Consequences of Stress Brought on by Natural Disasters

A few weeks ago I stumbled upon an article with a title that caught my attention. The article was explaining how post hurricane Harvey Texas is looking at the model of New Orleans’ Katrina recovery as what not to do. (I wish I had known then that I would want or need that article in the future, as of course I cannot seem to find it again.) But since the moment I read it I have been carrying a new weight of sadness for the victims of these huge natural disasters. The article explained how an entire generation of New Orleans’ children grew up no longer able to reach their pre-hurricane potential. This is because of the all-encompassing, life-altering amount of change and suffering that was a direct result of hurricane Katrina.

This week we were given a blog assignment to consider common stressors that impact a child’s life. Some major stressors could be neglect or abuse. Other examples of stressors include war, poverty, racism, natural disaster, isolation, hunger, noise, chaos, disease, environmental pollution, and violence. A quick reflection on myself and my immediate family members left me to realize just how blessed and privileged our lives have been. I immediately messaged my mom to express my gratitude. While there certainly was stress, and money was often tight, we never struggled in a way that I would say falls under any of those stressor categories. However the first thing that came to mind was a hurricane that came through while I was a teenager.

The hurricane damaged my (now) husband’s family’s house. We rode out the storm there at his house, watching and hoping the rising water would not come in. In the morning, as we ate breakfast splashing our feet in the water under the kitchen table, we could not quite understand how much would be impacted by some water damage. I recall going in to work that weekend, serving tables of customers their breakfast, and thinking to myself “how can they be so calm and happy when my mind is completely fearful for how much will change after this hurricane?” (And our hurricane was nothing compared to more recent ones.) In the weeks and years to come my now father-in-law would have a falling out with the brother he shared a duplex with. He would go into bankruptcy after paying to repair both sides of the duplex. Once the home was repaired they moved out of the duplex, thankfully still in our town (or my love story might not have been the same.) Their financial difficulties post-hurricane continued for nearly ten years. Thankfully my husband was old enough and supported enough to not suffer as a result. Further, it all would have been much worse had the entire town suffered rather than just a few houses. Reflecting on the situation immediately led me to that sense of sadness I am carrying for recent natural disaster victims, and for those “lost children” of hurricane Katrina (Reckdahl, 2015).

When a natural disaster strikes we all rush to help financially and with donations. Then, as weeks turn to months we outside of the situation are able to forget that the problem is still there. It is not until you really think about to that you realize the stressor of one natural disaster can bring on so many other stressors such as poverty, hunger, isolation, noise, chaos, disease, and violence. Reading the book Children of Katrina provided insight into exactly how one event creates an avalanche of stress, and the ways that impacts children. Consider the example of how mother Debra and eleven-year-old daughter Cierra were impacted. Caught in the traumatic experience of the storm within a hospital, a young child saw chaos, terror, pain, and even death. Then shuffled around shelters, eventually landing in a trailer home (provided by FEMA) in a city away from their home, isolated from all their family and friends who were also shuffled about. A mother left job-less and a child left without a school, it is easy to see how it would be difficult to meet Cierra’s basic needs in the coming months and years. But what kind of impact will this type of stress have on a child? Many studies are trying to answer just that question.

Lack of schooling is one major way children were impacted post-Katrina. According to information gathered by Fothergil and Peek, “In the two months following Katrina, as many as 138,000 students were not in school. Somewhere between 30,000 and 50,000 K-­ 12 students, most of them from Louisiana, missed virtually the entire 2005– 2006 academic year following Katrina. In the following school year, 2006– 2007, as many as 10,000 to 15,000 school-­ age children did not attend all or most days of school.” The impact of this is being seen now years later with Louisiana having the highest rates of unemployed and out of school young adults in the nation (Reckdahl, 2015). It is easy to see why these children are referred to as “lost.”

According to the US Department of Veterans Affairs page on PTSD, “Disasters can cause both mental and physical reactions. Being closer to the disaster and having weak social support can lead to worse recovery (Dept. of Veterans Affairs, 2015). On the other hand, being connected to others and being confident that you can handle the results of the disaster make mental health problems less likely.” The individual stories from the study The Children of Katrina demonstrate exactly that. Children such as Daniel (one feature of the book) who were at the lowest levels of poverty and without a social support system before the hurricane, were likely to end up suffering the most on a “declining trajectory” (Fothergill & Peek, 2015); while children such as Cierra, who suffered greatly, and previously struggled with poverty were lifted out of the initial post disaster difficulties onto an “equilibrium trajectory” (Fothergill & Peek, 2015).

