Saving Lives in a Time of Cholera



A health worker was disinfected after bringing cholera victims to a grave near Port-au-Prince, Haiti, in November 2010.                                    Photo Credit: Damon Winter/The New York Times



The New York Times, April 11, 2012, by Tina Rosenberg  —  Cholera is on the rise around the world. Last year, according to Unicef, West and Central Africa had “one of the worst ever” cholera outbreaks. An outbreak in Haiti sickened 1 in 20 Haitians and killed more than 7,000 people. The World Health Organization estimates that there are between three million and five million cases of cholera each year, and between 100,000 and 120,000 deaths. New and more virulent strains are emerging in Asia and Africa, and the W.H.O. says that global warming creates even more hospitable conditions for the disease.

In most parts of the world, the last few months have brought a respite. But April is the start of the rainy season, which is also the cholera season.

Cholera should not be a terror. It is easy to treat if you know how. Countries that live permanently with endemic cholera, like  Bangladesh, see fewer than one death per 100 cases. But in recent epidemics in Zimbabwe, Somalia and Haiti, death rates in some areas have been reported at 10, 20 or even 50 percent. In countries unfamiliar with the disease, people don’t know the steps to take or have the tools they need.

With cholera, speed matters. It can kill very quickly — in a few hours if victims are already malnourished. And since the incubation period for the cholera bacteria can be as short as two hours, it spreads fast.

Until now, early action has been nearly impossible. Governments, fearing stigma and a loss of tourism, often cover up cholera, and international organizations sometimes go along with the fiction. Even when governments  do call cholera by its name and start inviting international help and expertise, the W.H.O. and Unicef are bureaucracies — and such invitations can come weeks after a widespread epidemic is under way.

A new partnership between two organizations that battle cholera will make it possible to get supplies and knowledge to cholera-stricken areas much faster. Early next month, AmeriCares, a United States-based  aid group that specializes in airlifting medical supplies into disaster zones, will finish assembling a group of pallets containing everything necessary to treat 15,000 cases of cholera.

AmeriCares says it can get those pallets from the assembly site in the Netherlands to anywhere in the world within 48 hours. The know-how will be brought — also at top speed — by doctors and nurses from the International Center for Diarrheal Disease Research, Bangladesh, the world’s leading cholera experts. Instead of waiting for an invitation from a government or international organization, the center will bring the medical help in right away, alongside AmeriCares. “Until now, we’ve waited for an invitation from the World Health Organization or Unicef or the local medical authorities to come in,” said Mark Pietroni, the center’s medical director. “That’s sometimes six weeks late.”

This is increasingly the future of disaster management: prepositioning to get what’s needed to where it’s needed earlier. Instead of buying and shipping food stocks after a crisis begins, for example, the United States Agency for International Development and the World Food Program are increasingly buying food during harvests, when it is cheaper, and storing it near potential crisis zones, much of it in W.F.P.’s huge warehouse in Mombasa, Kenya.

Bangladesh is famous for its nongovernmental organizations — the Grameen Bank and the anti-poverty giant BRAC are the most widely known. But the Center for Diarrheal Disease  has achieved just as much. The center invented oral rehydration solution, a packet of salt and sugar that mothers can mix with clean water and give to a child with diarrhea. That packet saves the lives of some three million  children a year.

Despite its name, the center works on a lot of problems  — nutrition, H.I.V. and reproductive health, to cite a few. At its headquarters in the Dhaka, the Bangladeshi capital, it has trained more than 27,000 people from 78 countries. At its main field site in the subdistrict of Matlab, about 30 miles from Dhaka, the center has been collecting demographic data for more than 40 years. Interviews with a population that is now about 250,000 have provided researchers with key information: for example, the fact that 63 percent of child deaths are because of diseases preventable with vaccination. The results of the center’s health research in the area guide programs that have significantly reduced child mortality around the globe.

But in Bangladesh, the center is known as the Cholera Hospital. During the cholera season the center treats 1,000 people a day. “Cholera is a Bengali disease, coming from the Ganges delta,” Mr. Pietroni said. “The treatment is also a Bengali treatment.”

