[Warning: This is not appropriate reading for bedtime.]
I’m not sure where the complacency about undocumented workers comes from, but I suspect that it’s a combination of racism and economics. We tolerate the presence of these second class workers because it results in cheaper products and services for us, and because we don’t really have to look at these struggling immigrants very often. They operate in the shadows of our culture. These undocumented workers are transient, unrepresented, and frequently unwilling to report injuries or illnesses because of real concerns about their continued employment or their immigration status. They work in substandard conditions, with few or no benefits. But that doesn’t impact us directly, does it?
Well, think again. Our colleague Peter Rousmaniere, who tracks the issue of immigrant workers, has posted a truly terrifying scenario where the second class worker becomes the carrier for an unstoppable disease.
It Cannot Happen Here…Can It?
Peter links to the Occupational Health Disaster Expert Network (OHDEN), a website run by Gary Greenberg MD. The goal of this well-documented and extensively linked site is to speed up transmission of time sensitive information on high profile occupational risks.
Dr. Greenberg tells us that the danger from a new influenza will begin when its DNA combines with the ordinary “flu” we experience every winter. If (or when) this strain develops, the public health fear is of a highly transmissible virus
with frequently fatal consequences. The resulting novel germ could then spread through our species unimpeded by any prior immunity, and would kill millions before effective vaccination and antiviral therapies might bring it under control. This would no longer be an”avian” influenza, but an accidental hybrid, an intensely lethal human
pathogen.
A Workplace Illness
Avian influenza is an occupational disease involving poultry workers. So it is in the poultry-processing workplace that the we find the intersection of two distinct issues: undocumented immigrant workers and flu pandemic risk. Poultry workers are largely foreign-born and poorly educated. They routinely work in horrendous conditions. (Again, that’s ok, as long as we can get a good price on chicken parts in the grocery store…) Even without viral dangers, Greenberg points out that these workers are exposed to intense levels of ammonia, organic dust, disinfectant, environmental cold, bird-specific fungi and bacteria, allergens, insect pathogens, and then the violent instruments and machinery required for the production of boneless filets and dressed, plucked fryers. Yikes!
I won’t go into the ergonomic horrors of chicken processing jobs. Again, we all know it’s bad, but no one forced these people to come here. No one made them take these jobs! And yes, we know that the pay isn’t great, but it’s better than these workers would find in their home countries. As for benefits, they are unlikely to be able to afford (or qualify for) health insurance, and if undocumented, they are also ineligible for Medicaid. Many are migrants, and so they have no medical records, no continuity of care, and no routine access to health monitoring. They are off the radar screen and beyond reach of our medical system. So what’s the big deal?
Here’s the point where the proverbial chickens may come home to roost. Greenberg tells us that the creation of a deadly new virus requires just one single transformation – a single virus in a single victim. Once this killer virus is set loose, the costs to humankind will be beyond the calculations of all but the most intrepid actuaries.
While many people apparently feel either cultural superiority or indifference toward the millions of immigrant workers in this country, our fates are inextricably joined. Their second class status, combined with marginal working conditions, may place them at greater risk for the initial development of the virus. But once developed, the virus will make no distinction between second and first class. There will be no reliable barriers to transmission. We’ll all face the same, irresistible force, much like the tsunami that tore through Asia in 2004.
Solutions
Greenberg recommends a few practical steps to alleviate the risk of this unprecedented catatrophe. The steps are reasonable, relatively simple, and not all that expensive:
– All poultry workers need to be vaccinated against seasonal
influenza. This recommendation should be achieved worldwide. Urgent
action will be required for workers in the northern hemisphere (with
our own flu season already here).
– Free and urgent treatment of poultry workers’ respiratory illnesses
should be provided, regardless of immigration status and insurance
coverage.
– Health status among these workers needs to be evaluated, monitored
and reported.
