Hi Devany and everyone-
Thanks for asking; I’ve been in Alaska and swamped with work but this is only part of the reason I’ve been reticent to post further regarding the developing rat lungworm problem in Hawaii. Since today I'm obligated to be online for a two-hour teleconference call largely dealing with routine matters (I am on the Board of Directors for a scientific organization, a subgroup affiliate of the AAAS) and thus am chained to the desk for a long stretch this morning, I’ll switch the speakerphone on “mute” while tapping away on the keyboard and see if I can compose a constructive comment on the rat lungworm problem in Puna while listening with one ear to the teleconference and waiting for the agenda to work its way down to my report.
Being up in Alaska at the moment (although my next stint on the Big Island is coming up fast, 06-15JUN, and I’ll be moving over permanently in late August or September if all goes as planned) it is hard for me to figure out what --if anything-- is going on in Hawaii regarding the prevention of rat lungworm disease. For all I know there are skilled and conscientious scientific researchers, public health agencies, and public policy folks hard at work performing valuable research and prepping progressive legislation and/or implementing brilliant departmental directives. Since I am not yet in Puna full-time to be able to network face to face with researchers and policy makers there, let alone perform any hands-on direct field research and experimental clinical trials myself, I feel hesitant to comment on the situation in any way which may be interpreted as being critical since I may be ignorant of good work in process.
That said, I do have an opinion about the potential threat represented by rat lungworm in Puna and there have been some developments I am aware of which I can share. I will remove personally identifiable information referring to others from the following narrative except with regard to Councilwoman Naeole, since I do not have explicit permission to share the identities of private individuals in this regard. I trust elected officials, such as Councilwoman Naeole, holding public office as they do will speak up to clarify the record vis a vis their words and actions --or lack thereof-- if anything I report here is inaccurate in any way.
It has largely been the “lack thereof” portion of the rat lungworm prevention equation in Puna which has been bothering me enough to now break my silence of the last several months. Councilwoman Naeole is to be commended on that which she has done, such as it is, since as far as I am aware it is more attention and action than any other among the elected representatives have given to rat lungworm disease. Unfortunately, at least as seen from afar, not very much has been done since the media flurry early in the year. This is a pity as the momentum of the media stir could have been ridden like a wave to accomplish some constructive headway while attention was focused on the issue.
When last physically present on the Big Island in February I spoke with Councilwoman Naeole both on the telephone and in person regarding the rat lungworm issue. She seemed genuinely enthusiastic about crafting and introducing legislation promoting public health education and said I would receive a call from a staffer. I did indeed receive not just one but a couple of calls from a staff assistant to Councilwoman Naeole and spoke with the staffer for about an hour and forty-five minutes total on the issue. I was very impressed by her receptivity to the suggestions I was making toward crafting legislation which would be constructive with regard to not just the prevention of rat lungworm but potential emergent diseases (e.g., dengue fever) in general. The staffer said she would be calling me and emailing further with draft texts for collaboration on refining the proposed legislation. Since February I have never heard another word from either Councilwoman Naeole’s staffer or Councilwoman Naeole herself.
Word has subsequently reached me via telephone calls from a person in Puna who said she had spoken directly with the persons involved, however, as well as in the form of email messages from several people writing with questions and concerns. According to the person who called me a couple of times the staffer on point with this issue had indeed taken forward very promising draft legislation for Councilwoman Naeole to consider introducing. The proposal was an umbrella strategy for making progress with public health awareness and prevention strategies on emergent topical diseases in general with rat lungworm a specific and important subset within this area (which I think is a very useful approach to take). When Councilwoman Naeole was complimented on this effort being advanced by the staffer, though, Councilwoman Naeole abruptly cut off the comment by saying “[Staffer’s name] is not the boss. I am the boss!” and that, to paraphrase, Councilwoman Naeole thinks rat lungworm disease incidence is overstated and more an overblown scare than an issue of immediate as well as pressing future significance to Puna. Therefore, the amount of money she was willing to commit to the issue was to be significantly lower (less than half) that which had been initially stated and further that Councilwoman Naeole’s enthusiasm for introducing proposals toward advocating for prevention education has become somewhat muted. If I was accurately informed by the person who telephoned me and if understood correctly, the funding being made available from Councilwoman Naeole was much reduced but was appreciated as being better than nothing. There was a thought this small amount of funding might be used toward developing an informational website on rat lungworm in Puna. I was asked about my thinking as regards how that sum could best be spent; my reply was to note while an informational website is certainly a worthy effort, given the big picture and long range on this issue I’d instead suggest hiring a grant-writer dedicated to hunt sources of funding and then file as many applications as possible seeking more significant funding to fight rat lungworm.