The center has redesigned and been an evangelist for the cholera cot — a cot made of a plastic tarp with a hole in the middle and a bucket that goes beneath. Without such cots, doctors and nurses in cholera wards find themselves wading through pools of infectious stool. And center’s staff have traveled to epidemics around the world, training local health officials, doctors and nurses.

Their most important message is the importance of early and massive hydration — if a patient is too weak to drink, then IV solution is necessary. “The biggest mistake is that patients do not get enough hydration fast enough,” Mr. Pietroni said. “You have to give huge amounts of IV fluid in the first three hours — seven or eight liters. In Dhaka at the end of April you see people with IVs in each arm and leg. But as soon as the patient can drink, you switch them to oral rehydration.”

Flooding patients produces Lazarus-like effects. People who come in barely showing a pulse are sitting up and drinking just a few hours later. This September, in the midst of an outbreak in Somalia, two doctors and a nurse from the center gave a five-day cholera course in Mogadishu. “They did have an outbreak, but conditions in Somalia are really ripe for a really large, Haiti-scale outbreak, and it hasn’t happened so far,” said Gregory Anderson, a program officer for the Conrad Hilton Foundation, which gave a grant to AmeriCares and the center to provide training and supplies in Somalia and Kenya.

AmeriCares and the center realized they needed each other during their work in Haiti. “AmeriCares had the capacity to send things, but sometimes lacked the expertise,” said Alejandro Cravioto, the executive director of the center. “And when groups like us arrive, sometimes we have enough to work with, and sometimes we don’t. This was an obvious fit.”

In many cholera outbreaks, AmeriCares is already there: 70 percent of the disasters they respond to are water-related, like floods and tsunamis, and cholera usually follows two or three weeks later. Now, as soon as cholera is suspected, AmeriCares will ask a local partner to invite the Center for Diarrheal Disease. The center’s job is to confirm that the disease is cholera, work with a hospital to set up a treatment clinic — often a tent on the grounds — and, most important, train local medical personnel. AmeriCares handles the logistics: “We’d work with the ministry of health to get duty-free clearances,” said Ella Gudwin, vice president for emergency response. “We’d look at the generator, the supply chain, the availability of materials, where the water is coming from.”

AmeriCares and the Center for Diarrheal Disease  are employing an idea — a preventive, proactive approach to disaster — that is starting to get attention. The project was highlighted as particularly promising at the Clinton Global Initiative meeting in 2011. “This has definitely not been philanthropy’s role in the past,” said Mr. Anderson of the Hilton Foundation. “It’s been a very reactive sector. But we’re very focused on it. The return on investment is much better.”



Tina Rosenberg won a Pulitzer Prize for her book “The Haunted Land: Facing Europe’s Ghosts After Communism.” She is a former editorial writer for The Times and now a contributing writer for the paper’s Sunday magazine. Her new book is “Join the Club: How Peer Pressure Can Transform the World.” 

Arsenic in Our Chicken?


Caged Chickens


The New York Times, April 11, 2012, by Nicholas D. Kristof  —  Let’s hope you’re not reading this column while munching on a chicken sandwich.  That’s because my topic today is a pair of new scientific studies suggesting that poultry on factory farms are routinely fed caffeine, active ingredients of Tylenol and Benadryl, banned antibiotics and even arsenic.

“We were kind of floored,” said Keeve E. Nachman, a co-author of both studies and a scientist at the Johns Hopkins University Center for a Livable Future.  “It’s unbelievable what we found.”

He said that the researchers had intended to test only for antibiotics. But assays for other chemicals and pharmaceuticals didn’t cost extra, so researchers asked for those results as well.

“We haven’t found anything that is an immediate health concern,” Nachman added. “But it makes me question how comfortable we are feeding a number of these things to animals that we’re eating. It bewilders me.”

Likewise, I grew up on a farm, and thought I knew what to expect in my food. But Benadryl? Arsenic? These studies don’t mean that you should dump the contents of your refrigerator, but they do raise serious questions about the food we eat and how we should shop.

