Toxic Avengers

When the Leadie Eddie van visits neighborhoods in south Newark, N.J., to screen children for lead poisoning, the tiny patients are not appreciative. Dozens of babies and toddlers join in a noisy chorus of crying as they get their fingers pricked for blood tests.

But the nurses who do the screening know their work is worth the tears. The blood tests are the first step in preventing what could be dire consequences for many of these children later in their lives. Lead poisoning can cause learning disabilities, developmental delays and brain damage. Through screening programs such as Leadie Eddie, nurses can catch lead exposure early and reduce the risk that the children will suffer permanent harm to their health.

“This is health promotion at its finest,” says Felesia Bowen, RN, MS, PNPC, an African-American nurse who teaches at Rutgers University College of Nursing and is involved with the Leadie Eddie program. “It’s an opportunity to make a big difference in a kid’s life.”

This early detection program is just one example of the important role nurses can play in addressing environmental health issues in minority and disadvantaged communities. Environmental health has been a component of nursing ever since Florence Nightingale advocated for clean water and proper drainage at British military hospitals. But in today’s increasingly “green” society, environmental health is truly moving to the forefront of nursing, and opportunities abound for nurses of color who want to work with at-risk communities to prevent or reduce exposures to lead, pollution, toxic waste and other environmental hazards.

The Rutgers College of Nursing’s nurse-managed clinics helped implement the lead-screening program in Newark. “Leadie Eddie” is a van staffed by nurse practitioners who travel to poor neighborhoods to provide lead screening tests, preventive education and follow-up. The program was launched in conjunction with Episcopal Community Development, Inc. and the Maternal and Child Health Consortium, Inc., two local community-based advocacy groups.

About a third of the children under age six in Newark have elevated lead blood levels, Bowen says. Unfortunately, this isn’t just a local phenomenon. Lead poisoning is a serious problem in many of the nation’s poorest communities. In some inner city neighborhoods, more than half of the children have elevated lead blood levels, compared to the national average of less than 10%. Children can get poisoned through contact with contaminated soil or if they ingest dust or chips of lead-based paint, which is common in older, poorly maintained housing.

Fighting Environmental Racism

Lead poisoning is not the only environmental health problem that threatens minority communities and disadvantaged neighborhoods—they also have a disproportionate share of industrial operations that produce toxins, says Dorothy Powell, RN, EdD, FAAN, associate professor and associate dean of Howard University’s College of Pharmacy, Nursing and Allied Health Sciences, Division of Nursing, in Washington, D.C.

Corporate polluting is not colorblind, notes Powell, who is African American. “In the South, three out of four hazardous waste facilities are in low-income communities,” she points out. Not surprisingly, residents of these communities have higher-than-average rates of cancer and respiratory problems. Exposure to toxic waste can also lower IQ levels and lead to developmental delays and behavior problems in children.

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Powell believes nurses of color can play a powerful role in fighting this environmental injustice by serving as advocates and educators for minority communities that have been unfairly singled out as targets for pollution and other environmental risks. “Nurses who live and work in the community are in an ideal position to talk to people about the risks and inform them about what their rights are,” she explains. “Often what you find is that these communities not only don’t know their rights but are not even aware that they are being exposed [to environmental hazards.]”

Community education is critical. For instance, many people in disadvantaged areas continue to fish in polluted streams even when warning advisories are posted, Powell says. Poor families are reluctant to give up a free source of food, and often they don’t understand the advisories or realize that these warnings apply to them. Another common misconception is that the toxins can be removed simply by putting wine or vinegar on the fish or cooking it thoroughly.

In some communities, nurses are taking their advocacy role even further by working at the grassroots level to actually fight against corporate polluting in minority neighborhoods. For example, the California Nurses Association is a member of Health Care Without Harm, a national campaign to eliminate pollution by the health care industry.

