Customs arrests man
for smuggling ganja
~ Triggers study ~
By Judy H. Fitzpatrick
PHILIPSBURG--A sustained increase in the number of children being rushed to St. Maarten Medical Center (SMMC) with what is being described as a severe form of asthma has set off warning bells among local paediatricians and has triggered a study by two Dutch students who are hoping to determine the extent of the problem and identify the possible environmental triggers.
Paediatricians Dr. Pieter Offringa and Dr. Petra-Maria Greidanus became concerned after they noticed a sharp and sustained increase in the number of young patients being rushed to either the Emergency Room or the Outpatient Department with a severe form of the respiratory disease in recent years.
Offringa, who calls the trend “worrying,” reports that some children are taken to his practice with severe symptoms that include red, irritated eyes and air passages blocked to the extent that “their eyes are bulging out.”
Both paediatricians reported that an estimated 50-60 per cent of their patients were asthmatic – a level they said raised concerns as to whether there are new environmental triggers and whether these triggers can be managed to possibly reverse the trend. Greidanus tends to about 50 patients per week, a small number compared to those Offringa tends to on a weekly basis.
While Offringa was not certain whether the escalation represented a “real increase” or more parents were taking their children to the hospital when symptoms flared up, he said the numbers were sufficient to warrant an investigation.
The paediatricians are also concerned that many parents are in denial that their children have the disease and, as a result, fail to treat it with the prescribed medication. This failure, Greidanus said, could result in serious medical problems such as lung scarring and permanent constriction problems.
Offringa and Greidanus suspect the Sahara dust that blows off the coast of Africa, which USA Today reports reaches as far as Southern Florida, could be one of the environmental triggers. They also wonder whether ash from the Soufrière Hills volcano in nearby Montserrat may be a culprit.
However, Windward Islands Medical Association (WIMA) President Dr. Hidde Deketh and Antonio Halley, whose teenage son has been suffering from asthma since age five, believe the predominant triggers are much closer to home and are issues that can be controlled.
Both said the figures being reported should fuel renewed efforts by authorities to reduce potential environmental triggers such as dust in the air from the countless construction activities in St. Maarten and emissions from the Philipsburg landfill, which is frequently ignited by vagrants and sometimes burns for days, much to the chagrin of nearby residents and businesses operating nearby in the heart of the Dutch side’s capital Philipsburg.
But while these doctors are sounding the warning bells, general practitioner Dr. Pedro Arrindell of the Madame Estate Clinic believes there isn’t anything to be alarmed about. He contends that asthma is often confused with people suffering from “hyperactive air passages” and said without concrete evidence such as an asthmatic test to confirm that someone is asthmatic, there was a risk of the issue being blown out of proportion.
Health Sector Director Jorien Wuite underscored the importance of comparing the available figures to statistics from previous years or to figures from other islands to determine definitively whether there is indeed an increase. She said too that the issue of respiratory illness was a “global concern” and any potential increases were probably in line with “global trends.” She will be monitoring the research and its findings.
What is asthma?
Asthma is a serious, sometimes life-threatening respiratory disease that affects the quality of life of millions of people around the world. There is no cure for asthma, which is more predominant among children, but the disease can be controlled through medical treatment and management of environmental triggers.
Symptoms include coughing, sudden difficulty in breathing, and a tight feeling in the chest.
Concerns about asthma and allergies are the main topics of discussion at a paediatric mini-symposium organised by the Medical Specialist Association at the American University of the Caribbean (AUC) School of Medicine this Friday, April 11.
Study
University of Groningen, Netherlands, students Nicole Goossens and Heleen Bos are executing a six-month study among children who visit SMMC, the only hospital in Dutch St. Maarten, to determine the extent of the problem here, to try to pinpoint the prevalent environmental triggers and to recommend ways of managing them.
The research, which began in February and runs until July, is being executed with Dutch financing under the auspices of University of Groningen. The project was initiated after Offringa, in discussion with a professor of the university, had expressed concern about the trend. The professor took proactive measures to study the problem.
Under the research, potential asthmatic children will be subjected to a series of tests, including a skin test to determine whether they have an allergy, a lung function test, a blood test and the filling in of a questionnaire.
Almost half of the close to 50 children tested thus far are confirmed asthmatic patients, Goossens said. She added that although worldwide asthma and allergies were among the most common chronic disorders in children that disrupt their daily activities, reports from the local paediatricians coupled with the trend she had noticed indicated the prevalence of asthma and allergies in this 16-square-mile Island Territory with an estimated population of some 50,000 people appeared to be “above normal.”