It turns out that arsenic has routinely been fed to poultry (and sometimes hogs) because it reduces infections and makes flesh an appetizing shade of pink. There’s no evidence that such low levels of arsenic harm either chickens or the people eating them, but still…

Big Ag doesn’t advertise the chemicals it stuffs into animals, so the scientists conducting these studies figured out a clever way to detect them. Bird feathers, like human fingernails, accumulate chemicals and drugs that an animal is exposed to. So scientists from Johns Hopkins University and Arizona State University examined feather meal — a poultry byproduct made of feathers.

One study, just published in a peer-reviewed scientific journal, Environmental Science & Technology, found that feather meal routinely contained a banned class of antibiotics called fluoroquinolones. These antibiotics (such as Cipro), are illegal in poultry production because they can breed antibiotic-resistant “superbugs” that harm humans. Already, antibiotic-resistant infections kill more Americans annually than AIDS, according to the Infectious Diseases Society of America.

The same study also found that one-third of feather-meal samples contained an antihistamine that is the active ingredient of Benadryl. The great majority of feather meal contained acetaminophen, the active ingredient in Tylenol. And feather-meal samples from China contained an antidepressant that is the active ingredient in Prozac.

Poultry-growing literature has recommended Benadryl to reduce anxiety among chickens, apparently because stressed chickens have tougher meat and grow more slowly. Tylenol and Prozac presumably serve the same purpose.

Researchers found that most feather-meal samples contained caffeine. It turns out that chickens are sometimes fed coffee pulp and green tea powder to keep them awake so that they can spend more time eating. (Is that why they need the Benadryl, to calm them down?)

The other peer-reviewed study, reported in a journal called Science of the Total Environment, found arsenic in every sample of feather meal tested. Almost 9 in 10 broiler chickens in the United States had been fed arsenic, according to a 2011 industry estimate.

These findings will surprise some poultry farmers because even they often don’t know what chemicals they feed their birds. Huge food companies require farmers to use a proprietary food mix, and the farmer typically doesn’t know exactly what is in it. I asked the United States Poultry and Egg Association for comment, but it said that it had not seen the studies and had nothing more to say.

What does all this mean for consumers? The study looked only at feathers, not meat, so we don’t know exactly what chemicals reach the plate, or at what levels. The uncertainties are enormous, but I asked Nachman about the food he buys for his own family. “I’ve been studying food-animal production for some time, and the more I study, the more I’m drawn to organic,” he said. “We buy organic.”

I’m the same. I used to be skeptical of organic, but the more reporting I do on our food supply, the more I want my own family eating organic — just to be safe.

To me, this underscores the pitfalls of industrial farming. When I was growing up on our hopelessly inefficient family farm, we didn’t routinely drug animals. If our chickens grew anxious, the reason was perhaps a fox — and we never tried to resolve the problem with Benadryl.

My take is that the business model of industrial agriculture has some stunning accomplishments, such as producing cheap food that saves us money at the grocery store. But we all may pay more in medical costs because of antibiotic-resistant infections.

Frankly, after reading these studies, I’m so depressed about what has happened to farming that I wonder: Could a Prozac-laced chicken nugget help?

Don’t go to this website, unless you have a strong stomach.  I couldn’t read the whole thing.




April 10, 2012,  —  Mayor Bloomberg today announced that New York City has tripled its production of solar power by completing the installation of panels on City-owned buildings across the five boroughs. The 10 projects increase the City’s total solar production to 648 kilowatts – enough to power 143 households – and will cut 205 metric tons of carbon emissions, as well as save money on annual energy costs.

The Mayor also announced that the City’s first “green” hackathon, “Reinvent Green,” will launch this summer to spur the development of digital tools that empower New Yorkers to engage in sustainable practices. Mayor Bloomberg made the announcements at the opening of the new offices of Efficiency 2.0, a New York City-founded tech start-up that helps energy utilities engage with their customers to reduce energy consumption. Mayor Bloomberg was joined at the Efficiency 2.0 offices in the Flatiron district by Department of Citywide Administrative Services Commissioner Edna Wells Handy, Office of Long-Term Planning and Sustainability Director David Bragdon, New York City Department of Sanitation Commissioner John Doherty, New York State Energy Research and Development Authority Director of Energy Programs Michael Colgrove, New York Power Authority Director of Renewable Energy Guy Sliker and Efficiency 2.0 CEO and founder Tom Scaramellino.