My sense is those who would like to believe rat lungworm disease is a minor and transient problem both in Puna and Hawaii as a whole are grievously mistaken. Hopefully I am completely wrong and (despite the terrible damage to several known victims) this really is more a mere “media blip” than an instance of the first several canaries in the coalmine giving an early warning signal before an impending explosion, but time will tell. The reason I think we have just barely begun to see the full dimensions of this problem manifest is because of how I am reading the record of evidence and comparing it to similar experience elsewhere with other invasive disease vector species.
Yes, the rat lungworm nematode has been present in Hawaii for decades ...but the ideal intermediate incubator vector host for its larvae, the semi-slug
Parmarion martensi, is a very recently introduced invasive species which has been and is now spreading like wildfire, expanding radically in density and range throughout Hawaii. To stay with the wildfire and fuel metaphor for a moment, it seems to me like the fireworks (the rat lungworm organism) have been present for a long time on the Big Island but it is as if they have only been present on those stark barren lava flows over on the Kona side where there is scant chance of a wildfire catching and spreading, due to lack of fuel. Now, though, with the coming and spread of the
P. martensi semi-slug ideal host, it is like the fireworks are being set off amidst a dry eucalyptus forest: given this change or shift in the environment to provide more ideal conditions for the disease to proliferate the metaphorical blaze sparked can catch and spread much more readily, swiftly, and massively. I think we will see much more damage due to rat lungworm in future than in past. The good news is much can be done to avoid rat lungworm disease; the bad news is that it seems as if virtually nothing actually _
is_ being done.
As an example of other reports which have come my way, here is the to and fro transcript of e-mail messages exchanged with a couple of visitors to Hawaii which contacted me, with personally identifiable bits stripped out. This message was sent on 27MAR2009 and reached me on 29MAR2009:
Steven,
My name is XXXX XXXX and my wife and I spent 15 days in Hawaii for our 25th wedding anniversery. The first trip we took in 20 years, and were really looking forward to it. The last 6 days were on the "Big Island". Spent 2 days/1 night in Hilo and 4 days/3 nights in Kona. On the second night in Kona, during a wonderful sunset cruise, my wife went from super happy/excited to on the floor of the boat in agonizing pain.
Most of the pain was shooting up her arms. A nurse thought she was having a possible heart attack (she is XX) and 911 was called and the boat raced to shore to a waiting ambulance. Off to Kona Medical centre we went. The doctor said it was not a heart attack, but thought it was anxiety (something she has never had in her life). She spent the next 3 days in bed, and lost all use of her hands and arms. She then endured a 18 agonizing hour travel day back to XXXXX.
We have been to 4 hospitals here. They have done the MRI and see spinal problems and brains spots in the head. They are not sure what to label it. I'm positive it is Rat Lungworm. Today, over 5 weeks later, she is still in bed as now the steroids they have given her are kicking the crap out of her.
I feel Hawaii has a bigger problem then they want to admit. They are trying to cover it up to protect tourism. I spent $10,000 on the trip, and 5 weeks later my wife is still in bed! Happy Anniversary, eh'??
Just saw your name on the internet and the request to hear from people like me.
Thanks for your time,
XXXX XXXX
XXXXXX
Here is my reply of 29MAR2009:
Hello XXXX-
Thanks for making contact and relating your experience; my heart really goes out to your wife and yourself.
That more is not being done by the various officials, agencies, and non-governmental (industry) and community groups vis a vis this issue mystifies me. Rat lungworm disease is not a problem which will just go away if ignored. Moreover, if the issues are not effectively addressed then sooner or later there will quite predictably be a huge PR disaster when a busload of tourists or schoolkids are injured or killed by eating infected salad at a luau or somesuch, on a scale which cannot be mistaken, misdiagnosed, or otherwise swept under the rug. The best pathway is promoting awareness and being completely candid with residents and visitors alike and everyone making very well-informed choices, from growers regarding rat and slug control in gardens and greenhouses to restauranteurs regarding food prep procedures in the kitchens to diners making informed menu choices while ordering to medical staff recognizing symptoms and offering accurate tests and referral based on symptoms.