Among the campaign’s targets are medical waste incinerators, which release dioxin, a poison linked to cancer. Dioxin is released when plastics, such as IV tubing and IV bags, containing polyvinyl chloride (PVC) are burned. The California nurses are working with local environmental groups to raise public awareness about two medical waste incinerators located near low-income neighborhoods in Oakland.
Kevin Riley, RN, BSN, a community organizer for the nurses association, says the coalition wants the company that operates the incinerators to switch to more environmentally safe methods, such as microwaving or a process called autoclaving, which uses steam to sterilize waste. As a result of this campaign, he adds, increased public awareness has prompted local air quality officials to pay closer attention to the incinerators.

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Besides working through professional associations and environmental groups, nurses can also help advocate for minority communities’ environmental rights by serving in government or public service capacities. Lillian Mood, RN, MPH, FAAN, had worked as a public health nurse for more than 30 years when the South Carolina Department of Health and Environmental Control appointed her its first community liaison nine years ago.

Mood, who recently retired from her position, served as a link between environmental scientists and community residents, helping to inform the latter about environmental threats and their rights to protection. In one instance, a private company applied to open a landfill next to a minority neighborhood. Mood’s job was to arrange public meetings and to listen and respond to the concerns of the residents, who were strongly opposed to the project.
“Eventually, they raised enough valid questions that the landfill application was turned down,” she says proudly. “Many times the solutions lie in the communities themselves, once they have become armed with knowledge about the system and how to get involved.”

Reach Out and Trust Someone

While this may seem like a job better suited to professional environmental activists, health experts agree that nurses are a natural fit for the role of educating communities about their environmental risks and rights.

Toxic Avengers

“Nurses are in opportune places to address environmental health issues,” says Teresa Nastoff, RN, BSN, a health education specialist with the Agency for Toxic Substances and Disease Registry (ATSDR), a sister agency of the Centers for Disease Control. “Nurses are in schools, workplaces, home health care and other positions where they are clearly visible in their communities.”

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And, she adds, with nearly 2.7 million RNs currently practicing all over the country, nurses have the numbers and the potential to make a huge impact.

Nurses also inspire trust. Community residents are more likely to feel comfortable talking to nurses about their environmental concerns than to biologists and environmental engineers.

“Being a nurse was an invaluable advantage,” Mood says of her community advocacy work. “[Because of my background,] I could anticipate the questions people would have and I had a good understanding of the health implications. Nurses are taught how to listen and how to interview people. And the community is our home.”

Nurses of color who have strong ties to their local minority communities can play a particularly vital role in these outreach efforts. “With any community you work with, you need to develop trust,” says Donna Darity, RNC, MSN, an African-American nurse who teaches community health courses at Florida A&M School of Nursing in Tallahassee. “People are very suspicious of groups of individuals when no one in the groups looks like them. Diversity is very, very important.”

Even something as simple as knowing the food preferences of a culture can help foster communication. Educating the community about good nutrition is important to reducing risks of lead poisoning, because a child who has a diet low in iron and calcium absorbs more lead than children with diets rich in those nutrients. “As an African American, I can tell someone to eat collard greens [to get more iron],” says Bowen of the Leadie Eddie program.

Maria Alvarez Amaya, RNC, PhD, WHNP-C, a Hispanic nurse researcher who has been studying lead exposure among residents on both sides of the Texas-Mexico border, agrees that minority nurses can make a huge difference in ensuring that environmental health interventions are both culturally and linguistically competent.

“It is certainly helpful to be bicultural and bilingual, and not just here on the border,” she says. “You have to understand the cultural background, so you can understand what motivates people to change their behaviors.”

For instance, Amaya, an associate professor at the University of Texas-El Paso College of Nursing, was able to determine that some of the environmental health public education materials that were being distributed to people on the border were not culturally appropriate. The straight translation from English to Spanish missed the mark, and certain important cultural values, such as respect for elders, were not incorporated into the material.