The stress of experiencing a major natural disaster and all the stress that follows can cause PTSD and depression, both life-long mental struggles (Dept. of Veterans Affairs, 2015). One natural disaster can set a family on a completely different life course, often a more difficult one including shelter and food insecurity. Stress can cause less supportive or comforting parenting (Berger, 2015). All of these points can result in a child who is developmentally delayed, struggles to learn, and suffering through mental/emotional problems. Some will persevere, but not all. The individual stories shared in the sources I read are heartbreaking. I urge you to read some of them. I urge us all to remember these children in Texas, Florida, and Puerto Rico need help now and for years to come. I urge everyone to remember that you do not know anyone’s back story, and to not judge people based on miniscule moments of their lives. For all you know, they have suffered great stress and loss.

References

Berger, K. S. (2015). The Developing Person Through Childhood. New York: Worth Publishers.

Dept. of Veterans Affairs, U. (2015, September 5). Effects of Disasters: Risk and Resilience Factors. National Center for PTSD, p. Retrieved from: https://www.ptsd.va.gov/public/types/disasters/effects_of_disasters_risk_and_resilience_factors.asp.

Fothergill, A., & Peek, L. (2015). The Children of Katrina. Austin: University of Texas Press.

Reckdahl, K. (2015). The Lost Children of Katrina. The Atlantic, Retrieved from: https://www.theatlantic.com/education/archive/2015/04/the-lost-children-of-katrina/389345/.

Public Health Concern- Smoking and Child Development.

The health of our children is subject to many harmful pollutants and other public health concerns. One public health concern that I feel very strongly about is that of exposure to smoking. The CDC states that “Tobacco use remains the single largest preventable cause of death and disease in the United States.” (Center for Disease Control, 2017) Additionally, the CDC states that “Cigarette smoking kills more than 480,000 Americans each year, with more than 41,000 of these deaths from exposure to secondhand smoke” (Center for Disease Control, 2017) While these statistics do not differentiate adults and children, further research tells us that smoke exposure has significant effects on all stages of child development. Specifically, this is a public health concern because exposure for pregnant women has been linked to reduced birthweight, increased risk of urinary tract and limb malformations and potential risks to lung function. (Berger, 2015) Additionally, exposure of young children to smoke has been linked to poor executive functioning, attention deficits, and learning delays throughout childhood. (Pagani & Fitzpatrick, 2016) Smoking is an issue I am strongly against and unwilling to waiver. For these reasons and more, it is a choice that I simple cannot understand.

While individual studies are each specific in what they refer to as exposure to smoke, often meaning tobacco smoke; I feel every type of smoking that exists falls into the public health concern category. I believe there is enough potential for known and unknown risk to each type of smoke to including cigarettes, cigars, pipes, vape, and anything else new on the smoking market, as a public health concern. I have not focused my research on the hazards of other oral methods of tobacco use; however, it is known that the risks there are much greater for the user and the biggest risk to children is that of a social reference.

First and foremost I personally cannot understand any parent today smoking anything around their children or anyone else’s child. We as an American society know enough, even with the most basic of knowledge, to recognize that this is at the very least unhealthy. Even if one were to distance the actual smoke away from children, the stench remains, and the mere visual of watching loved ones smoke is a factor in creating the next generation of smokers. In fact, a study of 3,000 children and their parents found that the risk of the child becoming a smoker was reduced by 40% when parents quit smoking, and was 70% less likely when parents never smoked. (Bricker et al., as cited in Bottorff et al., 2013) The article goes on to detail a study of 28 parent dyads and how the adults constantly revise their approaches and justifications for smoking as parents (Bottorff, Oliffe, Kelly, Johnson, & Chan, 2013). Interesting, disgusting, disturbing, and sad were my thoughts. The study included narratives of their two year old child mimicking smoking with a crayon, justified with how the child does not understand what smoking is yet, and they told them it was yucky; which is certainly a contradiction. Also, when their older children begged them to stop the unhealthy habit, they justified that by thinking that means their child will be less likely to smoke themselves (Bottorff, Oliffe, Kelly, Johnson, & Chan, 2013). Clear evidence of addiction and an extreme level of selfishness in my opinion. The entire study was full of notes of parents explaining to themselves and their interviewer how they would quit when they really needed to, but that time kept being pushed back. Another point I gathered from the study was that mothers who quit while pregnant, took up the habit after birth, and acted vigilant in keeping all second hand smoke away from the infant, all eventually slacked on their attempts to protect the child as they grew in those first three years. One example of an excuse being parents breaking the no smoking inside rule when they were hosting friends (Bottorff, Oliffe, Kelly, Johnson, & Chan, 2013).  How does that make sense? You are not willing to inconvenience your friends with a simple step outside in the cold rule, you would rather your child suffer? Honestly, I found zero actual logic, and zero understanding or empathy for these parents. The entire article made me sad and angry. 

