I got an e-mail today from one of the colleagues I worked with on the injection drug use project. He is also an anthropologist and just got back from a trip exploring injection drug use in Bangladesh. I was thinking about Bangladesh last night because my cab driver was Bangladeshi. I was there last year on "vacation" visiting a friend who is spending two years there. It is a tough, intense, and fascinating country. Traveling there made me feel as though I was really on an adventure. (On one flight they put a man with one arm in the emergency exit seat. I also found myself on ferries bursting with people, livestock, trucks, and cars; stuck in three hours of traffic on a bicycle taxi; tracking tiger paw prints; fitted for a salwar kameez; and sprinkled with marigold blossoms at a Hindu puja.) Working domestically, I sometimes miss that rush of absorbing new vistas and making my way around in languages that I will never speak. Yet I do love New York City, and last night, my perfect cab ride home across the Brooklyn Bridge and through the illuminated downtown darkness made me remember why.
There are, in fact, many possibilities for "foreign" experiences right here in New York, and sometimes this job enables me to participate in them. Several days ago, I got a call from a colleague explaining that there had recently been several reports in other states that a toxic substance from the Dominican Republic was being sold as deodorant here. My colleague wanted to know how to do rapid outreach on this topic. As the deodorant was primarily being sold in botanicas (stores that sell healing and other products) and the people falling ill were Dominican, we talked about going to the neighborhoods with large Dominican representation, speaking with people who worked in Dominican community centers and clinics that serve a large Dominican clientele, and going to the botanicas directly to talk with the product vendors.
These kinds of issues emerge on a weekly basis and really keep me on my toes and aware of the wide variety of areas in which Department of the Health and Mental Hygiene works. While this situation was fairly straightforward, others are not, for a variety of reasons. Bioterrorism, for example, is a problem that is not straightforward in any way, but rather a vortex of powerful opinions, emotions, and politics. Toxins with bioterror potential are not as easy to deal with as toxic deodorant.
Obviously, since Sept. 11, 2001, bioterrorism has been on the mind of a lot of people—especially in New York City. For me, the idea of bioterrorism is so terrifying that I try to banish any thought of an attack—biological or other—from my head. Living under the specter of terrorism has remarkably changed the sense of freedom I used to feel in New York. (The whole duct tape fiasco also shows how much trouble the federal government is having providing sound leadership on this topic, which makes things even scarier and more uncertain.) Yet my job forces me to think about bioterrorism, specifically the risks associated with the intentional unleashing of organic pathogens.
Currently I am working on an evaluation of the smallpox vaccination program that was implemented in New York City last year. We're interested in learning the reasons why health-care and other municipal workers decided to be vaccinated and the reasons why they opted not to get vaccinated. (I personally opted out because I was born before '73, which means I had already been vaccinated; I also didn't think the risk of an attack was significant. My colleague, Lorna, on the other hand, felt it was her duty as a public health worker to be vaccinated—she could then be what's called a "first responder" in an intervention responding to an attack.) Talking to people, you begin to realize that this decision goes to the heart of how they feel about issues that go way beyond deciding to receive the smallpox vaccine or not. Our preliminary data suggest that decisions regarding vaccination are based on—among other things—concerns over side effects, but also how people feel about the fear of a smallpox attack, trust in national leadership, patriotism, and the state of the world in general.
We're hoping that learning about the decision-making process in this situation will enable us to develop initiatives that respond to people's concerns not only about smallpox, but about other organic pathogens, and that we'll be able to use information to help those who may be on the front lines during an attack—doctors, nurses, hospital personnel—to understand the importance of being vaccinated. Of course I hope we never experience an attack, but being prepared at least provides a modicum of comfort.
This is heady stuff. Tonight, to get away from it, I'm having some friends over for virgin cosmopolitans and a Sex in the City DVD-a-thon. Sometimes that is the kind of New York that I need to return to.