Karen Bowman, environmental-health nurse, answers questions | Grist | InterActivist

Questions from Grist editors | Questions from readers

Karen Bowman, president of Karen Bowman & Associates Inc.

I'm intrigued by environmental-health nursing as a career path -- I'd never heard of it until now! How did you become an environmental-health nurse, and how does the average person do so? -- Marta Lindsey, San Francisco, Calif.

I am so glad you asked -- and if I can do it, you can do it too! As you learned from my initial bio, I've been in occupational health for quite some time and had quite an interest in reducing chemical exposures, injuries, and illnesses in my worker populations. Well, the thing about us nurses is that we totally know how to network. I was in the right place at the right time. One of my professors in my graduate nursing program recommended me for an environmental-health specialist position being created within the Washington State Nurses Association. Needless to say, and glory to the gods and goddesses, I got the position and have been working to help nurses remember that the foundation of nursing practice is firmly rooted in environmental-health principles. Florence Nightingale's tenets of nursing called for clean air, water, and food in order to put the patient in the best environment for health and healing.

If you have an interest in environmental-health nursing, I would start by reading Nursing, Health, & the Environment. It discusses the history of environmental health and nursing and suggests environmental-health concepts every nurse must incorporate into his or her practice. Also read "Thinking Upstream" and "Upstream Reflections on Environmental Health" by Patricia Butterfield, or Rachel Carson's Silent Spring. Check out your local university's nursing school to see if they are a National Institute for Occupational Safety and Health educational resource center. If they are, you can get a master's degree or doctorate of clinical practice with a special focus in occupational and environmental health and NIOSH will pay for your tuition. If there are extra monies, they'll also give a monthly stipend. I had full medical and dental too. It's quite a deal. Did I mention it was free? Also check out the American Nurses Association or your local association for information. Nurses are the change agents to improve human and environmental health.

How did you and your company get involved with the efforts in Cambodia? -- Ryan Healey, Mansfield, Mass.

Well, my friend and I were turning 50 a few years back, and we wanted to celebrate by going to an exotic place. After a bottle of great wine and a spin of the globe, we chose Siem Reap, Cambodia, to go check out Angkor Wat, the 1,100-year-old temples that are spread out over 500 acres. As a community-health nurse with a specialty in occupational- and environmental-health nursing, it's hard to just stand around when there's so much work to be done. We just jumped in and started doing what nurses do.

Cambodia is one of the poorest countries in the world. Fifty percent of the population is 15 years old and under. Seventy percent of the country has no access to clean water, and 80 percent lack effective sanitation systems. Compound that with the dismantled health-care system caused by the social and economic impact of more than 50 years of war, and the people of Siem Reap Province face overwhelming community, occupational, and environmental health-care challenges. Siem Reap is in a precarious position as the gateway to Angkor Wat. Many multimillion-dollar hotel complexes are being constructed between the town and the temples, increasing the potential for worker injury and illness. Workers are exposed to workplace hazards such as dust, noise, and toxic chemicals. New hazards found with new technology, like prolonged periods of sitting in front of a computer or driving heavy construction equipment, and psychosocial stressors, such as long work hours and informal labor contracts with multinational corporations, will inevitably increase on-the-job injuries and illnesses. The environment also becomes contaminated due to inadequate hazardous-waste management systems. Many live where they work, resulting in continued exposure to occupational health hazards.

So, back to the story. We hooked up with a driver, John Teng, who has since become our great friend. During one of our day trips, John took us to the Chong Kneas Floating Village Hospital, which serves close to 6,000 villagers. The hospital is a one-room barge. We became friends with the locals there and wouldn't leave until they let us help. Without John Teng's help we couldn't do what we're able to do, like providing a generator, medical supplies, and money for medicines. I'm currently working on a grant in collaboration with Angkor Hospital for Children, researching ways to reduce incidence of diarrhea from exposure to the rotavirus, including wells to get toxin- and bacteria-free water to the villagers.

Just jump in, Ryan, come with me! You can also volunteer at Angkor Hospital for Children. They'll put you up, feed you, give you a bicycle, and teach you some Khmer to get by. It's the hardest job you'll ever love.

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You say that the majority of chemicals have little to no human- or environmental-health data. Are there any organizations or programs out there to gather the appropriate data and make it available to the public? -- Sarah Bronstein, Seattle, Wash.

There are over 86,000 chemicals on the market now. When the Toxic Substance Control Act was established in the early 1970s, they grandfathered in over 80,000 chemicals so they weren't tested for human- and environmental-health effects. From 2,000 to 3,000 new chemicals come onto the market every year. NIOSH certainly has some data on the health effects of some chemical exposures; the Centers for Disease Control and the Occupational Safety and Health Department should also provide some data. The U.S. EPA might be a resource, along with local departments of ecology and health. And, of course, environmental-health advocacy groups like the Environmental Working Group, U.S. Public Interest Research Group, Washington Toxics Coalition, and the Collaborative on Health and the Environment are excellent sources of information.

You have to kind of piece together the little data we have. Remember, we haven't studied how synergy or multiple exposures play on human health, and we just now understand that death isn't necessarily the worst end point either. Chronic diseases like asthma, cancer, autism, Alzheimer's, and other neurobehavioral diseases are rapidly increasing. Washington state has the highest breast cancer rates in the United States and also the highest rates of multiple sclerosis in the world. We've got to be diligent in pushing for a chemical policy that phases out the highly toxic, highly persistent, and highly accumulative chemicals first, supports green chemistry research, confirms chemicals are safe to humans and the environment prior to release, and provides better data on chemicals already in the environment. We can do this. We've got to, for a healthier tomorrow and to save our most precious resource -- our children.

What are your favorite organizations working on environmental-health issues? -- Marta Lindsey, San Francisco, Calif.