Can you tell me, XXXX, the exact dates in the chronology of your wife's experience in Hawaii? What date did she arrive, where did you first stay and at which places did you first eat --and what did you eat, if you can recall-- and then from there where did you next go, stay, eat, what was eaten, and so on up throughout the trip until the first symptoms were experienced? Referring to receipts and credit card billing records can be useful in reconstructing the step by step sequence of events, as might a diary or postcards sent to friends during the trip. The more specific you are able to be about the exact sequence of dates, places, and what was eaten where and when then the more useful this information could be to pinpointing a potential infection, especially if there were meals where she ate something which you did not (...although with angio it could just have been one little slug in one fork of salad eaten out of the same bowl you also were eating from).
Has any antigen test for detecting the presence of
A. cantonensis been performed, either in Hawaii or in XXXXX? If not, then are vials of your wife's blood still available from when they were drawn immediately after the symptoms were first detected? How about vials of blood from 1 week, 2 weeks, 3 weeks, and so on afterwards?
Honestly, XXXX, I really hope the appearance in this instance is misleading and your wife was not actually hit by a bunch of rat lungworm L3. If her clinical symptoms can be traced back to some other cause then there may be more options for treatment and so, perhaps, for recovery. If indeed this really is a result of rat lungworm then hers may be a long and at times hard road to an uncertain outcome with regard to recovery. Have you spoken with XXXX, in Puna? If not, then would you like to speak with her? Let me know, if so, and I'll see if I can arrange for her to call you or for you to call her. She was hit hard by angio some years back, is now functional again, and takes methadone daily to counteract pain from nerve damage. In conversation with her and others it seems likely to me that a number of people have been infected without accurate diagnosis and that many or perhaps even most of them did recover partially or maybe (when "lucky" enough to have a very slight infection and the L3 missed critical brain ganglia) all but completely. So, there is a solid reason to hang in there and persist in efforts toward recovery. Giving up all hope and even opting out (as at least one person has done to date) does not appear warranted, especially when there are medications for long-term pain management if indeed that turns out to be necessary. An accurate diagnosis would, I'd think, be instrumental in knowing how best to proceed.
Best wishes for a swift and full recovery.
Sincerely,
Steven
---
So, as you can see, there are more instances of this problematic issue than are making the front page (or even page ten) of the local papers.
I do not feel like I am “in the loop” (if there is one) with inside information on rat lungworm in Puna and certainly do hope much more is going on than appears to be the case with regard to prevention education efforts. Why there is not a massive rat control campaign going on right now is a mystery to me, as this measure is clearly indicated. Funds spent educating the public about the strong advantages of active rat control and subsidizing rat traps of several different designs (for use in different situations) would be money very well spent. Testing and popularizing inexpensive appropriate rat control technologies modified to Puna-local conditions would be highly constructive ...for easy example, this type of trap
http://journeytoforever.org/at_rattrap3.html
if covered with a raised “roof” (to prevent the bucket from filling and overflowing in torrential rains) and with the addition of some mineral oil (to form a slick on the surface preventing mosquitoes from breeding in still water) could be highly useful in Puna.
If there are efforts happening in Hawaii statewide, on the Big Island, and in Puna specifically which are targeted toward rat lungworm disease prevention then whomever may know of these efforts, please do post word of them.
An idea I have been mulling over for several months seems more and more potentially useful all the time, to me. I would be very interested to hear what other people think of this notion: I am considering initiating an art contest open to all ages, with several categories (such as K-2, grades 3-5, 6-8, 9-12, college student, community member, Seniors, professional artist, Most Colorful, Most Humorous, Best Parasite Life-Cycle Illustration, Hawaiian Traditional Culture Themed Poster Award, etc to involve as wide a range of participation as possible and excite as much pre-judging excitement and interest as possible) for prevention education posters targeting various aspects of effective rat lungworm disease prevention. Ideally the art in these posters would be interesting and beautiful enough that local businesses and households would want to have a copy displayed up on the wall or in a window regardless of the positive message conveyed regarding rat lungworm prevention. The art in the posters should show a healthy community using effective strategies for reducing incidence and severity of rat lungworm and its vectors of infectivity in Puna. Here are some of those strategies-
*Exert maximum effort to kill all rats present around the home and garden area; maintain active ongoing defenses to reduce the overall rat population. There are several different types of effective rat traps available; use the best trap for the situation and check the traps often.