Greenberg’s recommendations are prudent and doable. But there is no way they will be implemented. Our national denial of the immigrant problem fatally extends even to a situation where we are all directly at risk. Greenberg will be viewed as just another “Chicken Little,” claiming that the sky is falling. Politically, it’s likely to prove impossible to elevate immigrant workers to the point where they are both acknowledged and accepted, let alone routinely treated for respitory illness.
If we’re really lucky, there may be few direct consequences. The pandemic might not happen. If, however, Greenberg’s worst case scenario takes place, we will finally be confronted with the real cost of our current indifference. Then, of course, it will be too late.
At that point, I imagine that someone will start a new blog called “Journal of the Plague Year.” Let’s just hope we are all around to read it.

The Insider has warned tech-savvy readers that many of our indespensable gadgets can be the source of injuries. A year ago we wrote about Blackberry Thumb, to which we now return. Perhaps this is risk management on a small and highly personal level, but it’s risk management nonetheless. Despite the fact that few people seem concerned, in the interests of public awareness, we now expand our focus from the lowly thumb to include elbows, ears, and perhaps even the brain.
Thumb Troubles
People addicted to their Blackberry’s – or to text messaging on other portable devices – may find themselves experiencing some pain and numbness, possible symptoms of “Blackberry Thumb.” It’s really just another word for tendonitis and the latest incarnation of what used to be called “Nintendonitis.” Of course, if Blackberry has to shut down due to a long simmering patent dispute (the company appears to have lost out at the final level of judicial appeal), “Blackberry Thumb” will disappear as all Blackberry users inadvertantly follow the doctors’s advice for treating the ailment: lay off thumb typing for a while. If the shut down is avoided, loyal users in need of a break could try one-hand operation, typing in the letters with the blunt end of a pencil or a stylus, or simply typing shorter messages.
Elbows
Moving up the arm, we find that people who spend a lot of time on their phones (cellular or land based) may be susceptible to cubital tunnel syndrome, a kind of “tennis elbow” that is caused by pressure on the ulnar nerve. The symptoms are very similar to the pain that comes from hitting your funny bone, which is actually the ulnar nerve located on the inside of the elbow. The nerve runs through a passage called the cubital tunnel. When this area becomes irritated from injury or pressure, it can lead to the syndrome.
Numbness on the inside of the hand and in the ring and little fingers is an early sign of cubital tunnel syndrome. (Are you feeling these symptoms already?) The numbness may develop into pain. The numbness is often felt when the elbows are bent for long periods, such as when talking on the phone or while sleeping. The hand and thumb may also become clumsy as the muscles are impacted.
The solution is simple, but many people fail to follow it: Keep switching hands (and ears) as you talk. Or even better, get a headset.
What did you say?
Traveling further up the body, we come to the head – source of many of the world’s problems, indeed! Apple’s little Nano/Ipod devices have become enormously popular (over 22.5 million sold in 2005). This line of elegant, miniature products enables people to shut out the world, no matter where they are, and listen to music (or books, lectures, TV shows, whatever). The danger is the in-the-ear design of IPod earplugs: you are literally pumping sound directly into the ear drum. With the long battery life of these devices, people can place a strain on their eardrums for which evolution has not really prepared us.
Once again, the solution is relatively simple. Keep the volume at a reasonable level and take frequent breaks. You also might want to limit the heavy metal bands.
Moderation in an Immoderate World
In yesterday’s State of the Union address, the president acknowledges that we are addicted to oil. (That’s a bit like doctors telling us that we as a nation have a problem with prescription medications.) We are addicted to far more than oil. Omni-present devices connect us (phones and internet), disconnect us (music) and distract us (games). Our brains are on overload.
Here’s a prescription that doesn’t require a note from the doctor: a few times a week, leave behind your cell phone/Blackberry/Treo, IPod, portable CD player/radio, put on your sneakers and go out for a walk. As far as I can tell, walking is unambiguously good for you. It connects you the old fashion way: through the simple enjoyment of the sights, smells and sounds of the world around you. And the only energy consumed is your own.