living is downright dangerous, compared to life in the metros, according to a recent study. "The perception is that life in rural areas is peaceful, tranquil, serene," said Jeffrey H. Coben, M.D., a professor in the WVU Injury Control Research Center. "If you just look at violence - person against person - the rates are higher in urban areas. But for virtually every other cause of trauma, the risks are substantially greater in rural areas."
As the population density decreases, hospitalization rates for injuries increases. Hospitalization rates for injuries were 35% higher in sparsely populated rural counties compared to urban counties. Large urban counties carried the highest hospitalization rates for assaults. But rural counties led in hospitalizations for motor-vehicle crashes, falls and poisonings. Self-inflicted injuries were also higher in rural counties, with poisons, knives and guns the instruments of choice.
There are tons of reasons for the higher injury rates. More people are engaged in high-risk occupations in rural areas, like mining and logging. Injuries in car crashes are higher because people drive more and because seatbelt usage is lower.
In a front page story on New Year's Day, the Washington Post finds that a dwindling number of general surgeons are to be found in rural communities. General surgeons are the "essential ingredient that keeps full-service medical care within reach" of rural residents, reports David Brown. But the number of general surgeons graduating each year hasn't increased since 1980, even though the country's population has increased by 79 percent. There are shortages of general surgeons everywhere.
"Nevertheless, it's in rural America -- where some places have only half as many surgeons per capita as cities -- that the problem is most acute," Brown writes. "And it's likely to get worse. More than half of rural general surgeons are older than 50, and a wave of retirements is expected in the coming decade." Without surgeons locally, hospitals have to fly patients to metro facilities. That's hard on patients, and it's hard on the finances of rural hospitals that are losing business.
It will only be one of 8,500 community forums the Obama Administration will hold on the nation's health care system, but this was among the first, it was attended by incoming Health and Human Services Secretary Tom Daschle and it took place in a town of just 700 people. Some 35 people turned out in Dublin, Indiana, yesterday to talk about health care. A woman asked what her 13-year-old son would do for health insurance, given his congenital heart problem, according to a report in the Indianapolis Star. A family practice office manager told of the mountainous number of forms he had to fill out to be paid by insurance companies. The fire chief wondered who would pay for new equipment his volunteer outfit would need by 2010.
Daschle (above, at the meeting) asked questions and took notes. He said the stories he heard will help change the minds of some in Congress. The Washington Post sees the forums as part of an elaborate, grass-roots campaign similar to the effort that elected the Democrat. With other issues, it seems the Obama transition team has scant understanding of rural needs. Not so with health care, it appears.
A study of 2006 fatalities from drug poisoning in West Virginia shows that, with more powerful opioids in circulation, rural communities have caught up with a big city problem.
A study that attempted to determine if venison eaters had higher levels of lead in their blood was released this week. The results were inconclusive. Last year a Bismarck, North Dakota, doctor and hunter X-rayed venison collected from food pantries around the state. In May, a more formal study of 738 North Dakota residents began, reports the Bismarck Tribune .
The epidemiologist who conducted the study said the tests indicated that those people who eat a lot of venison killed with lead ammunition "tended to have higher lead levels than those who ate little or none." However, none of those tested had lead levels that would be considered elevated.
State officials recommended that people could minimize their consumption of lead by following safe processing procedures. The state's recommendations can be found here.
Many rural children are federally eligible for free dental care but fail to receive it, for many reasons and with dire consequences. Judy Owens reports on innovations in rural dentistry that are serving the young.
These days you don't read many 5000-word feature stories -- they're nearly as hard to find as a doctor in rural Idaho. So thanks to the Boise Weekly and writer Carissa Wolf for an excellent article about the state's shortage of physicians and the Family Medicine Residency program that's had some success bringing doctors in.
Idaho ranks last in the nation in physicians-per-patient. Susie Pouiiot, head of the Idaho Medical Association (IMA), told Wolf "if all Idahoans had health insurance, many would still have a tough time accessing medical care," even in Boise, the capital. In rural parts of the state, the doctor shortage is staggering. Wolf interviews a number of country doctors: "Everybody needs you and you're the only show in town," says one. Another makes his weekly rounds via airplane.
Wolf describes a breathless day in the life of a rural physician. She also explains the difficulties attracting new doctors and a number of state efforts to turn the problem around: a possible Idaho medical school, reduced tuition at med schools in neighboring states, analysis of rural physicians' "personality types." But Pouliot of the IMA has found, residency programs "give you the best bang for your buck."
Wolf writes that "physicians tend to establish practices near their residency programs. Fifty-four percent of the graduates of the Family Medicine Residency of Idaho program practice in Idaho. The majority of those physicians practice in rural areas."
The abuse of opiates is a harrowing problem in parts of rural America. So is addiction treatment. In a letter to the professional journal Psychiatric Services, a doctor in Golden, Colorado, describes how he has been working with rural patients through telepsychiatry. "Over the past two years, I have treated approximately 40 opioid-dependent patients from communities throughout Colorado, all of whom were seen exclusively via telepsychiatry from their own homes or offices," writes Dr. Douglas M. Ikelheimer.
Ikelheimer is among the "relatively small number "of physicians certified to prescribe buprenorphine, a drug recently approved to manage dependence on opiates. Using fairly inexpensive video-conferencing software (like iChat and Skype), he is able to diagnose patients and monitor their conditions, working in conjunction with local doctors, laboratories, and pharmacists. Patients with home computers, Webcams, and the high-speed Internet access they require, can take advantage of this treatment.
"As this process becomes more widely accepted by physicians, patients, and the insurance industry," he writes, "it may well represent the long-sought realization of the potential for telepsychiatry as an efficacious and cost-saving modality with far-reaching implications."
Dr. Regina Benjamin has made house calls to hurricane evacuees and rebuilt the Bayou La Batre Rural Health Clinic not once but twice. She heard Monday that the MacArthur Foundation, based in Chicago, will give her effort a shot in the arm: $500,000 over five years. She's one of 25 "Genius Grant " recipients for 2008.
Dr. Benjamin's clinic, on the Gulf Coast on Alabama, serves rural patients no matter their ability to pay. The clinic's buiding was destroyed by Hurricane Katrina, and a new facility burned New Year's Day 2006. Even so, the work of caring for 4,300 patients has continued.
Benjamin said that the health safety-nets for her patient population have split open. "People who were insured all their lives are losing their insurance, losing their jobs, or they just can't afford it anymore," she said.
The MacArthur grants may be spent in any way the recipient chooses. Benjamin said she may establish scholarships that would direct local students into math, science and health care professions.
"We don't have enough kids from rural communities, and particularly minority kids, going into health careers," she said.