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To come up with a more effective tool for delivering the message, Amaya worked with local community groups to produce a 14-minute public education video about lead poisoning. Soap operas are popular in Mexico, so she packaged the information in a soap opera-like drama. To lend cultural credibility, an older actress plays the character of the elder who delivers the public health information. Amaya also produced a photo novel featuring dialogue and still pictures from the video.

Amaya will continue her research and environmental outreach work over the next five years, thanks to a $1.7 million grant from the National Institute for Environmental Sciences. Through the grant project, she will work with other health care professionals and community groups to identify children in El Paso and Juarez who have been exposed to lead and develop a plan to remedy the situation and inform the public.

Educating Environmental Advocates

As environmental health issues continue to become a high priority on the nursing profession’s agenda, a growing number of universities and government agencies are working together to incorporate environmental health education into nursing curricula.

In 1995, the Institute of Medicine, part of the National Academy of Sciences, developed a list of general environmental health competencies for nurses. According to the institute, all nurses should be able to understand environmental concepts, complete environmental health histories for patients and make assessments and referrals. They should also know how to inform patients and communities about environmental risks, understand the policy framework for addressing environmental health and know the major environmental laws and regulations

The National Environmental Education and Training Foundation is working with several nursing schools and professional associations to incorporate information about pesticide exposure—a particularly serious health risk for migrant farm workers–into nursing curricula. This partnership is developing guidelines for content and looking at how pesticide exposure should be incorporated into patients’ health histories. Program Coordinator Jennifer Bretsch says the foundation is working on one environmental issue at a time and will expand to include others as the program matures.

The Nationwide Environmental Health Nursing Initiative is still another effort aimed at beefing up environmental health education for nurses. The initiative, launched by the Agency for Toxic Substances and Disease Registry, is working with nursing schools and other groups to develop tools, curricula, training and distance learning programs.

Meanwhile, the Howard University Division of Nursing, one of the nation’s most prominent historically black nursing schools, has co-developed an environmental health curriculum focused on the Mississippi Delta Project, a coalition that is identifying and addressing environmental concerns in disadvantaged communities in a seven-state, 219-county area along the Mississippi River in the Southern U.S.
Corporate farming, petroleum processing and a growing number of other related industries are concentrated there. Environmental health issues have become a major concern because Delta residents have been exposed to pesticides and other toxic materials. Cancer rates are higher in the Mississippi Delta region than in the rest of the South, Powell says. Yet many health professionals in the region lack environmental health training.

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The curriculum, which the university developed in partnership with the Minority Health Professions Foundation and the ATSDR, includes six modular units that nursing schools in the region can incorporate into their education programs, either in parts or as a whole. The topics include environmental health and the Delta; the impact of culture, race and economics on environmental health; common toxins in the Delta and their implications for health; human and community responses to toxic substances; environmental justice; and strategies for working with communities at risk.

Getting More Involved

All nurses should have some environmental health knowledge, experts say. But what other skills and qualities are necessary in order to work effectively with communities on solving environmental health problems?

“Environmental health nurses must have good listening and communication skills and an understanding of how the human body responds to stress–physically, mentally and emotionally,” Mood believes. This is because nurses need to stay calm and relaxed in situations where community residents may feel fearful, angry and suspicious of health officials, she explains. “You need to have enough self-awareness and personal maturity to feel comfortable with yourself so that you will not be intimidated or react defensively.”

Darity offers the following suggestions for nurses interested in getting more involved with environmental health issues:

  • Get to know the key players in your local community and your state.
  • Get involved early in the process of emerging environmental health issues.
  • Join and network with professional nursing organizations to learn more about environmental health.
  • Volunteer for a committee at your workplace that deals with environmental health. For instance, many hospitals have adopted the goals of Health Care Without Harm, which is not only focusing on curbing pollution from medical waste incinerators but also working on issues such as eliminating the use of mercury in health care settings. Nurses can play an active role in these efforts at their clinics and hospitals.
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