00:00 Loud music
00:20 Just imagine that you're going about your normal day and then all you see is black ash raining down on you. The ash is slowly falling down on the ground like white snow, however, this “snow” is dangerous to your lungs, throughout this podcast I will tell you how people's repository system is being affected by the volcanic ash.
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00:50 On January 13, 2020, the Taal volcano in the Philippines ruptured around 50 to 500 m high. This explosion was so large in magnitude that it was seen from space. On the 13th the volcano was rated a level 3 and then updated later that day to a level 4 by the Philippine Institute of Volcanology. Level 4 means that the Volcano is active with the possibility of multiple eruptions.
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01:32 When closely at the ash in the lung, I interview Dr. Ellison to help me understand how it could really affect a person's health. “I graduated from the University of Oklahoma. For my medical training and complete residency and fellowship at Wake Forest Baptist Medical center. My fellowship training is in pulmonology and critical care medicine.”
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01:57 Because of the eruption, many people had evacuated their homes and work area. With the ash blanketing the Provinces (which are states) many people had to be evacuated from their homes leaving all that they knew behind. Days after the eruptions there were many organizations that have stepped up and helped evacuate families and individuals. When telling other people about this topic they don’t understand why people choose to live there. There are two main reasons why people live there. One tourism, locals benefit from the volcanoes because they are a tourist attraction. It is easier for them to live closer to their work. Two, the volcanoes enriched the soil, providing fertile soil for growing and harvesting crops. The Taal volcano is actually a part of the Pacific Ring of fire, so the locals understand that there could be a potential eruption at any time. “So if they know that they're going to be in an area of volcanic ash all they can do is prevention. They should wear masks. They should stay away from those areas because once you have deposition of the silica from the volcanic ash there is not a treatment for it. All you can do is manage symptoms. Depending on if you have underlying lung disease, we can give inhalers and we can give medications but it's not going to cure that exposure to volcanic ash once it is deposited in your lung tissue.”
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03:23 To give you a more basic idea of what ash is, it is the remains of a fire. “Because we are expelling content of the core of the earth, or the crust of the earth it can come in various sizes.” Depending on what the size of the ash is, it can result in where it can go into your body and how it can affect it. “With the larger particles those that are greater than 10 microns it can mostly be in the Oropharynx. As you get to smaller particles about like 5 micrometers they, it can get to the trachea or the large airways called the bronchi. Once it gets smaller than 5 microns that when you really worry about Alveolar sac irritation. That is deep-seated lung irrational and that can cause inflammation and what we call acute exacerbation of respiratory issues.” To put in laymen’s terms the larger particle can be predicted to be the area in your throat where your mouth and nose meet. And the smaller particles will probably end up into your main lobe that goes into your lugs or in the area that separates your two lungs. “And so when we talk about the negative consequences are they having just one, are they irritated by just lung particles. Two are they having acute silicosis reaction, or three eventually over a long period of time when we're talking 10 years of exposure for those people in the areas of volcanic ash will they devolve chronic silicosis.” Acute Silicosis can cause your lungs to fill up with fluid which leads to shortness of breath and low O2 levels in the blood. While chronic silicosis can cause your lungs and lymph nodes to swell and make it very difficult to breathe. Just imagine having crystals forming inside your lungs.
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05:27 Let’s say there is a young woman named Tala, she is around 20 years old and lives with her parents and younger sister. To help support her family she works at her local farm. On January 13 the eruption happened, which caused everyone to panic. Because she was out in the field and not aware that this was supposed to happen she inhaled some black ash when trying to get home to her family. She started to cough while her parents were telling her to pack up her things because they needed to evacuate. Little did Tala know she was having an immediate reactive airway disease. “We worry about people that are being exposed to it, especially with chronic lung disease developing something called chronic silicosis. If you truly have a diagnosis of chronic silicosis that is related to volcanic ash then it can lead to pulmonary fibrosis. And that is another way to describe the stiffening of the lungs, where people aren’t able to breathe as well they have a chronic cough, they have chronic shortness of breath related to the lung pathology changing from these depositions of the minerals.” She and her family ended up being put in this large building with other people. Even though her and her family had a meal to eat, they didn't have anything to call home. Her parents are worried about her and her sister. There haven’t actually been many studies to look at or compare for children in these situations but “One of the more common things that we try to keep an eye for is undiagnosed asthma. So those children that haven't had an exacerbation before might be having an asthma attack when they are exposed to these particles.” Despite the many cases that doctors do catch of undiagnosed asthma there are children that are healthy but still face problems. “Even kids with healthy lungs, sometimes they can have reactive airway disease. And they will respond by coughing or lung irritation bronco spamming, those types of lung reactions due to the irritant.” After getting adjusted to living in a shared community space Tala and her family were finally allowed to go back to their home. When they arrived back it was heartbreaking to see. The weight of the ash made the home concave into itself. Without a home to go back to, they stayed with family friends while Tala and her family rebuilt their home. With the help of environmental specialists in the Philippines, the family was able to rebuild their home with a mixture of leftover ash and plastic. Even Though everything is looking up for Tala and her family, there is still the threat of them having Acute or chronic silicosis. Dr. Ellison mentioned that it can take up to 5 weeks to 5 years for it to occur. “Often time it can lead to poor quality of life and if you're not able to breathe then it leads to long term lung and heart issues.”
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08:30 Given that the Philippines is a middle to low-income country, medical supplies is scarce, therefore it's hard for the locals to get the things they need. “You know, what I recommend and what is recommended by the CDC is an N95 mask, so those are able to filter out particles that are less than .4 micrometers small. So I mention to you before particles that are 10 or 5 micrometers large, we can filter out those particles and hopefully prevent any airway reactions from the volcanic ash.” This knowledge should be spread throughout the provinces so people can understand what to do when the time comes. “If you are actually in or exposed to the volcanic ash, just know that these particles are small and can stick to your clothes. And so we always tell people and it's been recommended from a national international level that your clothes can carry particles. So if you wear the same clothes that have been exposed to the ash in your house or in your car, your risk exposure to your family to yourself at a later point in time.” should be common knowledge. If someone wasn't able to get a mask or were exposed to the ash they might have these long-term effects.
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09:55 As it's been a few months since the volcano eruption passed, now the updates are about the cleanup effort for the provinces and areas that were affected. Many local and national corporations are getting evolved. The major organization is the Philippine Red Cross. They have created different teams to help provide care for everyone. An example is how they have an action team that directly correlates to emergency health and they also have a community-based volunteer team to help with people that have a non-emergency issue. The Philippine Red Cross has also helped evacuate and rescue people days following after the eruption. They have provided dust masks, hot meals, and other services for the evacuees. During this time there are only a few ways that the government and agencies can clean up the ash effectively. There have been many community organizations like Asian medical student Association that have come together to help provide healthcare to people that needed assistance. The most effective way to clean up the ash is to sweep it up and then put it into plastic bags and seal it, from what is shown people are following the suggested method of clean up. It’s yet to be determined how the plastic bags are effective the environment.
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11:18 My name is Taylor Young. This podcast was produced for the Spring 2020 Global Health course at Guilford College.