I wonder if the parents in the above study would have finally made the choice to quit if they were given the chance to read the study of brain development and academic repercussions of exposure to second hand smoke published by Pagani and Fitzpatrick. In a longitudinal study of Canadian children from the age of five months old through age ten, they determined that exposure to smoke had negative effects on children’s classroom behavior. Specifically, those exposed to “early childhood household smoke showed proportionately less classroom engagement, which reflects task-orientation, following directions, and working well autonomously and with others.” (Pagani & Fitzpatrick, 2016) As these types of executive skills are necessary for school and adult life it is easy to imagine long-term effects. A few examples as stated by the authors are that these results can be precursors for future struggles such as dropping out of high school, as well as risky and unhealthy life choices. (Pagani & Fitzpatrick, 2016) The article is actually a wealth of information, which I wish I could share with every smoker I meet.

The American Academy of Pediatrics published a Policy Statement in regards to the need for action against this public health concern. (Pediactrics, 2015) The AAP concluded that tobacco smoke is harmful to children’s health, and that tobacco dependence is a pediatric disease; thus, to protect children’s health “Pediatricians can and should take actions to protect children and adolescents from tobacco dependence and tobacco smoke exposure.” (Pediatrics, 2015) They identify tobacco dependence as “one of the most common severe chronic illnesses of adolescents and adults.” (Pediactrics, 2015) Therefore, they emphasize the importance of the need for funded training for health care providers in treating tobacco dependence. (Pediactrics, 2015) I would love for pediatricians to take a more active role in this problem, and for them to have the ability to help smoking parents understand and then quit for the sake of everyone’s health.

As it seems for some the health concern for our children, our world’s future, are not enough incentive to make changes in regards to the public health issue of smoking, maybe the staggering financial costs of its consequences will encourage movement toward better policies as well as training, educational, preventative, and treatment programs. The American Academy of Pediatrics has gathered financial data for the extreme costs of childhood exposure to smoke, estimating medical costs in the USA to be $260 million per day (Best et al., as cited by Pagani & Fitzpatrick, 2016) Further financial costs could be determined when considering parental lost wages for school absenteeism due to the health concerns connected to exposure to smoking. (Pagani & Fitzpatrick, 2016) That is BILLIONS every year! BILLIONS!

We are on the right path. Around the world, and in the US, smoke-free legislation has been decreasing the rates of second hand smoke exposure in public places such as transportations, restaurants, parks and schools. Still, Smoking in private areas such as one’s home or car are much less regulated. (Blanch, et al., 2013) Recently, Blanch and colleagues published the results of their multi-level intervention against exposure to second hand smoke in several schools in Spain. (Blanch, et al., 2013) They determined their intervention had modest result in reducing exposure to second hand smoke at home, school, and in vehicles; and that while not a hugely successful intervention, any decrease is a positive effect for those children involved. (Blanch, et al., 2013) Their study seemed to lead them to the same conclusion as that of myself, Pagani, and the AAP, which is that we certainly have room for improvement; and now that public smoking is less prevalent, that improvement can be accomplished by targeting private smoking through education, and regulations. (Pagani & Fitzpatrick, 2016) (Blanch, et al., 2013) (Pediactrics, 2015) I could not agree more.

References

Berger, K. S. (2015). The Developing Person Through Childhood. New York: Worth Publishers.

Blanch, C., Fernandez, E., Martinez-Sanchez, J., Ariza, C., Lopez, M. J., Moncada, A., . . . RESPIR_NET Research Group, T. (2013, November). Impact of a multi-level intervention to prevent secondhand smoke exposure in schoolchildren: A randomized cluster community trial. Preventative Medicine, pp. 585-590 https://doi.org/10.1016/j.ypmed.2013.07.018.