“In clean tech, New York City is leading by example and the solar projects we’ve completed will generate clean, affordable energy while cutting our carbon emissions and energy costs – goals that are central to our Administration’s sustainability agenda, PlaNYC,” said Mayor Bloomberg. “We’re also committed to tapping into the power of the private sector and with the success of startups like Efficiency 2.0, we are making our city the place to be for innovation.”

“We are thrilled to announce the installation of 10 new solar photovoltaic systems throughout the City, roughly tripling the solar capacity installed on City facilities,” said Commissioner Handy. “This project was a true citywide effort and a testament to world class teamwork. We applaud the extraordinary efforts of the solar host agencies – Police, Fire, Sanitation, and Transportation – and recognize the support of our other governmental partners at the New York Power Authority, New York State Energy Research and Development Authority, Department of Buildings, Fire Department, and the Public Design Commission.”

“The new solar installations are one example of this Administration’s progress toward our PlaNYC goals to reduce our carbon footprint and encourage the development of renewable energy,” said Office of Long-Term Planning and Sustainability Director Bragdon. “The City’s commitment to new technology, combined with the private sector’s partnership, is helping us create a more sustainable future.”

“Making renewable energy investments viable in New York City is essential to ensure that our supply remains reliable, clean, and affordable,” said Deputy Mayor for Operations Cas Holloway. “New York City is leading the way, and the installation of these solar photovoltaic systems is part of a comprehensive strategy to use the City’s assets to encourage and support the development of renewable energy sources throughout the five boroughs.”

“Today’s announcement highlights the growing synergy between sustainability, economic development and job creation,” said Deputy Mayor for Economic Development Robert K. Steel. “Entrepreneurs are beginning to capitalize on the growing market opportunities in New York City that are driven by Mayor Bloomberg’s PlaNYC initiatives.”

“New York City’s clean energy community is unique in its focus on low capital intensity and high opportunity clean technology companies. Combined with unparalleled access to talent and capital, the City’s commitment to clean energy makes it the best place in the world for innovative technology companies to start, grow, and succeed,” said Tom Scaramellino, founder and CEO of Efficiency 2.0. “The City has always been the home of the boldest ideas and has a long tradition of exporting innovation. We are proud to help continue that tradition by addressing society’s critical energy issues.”

The 10 solar project sites have a total solar photovoltaic capacity of 428 kilowatts, tripling the City’s current production and helping reduce greenhouse gas emissions, while also creating energy cost savings. The projects were funded through federal grants distributed through the New York State Energy Research and Development Authority. The New York City Department for Citywide Administrative Services oversaw the various agencies’ projects, with the help of the New York Power Authority. The project sites include:

  • New York City Police Department, 48th Precinct – Bronx
  • New York City Police Department, 114th Precinct – Queens
  • New York City Police Department, 115th Precinct – Queens
  • Fire Department R&T Repair Shop – Queens
  • New York City Fire Department Engine Company 168 – Staten Island
  • Brandeis High School – Manhattan
  • New Horizon High School – Brooklyn
  • Department of Transportation Maintenance Shop – Queens
  • Department of Sanitation garage – Brooklyn
  • Department of Sanitation garage – Queens

“Solar projects like these will provide clean, reliable energy for years to come, helping the state to meet the goals of the NY-Sun initiative under the leadership of Governor Cuomo,” said Francis J. Murray Jr., President and CEO, New York State Energy Research and Development Authority (NYSERDA). “Both New York State and the city have demonstrated a strong commitment to solar energy, and we hope to see business and residential property owners throughout the city follow the lead of these departments.”

