|From Russia, With Love|
Sojourn in Belarus Transforms NCI's Simpson
By Rich McManus
Photos by Nancy Simpson and Yuri Pliushchev
On the Front Page...
It's probably a pretty common syndrome among those who go abroad to give aid to a stricken population: You find beauty amid the horror, and soon you fall in love with the place. And to be frank, Nancy Simpson, a program director and public health advisor in NCI's early detection research group, Division of Cancer Prevention, seems prone to affection: a native of South Pasadena, Calif., who in high school used to help build floats for the annual Rose Bowl Parade on New Year's Day, she is herself of rosy disposition she brims with empathy for the populations she has helped over the years in Appalachia, Bangladesh, Indonesia, and now Belarus, a republic once part of the Soviet Union from which she returned in August after an 18-month assignment.
"I always seem to work with issues involving special populations," she admits. "This is what I'm interested in."
A 9-year NIH veteran who used to work on drug and alcohol issues for the old federal conglomerate ADAMHA, Simpson has for the past 6 years been a program director whose projects have included the Appalachian Leadership Initiative on Cancer, which paired agricultural extension services with their deep community roots with cancer centers, and minority recruitment for major NCI trials involving screening for cervical cancer, and for the PLCO (prostate, lung, colorectal and ovarian cancer) screening trial, for which she has recruited blacks in Alabama and Hispanics in Colorado. To each of these projects she has brought an empathy that seems to come quite naturally to her.
Two years ago, when her husband got an assignment to craft the U.S. Agency for International Development's strategy for Belarus, Simpson got a leave of absence from NCI to accompany him. For the first year, she worked as a public health advisor in Minsk, the capital of Belarus, a country of about 10 million highly educated but impoverished people. A letter from Ambassador Daniel Speckhard to NCI director Dr. Richard Klausner helped extend Simpson's service to the U.S. embassy for another year.
What she found there was heart-rending. "The old Soviet system is still in place there is very little private sector. Physicians and researchers earn about $50 a month. The people are very isolated and deprived, but also very highly educated, both women and men. The economy is just crumbling, though. All of their income goes to Russia to pay for fuel. The agricultural system is collapsing. Serious shortages of food are common. At times there is no sugar. Milk was unavailable for weeks at a time last winter."
Despite their poverty, many people have dachas, or cabins, away from the city. "That's where they grow their food," Simpson said. "The whole economy depends on this. Grandparents often live in them and grow food for the whole family. The growing season is short, but intense; home canning is a big industry."
Tragically, 75 percent of the radiation from the April 1986 Chernobyl reactor disaster in the Ukraine fell in the southern part of Belarus, Simpson explained. The contaminated territory was marked off and evacuated, but people, out of sheer necessity, have farmed on land they know is harmful. Forests closed to the population due to health risks have been broached by folks harvesting mushrooms and berries, which absorb cesium from the soil, Simpson said. "Cows, which every family has, forage on grass that's been contaminated, so it gets into the meat and milk," she continued.
Although there is a good system in place for evaluating the safety of food, many products are sold outside of the system, she observed. "Street vendors little old grannies selling mushrooms are very common. But there has been very little in the Western press about ingestion of radiation. The pediatricians in the region are very concerned. Already there are serious signs of problems."
An article in the British Journal of Medicine has reported on the health of Jewish emigres from Belarus who have settled in Israel, and Simpson says the U.S. is trying to support doctors and scientists who are studying the radiation issue. "The U.S. goal is to encourage the private sector to create independent NGO's (nongovernmental organizations) and public health associations like the American Cancer Society, which they don't have, or advisory groups like the Susan G. Komen Breast Cancer Foundation."
Simpson lectured all over the country on public health, introducing the concept of focus groups to the nation. "The old Soviet system was top-down; nobody ever went from the bottom up," she explains. She designed a new community health services project for a Chernobyl-contaminated area in Gomel Oblast (oblast is state); the project focused on introducing new disease prevention and early detection measures. Her other activities included helping develop an iodine deficiency eradication project for Brest Oblast, assisting the U.S. military's effort to provide Belarus with hospital renovation funds, and working with NGO's to develop health programs.
But her work took place against a frightening backdrop. "The politics there are very scary. The KGB there is large and very active. There are militia dressed in fatigues on every corner in Minsk. It feels like a police state," she said.
Alcohol abuse is a major problem. Because the government subsidizes the production of vodka, it is "cheaper than soda and juice, and sold in every store," reports Simpson. "Beer is also very popular, and the alcohol content is higher than in the U.S. Teens openly carry drinks on the street. There is a lot of drunkenness in the evening on the streets it's very, very common."
There is very little knowledge of fluoride's benefit to children's teeth, she said, and there is a serious deficiency of iodine in the diet because the salt is not iodized.
That such common public health interventions, not to mention concepts such as budgeting and cost-effectiveness, are absent in Belarus astonishes Simpson. "They are a highly organized society with well-educated people it's really an anomaly."
It was the U.S. ambassador's wife, a psychologist, who offered insight that made the best sense to Simpson: "She said they are a 'traumatized population.' One in four of their people died in World War II; they've never recovered from it memorials are everywhere. One of Hitler's largest death camps, Trostenyets, where at least 250,000 people died, is located on the outskirts of Minsk. And Stalinization hit hard; most families lost members in the thirties and early forties in killing fields such as nearby Kurapaty and in the gulags of Siberia. Then there was Russia's war with Afghanistan many Belorussians were lost there. Then you add Chernobyl to that. Sometimes I would feel like I was in hell. I would look at my husband and say, 'Where are we? Where are we?'"
Another tragedy struck while Simpson was in Minsk, but news of it made hardly a ripple in the West: Some 50 youngsters attending an outdoor rock concert died in a stampede outside the city's subway system after a freak storm hit the area. "That was particularly sad because the birth rate in Belarus is dropping below the replacement level and here all these beautiful young people were lost."
Simpson says despite an oppressive history, the people are peaceloving and tolerant. "They look at you with a tear in their eye and say, 'This is our life. What can we do?'" But they are also deeply cynical and pessimistic. "They don't trust anyone or anything. They are used to hypocrisy. The culture has not been able to grieve all that it has suffered."
Still, the land is beautiful and the citizens revere nature. "There are wonderful artists of all sorts," Simpson said. Physicians there two of whom she gave English lessons are hungry for information; Simpson plans to inquire whether NIH can send excess computers their way.
Back in the U.S. since Sept. 10, Simpson has turned now to issues involving women and minority health in this country. But Belarus has marked her and she cannot forget the people she met or their needs. "They are so alone," she said.
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