Bottorff, J. L., Oliffe, J. L., Kelly, M. T., Johnson, J. L., & Chan, A. (2013). Reconciling Parenting and Smoking in the Context of Child Development. Qualitative Health Research, 1042-1053 DOI: 10.1177/1049732313494118.

Center for Disease Control. (2017, June 20). Current Cigarette Smoking Among U.S. Adults Aged 18 Years and Older. Retrieved from: https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html

Pagani, L. S., & Fitzpatrick, C. (2016). Early Childhood Household Smoke Exposure Predicts Less Task-Oriented Classroom Behavior at Age 10. Health Education & Behavior, pp. 584-591 DOI: 10.1177/1090198115614317.

Pediactrics, A. A. (2015, November). Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke. Pediactrics, p. Retrived from: http://pediatrics.aappublications.org/content/136/5/1008.

Assignment- Childbirth In Your Life and Around the World

This week in Early Childhood studies we are looking at prenatal development, the many factors that can influence that earliest development, and the potential impacts on children as they continue to grow throughout life. I have never given much thought to the impacts my prenatal care or birthing experience has had on the development of my children; except to consider that I must have done things “right” as they are wonderful, healthy children. My studies are teaching me many details that could have been impacted in ways I never realized before. The following is the story of how I brought two children into the world.

I have had the pleasure of carrying two healthy children into this world. While pregnant the first time I turned to the well-known book, What to Expect When You’re Expecting. I enjoyed reading details about prenatal growth, and I took every bit of nutritional advice to heart. Already a non-smoker and non-drinker, I made sure to avoid soft cheeses, lunch meat, too much large fish, and more. Of course I craved those things like I never had before! Unlike those in poverty, we had the benefit of having health insurance to cover all the prenatal care necessary and the finances to afford well-rounded healthy foods as well as indulgent chocolatey pregnancy cravings!

Due to a health condition I have called Chiari I Malformation, we had to have an extra ultrasound with a specialist to determine if my children would inherit the condition. Mine is a very minor level, but the condition can be very serious. Thankfully, the ultrasound was clear. Also due to my condition it was determined that I could not risk the physical pressure of experiencing contractions and labor. I would require a cesarean. Not just any cesarean, a cesarean under full anesthesia. I was disappointed, but I quickly came to terms with the concept that it was more important for me to survive to raise my child than to be awake for their entrance into the world. My scheduled cesarean went well, my daughter was born at 38 ½ weeks, 6 lbs 7 oz., 19 ½ inches. The downside was that I was very disoriented, even incapacitated at times during the first 24 hours after her birth. Thankfully, my husband instantly became an amazing father. 

In the years before becoming pregnant with our son, I read an article explaining that cesareans under full anesthesia for Chiari patients is overly precautious and sometimes unnecessary. I approached my obstetrician with this information. They felt that I should see my neurologist for a check-up before proceeding. My neurologist said my MRI scans were out of date, and insisted on new ones before agreeing to a regular cesarean. Reluctantly, I booked an MRI. I had checked to see if this would harm my unborn child. I found nothing to suggest it would. Still, I cried throughout the lengthy scan, fearing I was doing harm to my son. My scans showed that my condition had not changed for the worse, and my neurologist agreed that a regular cesarean was a possibility. Then he retired. 

I went and picked up my file before my scheduled cesarean, pleased to hand it over to receive the opportunity to be awake as my son entered the world. You know what they say about the best laid plans. Apparently, the neurologist had made no note about his latest opinion and the obstetrician had to proceed as they planned with a cesarean under full anesthesia. I found this out while in surgery prep around 7am. Extremely hormonal, I cried, uncontrollable tears. I tried to calm down as it was time to go into surgery. But while lying spread out, naked and shivering on the surgery preparation table I could not contain my disappointment and I cried more. The surgeon even noted my crying in the surgery notes. With my first pregnancy I was the first of my friends to have a child, I was told anesthesia was the only option and accepted it rather blindly. I had not allowed myself to consider what I would be missing. But with my second child I knew more. I wanted to be there, and I could not believe that even after taking my unborn child into an MRI, that I had not done enough. Looking back I can see what could have been done differently, I can see how a busy mommy brain forgot details like checking the file for the notes before my cesarean. Yet, I remind myself that the point remains- It is more important that I am alive to raise my children. After all the stress, I came out of anesthesia (much better this time) to meet my sweet son; born at 38 ½ weeks, 6 lbs 9oz and 19 ½ inches. 