Trend
Offringa, the only paediatrician in St. Maarten for close 10 years before Greidanus joined the scene in late 2006, said he had seen a steady increase in the number of children with asthma over the past decade. However, he has noticed more and more children with a more severe form of the respiratory disease in recent years, a trend he described as “troubling.”
Offringa has also noticed a seasonal trend, with a sharp increase in asthmatic children being rushed to SMMC during the last few and first few months of each year.
“We have bouts of kids coming in with very heavy asthma attacks and sinus trouble. We need to know what’s triggering this. Is it something flying over the island such as the Sahara dust or could it be explained in the Montserrat volcano?” he wondered. “We don’t have much information and this is the intention of the study: to try to figure out what is triggering the asthma and if there is something we could do about it.
“We don’t have a reference (material) and it is troubling. Being a sinus patient myself, I know how difficult it can be. It affects your health. You can’t sleep and it brings on a whole lot of problems.”
Misconception
Common misconceptions about asthma are not helping the situation. Greidanus said she had encountered many parents who believed that using asthma medication such as Ventillin fuelled an asthmatic condition and, as a result, refused to have their child take the medication.
She implored parents whose children have asthma to follow the professionally prescribed treatment, because failure to do so could have negative health consequences such as lung scarring and permanent constriction problems.
Hyperactive air passages
Deketh and Arrindell are not sure whether this issue is a concern. Neither has noticed any unusual changes in the number of children visiting their practice with asthmatic conditions. However, Deketh said his client base comprised mostly tourists and immigrant students from American University of the Caribbean; therefore, his figures might not be a proportionate representation of the population.
But Arrindell said asthma was often confused with a condition he called “hyperactive air passages” and said a “Peak Flow” test could rule out questions and readily determine whether someone was asthmatic and whether there should be cause for concern. “I haven’t seen any changes or any increase at my clinic, but I do know that there are many people with hyperactive airways.”
Goossens said: “Asthma and allergies are prevalent all over the world, especially in the Caribbean. The causes are not known yet. Most people with asthma and allergy have symptoms after contact with specific allergens such as pollens, animals, house mite, food and cigarette smoke.
“If the causes are known, then causes can be treated instead of the complaints. For example, if a child is allergic to house dust mite, you can prevent the symptoms by cleaning the bedroom every week and getting rid of the teddy bears in the bed of your child.”
A bigger issue
But some believe that the predominant triggers for the sustained increase in this respiratory disease are not limited to factors in a person’s immediate environs that can be controlled through cleaning.
For example, Halley, who lives close to the Philipsburg landfill, is of the firm opinion that smoke from the landfill was one of the primary triggers of his son’s asthmatic condition, but noted that addressing this issue was beyond his reach.
He said his son’s condition has become progressively worse over the years and on many occasions had caused the family a lot of heartache. He is also convinced that the polluted air in St. Maarten affects the health of his younger daughter who he said was now showing asthma-like symptoms.
“There are so many pollutants in air that it is becoming a hazard. You can clean your house as much as possible, but certain things are (beyond your control),” Halley said, adding that his son was on medication which the elder Halley said had “levelled out his condition.”
Deketh alluded to the smog and dust from the countless construction activities as other potential triggers that were controllable. Environmental watch group St. Maarten Pride Foundation President Jadira Veen said that while she was no health expert, attention should be paid to the air quality and commercial activities of places such as boatyards, cement plants and car repair shops located in the midst of residential areas.
Veen, a lung tumour patient, said vehicle smog and the absence of a no-smoking law also affected respiratory patients and were things that should be controlled.
“I thought he would die”
Halley gave an emotional account of what his family went through in caring for their asthmatic child. “The first time my son had an asthma attack, I thought he would have died, but now I know how to cope with it and I understand it.
“We have to also look at environmental issues and all the things that we breathe in daily, and see whether they have an effect on our kids, because they are the next generation.”
Both of Halley’s children have been included in the research currently being carried out and Halley remains hopeful that the warning signals that are being sent out will be heeded and something will be done quite soon to reduce air pollutants and make life healthier for the growing number of children with asthmatic and similar conditions in St. Maarten.
Anyone whose child shows signs of asthma or allergies can contact Dr. Offringa or Dr. Greidanus (tel. 543-1111 (ext: 1302/1303) so that his or her child can be tested and included in the research.
(Feedback: judyfitzpatrick2002@yahoo.com)