“The New York Power Authority is proud of its long-standing partnership with New York City to improve its energy efficiency and increase clean renewable generation,” said Gil C. Quiniones, president and chief executive officer, New York Power Authority. “Starting in the early 1990s with New York State’s first large-scale solar PV system built in the Bronx, to the recent completion of eight solar arrays atop city public buildings, to our ongoing collaboration on the NYC Solar America City initiative, we are looking forward to helping build a more sustainable New York. This successful partnership also includes significant energy-saving measures to lower electricity demand and greenhouse gas emissions.”

In addition to the solar installations, the federal grants helped fund other efficiency measures. High efficiency lighting was installed on 12 sites throughout the City to cut more 917 metric tons of carbon emissions and save more than $332,000 each year. The funding also provided for the adoption of clean vehicles, which will save more than $163,000 annually and provide for reduction in fuel use and emissions. Since the launch of PlaNYC, the City has completed a total of143 energy retrofits and clean energy installations, and have another 99 projects in design and construction. Together these will reduce our energy costs an estimated $32 million a year.

“The FDNY is committed to not only making New York City a safer place to live, but a greener one as well,” said Fire Commissioner Salvatore J. Cassano. “Whether it’s using energy efficient lighting fixtures in our firehouses, or installing solar panels on our existing buildings and in our new construction, the Department is making great strides towards reaching the city’s long-range sustainability goals. The result is a more energy efficient and less expensive Fire Department, while still maintaining the best fire protection and pre-hospital medical care in the world.”

“The DSNY is pleased to have participated in this significant program that is bringing the city closer to achieving the Mayor’s bold energy reduction goals,” said Sanitation Commissioner Doherty. “Having two of our 59 district garages fitted with solar panels sets in motion our exciting plan to use the sun to power our electric cars. Also, our newest generation hybrid collection trucks and first in the nation, hybrid street sweepers have set the standard for all U.S. municipalities to follow. These heavy-duty hybrids perform at the same standards as their non-hybrid counterparts, with the added benefit of significant reductions in Green House Gas (GHG) emissions and lower fuel consumption.”

This summer, New York City will launch “Reinvent Green,” its first “green” hackathon that will focus on sustainability and the urban environment. Hosted by PlaNYC, the Department of Information Technology and Telecommunications and NYC Digital, the two-day event invites developers and designers to use the City’s environmental open data sets to create digital tools and apps that empower New Yorkers to engage in more sustainable practices. The hackathon is part of PlaNYC’s initiatives to create a greener, greater New York. Interested participants are encouraged to visit and search for “reinvent green” to apply and learn more.

“Congratulations to Efficiency 2.0 on their exciting new expansion. Efficiency 2.0 is a great example of merging digital and green objectives, and in that vein today we are excited to announce the City’s first-ever green hackathon this summer,” said Chief Digital Officer Rachel Sterne. “The Reinvent Green hackathon will help us meet the Mayor’s sustainability goals through innovative, digital approaches that will make our City even greener and greater.”

Through its Personal Energy Efficiency Rewards Program, Efficiency 2.0 rewards utility customers for saving energy. Using customer engagement software, and national and local valuable rewards opportunities, Efficiency 2.0 delivers energy savings and other benefits, and has generated substantially higher savings at a significantly more cost-effective rate than competitive programs. Efficiency 2.0’s programs with leading U.S. utilities will save energy equivalent to removing about 3,000 Manhattan apartments, an entire 500,000 square foot commercial building, or about 25 million pounds of CO2 reductions. Efficiency 2.0 was founded in New York City in 2009. It currently employs 30 people and has plans to double its workforce this year.

Today Efficiency 2.0 announced the launch of the Home Energy Advisor and the Business Energy Advisor, comprehensive customer engagement and integrated demand-side management software for Southern California Edison. The Home Energy Advisor and Business Energy Advisor are first-of-their-kind tools that demonstrate utilities’ commitment to helping customers better manage energy costs, particularly during tough economic times. The Home Energy Advisor and Business Energy Advisor tools leverage more than 500 million energy data points to identify targeted energy improvements for SCE customers based on their unique energy profiles. The tools then present energy savings recommendations to customers, delivering suggestions on efficiency upgrades and solar power installations in an engaging format.



New York City leads the way with solar energy installations