I'm so glad you asked, Marta. Here's my list: Washington Toxics Coalition, Toxic-Free Legacy Coalition, Health Care Without Harm, Collaborative on Health and the Environment, American Nurses Association and the Washington State Nurses Association, the Breast Cancer Fund, People for Puget Sound, Physicians for Social Responsibility, and the Washington State Public Interest Research Group.

I'm working on a project which aims to assess the health effects of changing from a more processed diet to a sustainable, locally sourced one. I'm trying to test as many of the health effects as I can, in an organized way. Do you know of any organizations similar to your own that carry out tests on humans for nutrient levels, contaminants such as mercury, or, ideally, pesticide residues? -- Eliza Mutino, Pound Ridge, N.Y.

I am so impressed with your ideas, and you are definitely heading in the right direction. Health Care Without Harm is researching using local organic produce in hospitals to improve nutritional support and decrease health effects of pesticides and other contaminants while supporting local sustainable farming methods. You might also try your local health department for mercury research. I'm not aware of any organizations that are doing human research on nutrient levels, but you might also check with the Collaborative on Health and the Environment on contaminants in foods, etc.

You mention swapping out household products -- what are the top five that you'd recommend getting rid of? -- Name not provided

First, ditch the drain cleaners and oven cleaners -- eww! These chemicals are very caustic and can burn the skin, cause permanent damage to the respiratory tract, and, if splashed in the eyes, cause blindness. To clean drains you can use a snake or do routine cleaning maintenance by placing one-quarter of a cup of baking soda down the drain followed by half a cup of white vinegar. Wait 10 to 15 minutes, then flush with boiling water. I learned this from my 87-year-old neighbor. The chemical reaction of a base (baking soda) and an acid (vinegar) creates a bubbling effect that can clean the drain and remove small clogs of hair, grease, etc. I have a self-cleaning oven, which is a great engineering control. If you don't have one, there are safer alternative oven-cleaning products by Seventh Generation.

Swap out that blue window cleaner for one cup white vinegar mixed in with one gallon of water. Clean the window with newspaper. Streak-free every time -- even for me, and I'm the worst window cleaner. The blue cleaner can contain ammonia, which is caustic to lungs, skin, and eyes. If you don't want to make it, I suggest Seventh Generation window cleaner.

Swap out the powdered cleaners with bleach for a baking soda, lemon, and water mixture, or Bon Ami. Still, though, be cautious when pouring any cleaning powder onto a surface. We want to reduce the amount of particulates released into the air to reduce exposure through inhalation.

Try to cut your bleach use to minimal or none. I know, I struggle with this too. I understand bleach is a household word synonymous with "clean, sterilized, and white," but because of its "commonness," people overuse it and do not treat it with the respect it deserves. It's very toxic to human and environmental health; I've treated many people for sodium hypochlorite (bleach) exposure. Health and safety measures should be taken for the use of bleach in the workplace; insist employees wear a respirator, safety face shield, rubber gloves, and apron. Mix small amounts using a dilution of 1 to 100, which will still clean and sterilize effectively. For home laundry, you can use a non-chlorine bleach. Seventh Generation's non-chlorine bleach, all-purpose cleaner, and toilet cleaner remove stains pretty well. If you want to sanitize, use isopropyl alcohol 70 percent or a good soap. Murphy's soap is great, nontoxic to the lungs and skin, and smells clean and fresh. Dr. Bronner's soap is another stock item in my house.

Do we need to have our houses smell like "meadow mist," "evening at the beach," or "springtime in the Rockies?" No. It would be nice to have fresh, clean air every so often, but I don't think we need a fake chemical smell in the house. Research is now showing that household air can be more contaminated with environmental toxicants than outside air, from PBDE-contaminated house dust and fumes from carpets, paint, cleaners, etc. Periodically open the house up for an hour or so. Also, make sure plenty of sunlight gets in. UV light kills bacteria, which can also create funky smells. I think it's good for the spirit too! If you must have some "smelly smell," try organic essential oils like lavender, lemon, or rosemary. Ask others first though -- just because they're organic essential oils doesn't mean people can't be sensitive to them.

I think it is critical to remember that even though cleaning alternatives may be green or made with common household items, you still need to protect yourself from exposure. Wear protective eyewear and gloves. Because I have severe asthma, I sometimes wear a dust mask or N-95 respirator when using powders, or use a squirty bottle. Please, read instructions on store-bought products thoroughly, and know what to do in case of emergency. Know your poison control telephone number too.

How hard was it to get your business up and running? -- Andrew B., Seattle, Wash.

Well, it was very hard, but it has been the most rewarding enterprise I've ever committed to. One of the smartest things I did to improve my odds at being successful was to do a business plan for an occupational-health nurse consulting business as my scholarly project. The research was invaluable. I must say, though, having a stellar reputation in the community from being the chief nurse at the only occupational medicine clinic system in the Pacific Northwest didn't hurt either. Here's the CliffsNotes version on what I found.

Barriers to a successful environmental-health business: not having the necessary expertise or credentials; not having the positive "people person" personality of an entrepreneur; not being used to taking risks or failing; and not having a business plan. Also, remember that there's no health insurance, vacation, or sick leave pay, and if you don't know how to do finance management, accounting, marketing, business law, etc., you must hire out to get these services. Without them, you will fail. Nurses typically do not have business training; I don't even balance my personal checkbook. I love my accountant. I'm also probably the only person who loves their attorney.

Facilitators to a successful environmental-health business: networking; developing support; having a mentor; taking a finance or business class; establishing your reputation in the community; having money and a passion for what you do; having fun; and knowing your competitors.

Feel free to contact me personally if you want a mentor.

Questions from Grist editors | Questions from readers

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Karen Bowman, environmental-health nurse, answers readers' questions