Long Term Effects

Before you travel to a developing country, people will warn you, “Don’t drink the water.” It’s a good idea to try to follow that advice, since third-world water systems are notorious for harboring bacteria, viruses, and parasites. But in practice it’s nearly impossible to limit your exposure to zero. The longer I’ve been here, the more I am aware of all the ways I am being exposed – eating off of plates that have just been rinsed in the water, drinking juice in people’s homes, eating at restaurants, etc. – and the more comfortable I feel knowing that I am getting some small dose of whatever is in the water on pretty much a daily basis.

Still, I have been shocked more than once by hygiene practices that I consider appalling. The worst was in a public bathroom in a bus station in Jinotega City, where the toilets have to be flushed with a jug of water. Nothing gross so far, just the norm. To flush, you use a gallon milk jug with the top cut off to scoop the water out of a big metal barrel. Here’s the gross part: people then use the water from this same barrel to wash their hands – by dipping their hands into it and splashing them around for a second or two. Clearly, there is nothing sanitary about this system. The only thing it’s good for is mingling your poo germs with everyone else’s.

This brings me to a discovery I have made here, which is that in general, people’s grasp on germ theory is pretty weak. The idea that germs are what cause disease, that you can’t see them, that even if your hands feel clean they can still have germs on them, these concepts have not made it into the popular worldview. Among poor people, the general belief seems to be that water equals cleanliness. So after simply splashing their hands with water – even dirty water – people feel confident that their hands are clean. This explains why sometimes fruit vendors carry their fruits in bags filled with water, supposedly so that they will be ready to eat without the need for additional washing. It also explains why people feel comfortable washing their hands with water that another person (or people) has already used to wash their hands. And why people feel just fine washing both their clothing and themselves in rivers that cows and horses wade through.

But these are no longer the kinds of things I worry about, at least not for my own personal health. When I first arrived in my site seven months ago, the volunteer down the road came to visit me. At that time I was still preoccupied about the hygiene practices (or lack thereof) that I had seen, so I asked her if she’d gotten sick a lot during her time in Nicaragua. She said, “Well, I did at first, but now I have a cast iron stomach.” By now my stomach has gotten pretty strong too (though I wouldn’t want to jinx it by comparing it to cast iron).

Now instead of worrying about whether the last meal I ate will make me ill, I find myself worrying about the long-term health effects of living in a poor country. I have been making a list of all the toxins and carcinogens that I am exposed to here on a regular basis, likely in greater amounts than what I was exposed to in the US:

Aluminum – in cooking pans
Aflotoxin – from peanuts (look this one up if you haven’t heard of it. It’s kind of scary)
Burning plastic
Chlorine
Chloroquine – anti-malarial medicine, supposedly bad for the liver
Dust
Hydrogenated oils – in local baked goods, instead of the traditional rendered animal fat
Pesticides
The sun
Scratched non-stick pans
Occasional doses of antibiotics and anti-parasite meds
Wood smoke
Zinc – in cooking pans, etc.

So I wonder: is there any data on populations like Peace Corps Volunteers that shows the long-term health effects of spending two years in a less developed nation? Is sum total of everything I’m exposed to here any greater than my exposure in the US would have been? Is fresh food, fresh air, and abundant sleep enough to make up for all the bad stuff? And is two years enough to have any kind of lasting effect?

Clearly there are long-term effects of the kind of exposure that Nicaraguans are suffering – the life expectancy is lower here, there is a higher infant mortality rate, etc. But Peace Corps Volunteers have good access to quality medical care, were better nourished as children, and are only spending a couple of years in these conditions. Given the fact that we are already a special population – generally from well-off families, health conscious, well-educated – do a couple of years of exposure to the hazards of the third world in our young adulthood make long-term difference on our health? I would love to know.