*Avoid ingesting higher-risk raw and untreated or uninspected veggies and fruits (as from cluttered shady gardens with no slug control strategies present, veggies with no prior inspection or treatment, and fruits & veggies from such sources presented in the form of blenderized smoothies where it would be impossible to detect slugs if such are present).
*Treat --there are several different options for treatment from immersion for a period of time in various dips (such as distilled water or salty brine) and subsequent rinsing, to scrubbing-- and inspect raw veggies and fruits before consumption.
*Cooking or boiling kills the infective rat lungworm agent (as in prawns).
*Do not create another problem (such as making breeding pools of still water for mosquitoes, or spreading rat poison inappropriately) via flawed efforts toward solution of the rat lungworm problem (as by setting a rat bucket trap without oil in it to kill mosquito larvae).
*Use raised beds with metal-strip slug barriers; eliminate cover for slugs around gardens (sunlight and drying out are the best defense against slugs, along with perhaps Guinea fowl, ducks, or chickens).
*Cut away overhanging vegetation (especially fruit trees) from roofs feeding to water catchment tanks, install filter plates to keep slugs from washing into tanks and drowning there, and install a 10 to 20-micron (minimum) filter and UV sterilizer between the tank and taps.
*Be wary of gathering fallen ripe papaya, figs, avos, or other fallen fruits as well as fruits in trees with slugs upon them.
*Educate children regarding the hazards associated with eating a slug (as well as other invertebrates, raw prawns, and potentially raw frogs too), to check and wash fruit and veggies before eating them, and to actively watch toddlers and prevent them from ingesting soil or other material which may harbor slugs.
*Do not leave pet food and water bowls out overnight on the ground where slugs can get into them.
Prizes for winning posters could be incentive items and services donated by local businesses, trophies, ribbons & certificates, being featured in the local press, as well as the prestige and distinction of being selected as a winner and seeing the artwork up all over Puna. The posters themselves could be used anywhere viewed frequently by the public from cafes and buses to laundromats, grocery stores, and the public schools. If there are enough beautiful and stirring images (as seems likely in as artistically gifted a community as Puna) then perhaps there would even be interest in producing a calendar with a different poster featured each month.
Honestly, there are now books immortalizing great poster art for topics from rock and roll in the Sixties to military propaganda to astonishingly cynical cigarette and alcohol advertising. Poster art can be quite striking and beautiful; getting the word out on rat lungworm is important. If you have thoughts about this notion or enthusiasm for volunteering in developing poster judging criteria and categories, being on a committee of judges (or maybe voting could also take place online by the public at large?), asking local businesses and government agencies for support in the effort, and so on then please post them to this discussion or e-mail me at AlaskaSteven@yahoo.com . I have a couple windows of unscheduled time available between 10-12JUN if folks would like to connect in person for chow and conversation discussing the poster contest idea somewhere in Pahoa or Hilo, such as at the savory crepe cafe Le Magic Pan.
My teleconference is just ending (my report went well and we took a couple of votes with constructive outcomes) and other tasks of the day demand I get up off my butt in front of these computers so I’ll sign off for now, but do hope folks in Puna will continue to stay involved with the rat lungworm issue and will call upon elected public officials to either produce tangible results or please get out of the way and make room for someone else who will effectively do so. If we stay ahead of this issue then there may never be a massive tragedy and PR disaster -such as a boatload or bus-full of tourists or schoolkids being maimed or killed by rat lungworm; once that sort of disaster happens it will stir up a genuine national or even international sensationalized media frenzy indeed, an unconstructive frenzy which leaves Puna and Hawaii with both a massive image problem, lower visitor rates, and increased revenue difficulties -not to mention the genuine lack of aloha demonstrated toward injured visitors and residents alike if the issue of rat lungworm disease in Hawaii is neglected.
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A pleasant slideshow:
http://www.thejoymovie.com
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