With both of my children I enjoyed holding them skin to skin, as did their father. They spent the nights in a bassinet in my hospital suite for the four day stay. My husband slept on the sofa chair and helped endlessly with their care. I began nursing them immediately, though that went much differently with each child. My first, I had no milk but insisted “breast was best,” but as she lost weight we compromised by taping a tube to my breast for my husband to push a syringe of formula through while our daughter “nursed.” Eventually I had some milk, but never enough to be a full diet so we continued by supplementing formula bottles. Looking back I think my lack of milk was due to my age, my first pregnancy, and my required early scheduled cesarean. Interestingly, with my second child, I had an overabundance of milk, which came with new issues to overcome. 

My sweet children were born to two parents in their twenties; two parents with well-paid full time jobs; two parents with complete health insurance, a home, safe vehicles, and family/friends/ and funds to buy every modern thing a child could need. Now 8 and 5 years old, they are bright, curious, creative children with their whole wonderful lives ahead of them. We have much to be grateful for.

After reflecting on my own birth experiences, I chose to look at birth practices of Japan in comparison. Japan has followed a similar progression to the US; from having historically mostly home births, to medical advances resulting in majority of hospital births, to a recent revival of interest in home births with midwives. The article Post Modern Mid-Wives in Japan: The Offspring of Modern Hospital Birth, detailed the history of Japan’s approach to birth in pre-modern, modern, and post-modern time periods. (Matsuoka, 2010) The points that struck me the most was the impact of Americans on Japan’s practices, and how new medical advances post WWII were twisted to make birth a more profitable and convenient business for obstetricians; further, how those practices resulted in extensive amount of infant deaths, and disabled infants. I was more pleased to see the post-modern resurgence of interest in home based mid-wives and natural births. Not because I feel that is the only best option, but because I feel it shows Japanese women are continuing to educate each other on the process of pregnancy, birth, and postpartum rather than accepting the “status-quo” doled out to them by dominant males as was the situation experienced by Brett Iimura, an American living in Japan. (Iimura, 2005) 

In another article I found that the Japanese government also seems to be recognizing the benefits of more natural birth on both mother and child, as it has funded programs to train medical personnel, execute studies, and implement practices for the “Humanizing of Child care” and “Humanizing of Maternity care.” Still, it is typical of the Japanese culture for the women to not take a leading role in the decision making process of their child birth experience, and to lean heavily on the word of their medical personnel. (Behruzi et all., 2010) It is unlikely in Japan that a woman would approach her doctors as I did in regards to a medical condition and birth procedure.

Despite, or maybe because of, a time period of many medical interventions during child birth, Japan seems to culturally have the perspective that less intervention or medications are best for prenatal care and child birth. This is probably in contrast with the opinion of the majority of Americans, where epidurals and cesareans are the norm. Additionally, in Japan after vaginal birth mother and child stay in the hospital/birthing center for one week receiving monitoring and breastfeeding support; much different from the quick discharge in the US after a vaginal delivery. Another difference however leans toward American’s having a step up in the humanizing approach, which is the participation of fathers and family members during birth. In Japan, the culture doesn’t yet encourage or allow for family participation to support the mother’s emotional wellbeing. (Behruzi et all., 2010)  Sometimes this is simply because it is not financially responsible for the father to participate. Overall, I think there are many similarities between American births and Japanese. Contexts such as education, and economic status, and services available will similarly impact pregnant women and new mothers in both countries.

References

Behruzi, R., Hatem, M., Fraser, W., Goulet, L., Ii, M., & Masago, C. (2010, May 27). Facilitators and barriers in the humanization of childbirth practice in Japan. BMC Pregnancy Childbirth, pp. doi:  10.1186/1471-2393-10-25.

Iimura, B. (2005). Birth In Japan. Midwifery Today, 60 (3).

Matsuoka, E. (2001). Postmodern midwives in Japan: The offspring of modern hospital birth. Medical Anthropology, 141 (45) dx.doi.org.ezp.waldenulibrary.org/10.1080/01459740.2001.9966193.