The Bugs of Summer – Avoid the Bites

woman spraying a child in a purple tshirt with bug spray when in the woods

Tiny Vampires

We are gathering carefully outdoors more than ever this summer in order to stay COVID-safe. And who else likes to have a meal outside on a warm evening? Mosquitos. All they want is a little of your blood, but what they leave behind under your skin is an unwelcome parting gift –their saliva. Mosquito saliva contains highly irritating proteins which alert your immune system to send out the histamine troops to get those foreign proteins under control. So, those itchy, red welts that last a couple of days are from your system trying to help out.

Here’s what I’ve learned from 5 trips to Tanzania and 2 to Honduras where mosquitos transmit malaria, dengue fever, zika, and chickungunya. In Tanzania, I was also bitten by Tsetse flies and Nairobi sand flies. Both leave huge painful welts, so I’m all about prevention and protection.

Go with Prevention

  • Clothing – The proboscis of a mosquito can fit through the fabric of most clothing, especially if it is a thin fabric and fits tightly against the skin. Spandex and yoga pants? Not so good. Tightly woven and heavier fabric that fits loosely is best. Long sleeves and long pants? It’s a great idea, but, in warm weather usually, we are in shorts and a sleeveless shirt so you might need other measures.
  • They Don’t Like a Breeze – Even a light breeze makes it hard for mosquitos to fly and navigate. Pick a picnic spot with some wind, or set up a couple of fans on your patio. Aim them down as the little buggers fly low to avoid strong air currents.
  • Mosquito Mealtime – Because they don’t like wind, mosquitos prefer to dine out on you at dawn and dusk. They are crepuscular – An SAT word for your teens for sure, which means, active at twilight. That’s when to stay inside. Also, mosquitoes breed in stagnant freshwater so check your yard for plant saucers, buckets, etc. where water has been sitting. 
  • DEET (N, N-Diethyl-meta-toluamide) repellent – There is wide scientific consensus that DEET is safe and effective when used as directed. This means spray on your clothing, hat, socks, but use in lotion form on your hands to carefully apply to uncovered skin. Do not get near eyes or mouth.
  • Picaridin is another synthetic compound that mimics piperine, a natural compound produced by pepper plants. Picaridin has similar effectiveness to DEET.  Lotion lasts for up to 14 hours against mosquitoes and ticks. 
  • Synthesized Plant Oils – effective on mosquitoes, some ticks.  These plant oils are still considered chemicals and are regulated by the EPA. 
  • Lemon eucalyptus oil can repel mosquitoes for up to six hours.
  • IR3535, a synthetic based on a natural amino acid, can last up to eight hours
  • If you live in area with a lot of mosquitos, be sure to have screens over the windows. 
  • Use your air conditioner to cool the house down as there are filters that trap flying insects

Mosquito & Tick-Borne Illnesses

There are reasons beyond the annoying itch to avoid getting bit by mosquitos or ticks. Mosquitos can carry a variety of diseases: West Nile, Zika, or encephalitis viruses, and also in other countries, chikungunya, dengue, and malaria. 

While I was in Honduras, I cared for many people with Malaria, Dengue, and Zika. 

  • West Nile Virus – The incubation period is from two to 14 days, with symptoms such as body and muscle aches, fever, headaches, fatigue, joint pain, and stiff neck.
  • Zika Virus – fever, rash, headache, joint pain, conjunctivitis, muscle pain. There have been no reports of someone getting Zika from a mosquito in the continental U.S. since 2017.
  • Chikungunya Virus – fever, joint pain, headache, muscle pain, joint swelling, or rash.
  • Encephalitis Virus – headache, flu-like symptoms, sensitivity to light, neck stiffness, lethargy, confusion, or hallucinations.
  • Malaria – fever, flu-like illness, shaking chills, headache, muscle aches, tiredness, nausea, vomiting.
  • Dengue – most people will not feel sick, but a few will develop a mild case leading to headache, muscle and joint pain. Rarely, dengue becomes severe leading to internal bleeding and even death.  

Ticks

Ticks are found in grassy and woodland areas in most of the US. They drop from trees (wear a hat!) and jump from tall grasses and hitch rides on unsuspecting hikers and campers. And check the dog too, especially in the crevices in their paws. Ticks can carry several illnesses:

  • Rocky Mountain spotted fever – a rare bacterial disease spread through the bite of an infected tick. Most people who get sick with RMSF will have a fever, headache, and rash..
  • Lyme disease – Lyme disease is now the most common animal to human illness in the US. Symptoms include fever, chills, aches and pains, and a rash visible at the site, often in a red bulls-eye-shape. If you find a tick, do try to save it in a plastic bag for testing.
  • Ehrlichiosis – a bacterial illness transmitted by ticks that causes flu-like symptoms from mild body aches to severe fever.
  • Anaplasmosis – spread by different species of ticks most frequently reported from the Upper Midwest and Northeastern United States 

First Aid for Bites

  • ice or a cold compress
  • calamine lotion or caladryl cream
  • apply a paste of baking soda and water 
  • take an antihistamine 
  • apply Over the Counter hydrocortisone cream
  • apply a paste of oatmeal and water
  • avoid hot showers, this increases blood flow to the area, which makes the symptoms spread

Or, this ancient Chinese remedy – rub the inside of a banana peel directly onto the bite and leave for a while. Can’t hurt. 

I hope these help. Do send me your tried and true tips for avoiding bites this summer. 

A Conversation About Racism for All Health Care Providers

multi ethnic wallpaper of people

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
– Martin Luther King, Jr.

Brad Snyder, NP and Barb Dehn, NP

Bio: We became friends while volunteering at FAME Hospital in Tanzania several years ago. As the fight for racial justice and the Black Lives Matter movement evolved, we both felt compelled to reach out to all of our healthcare colleagues to start and continue a dialogue on racism that impacts our patients, our communities, and our colleagues. 

We Need to Do better

Our world is in peril. In this unprecedented moment, two global pandemics are coalescing to reveal some of the deepest wounds in this country: a broken healthcare system and systemic racism. As nurses and nurse practitioners (NPs) we are inundated with conflicting COVID guidelines and nebulous information about how best to care for our communities, while simultaneously feeling the streets tremble as millions rally in the fight for racial justice. While there is no doubt that we are doing our very best to tackle COVID, when it comes to racial justice – We Need To Do Better!  We are talking to ourselves and specifically those of us who comprise the vast majority of all healthcare professions – that’s right, white clinicians and providers. We all have a responsibility to do better, not just now, but for the long-term.

To Our Colleagues: Black, Brown, Indigenous and People of Color 

We know you are hurting. We acknowledge your resilience as you muster up the strength to go to work and give of yourselves given the current state of our country. While we will never know what it’s like to walk in your shoes, our hope is that after reading this article more people will do the hard work of recognizing how they perpetuate racial injustice and work to fix it. We admire your courage and recognize the invaluable roles you embody as clinicians, leaders, educators, advocates, and role models. Please know that we see you and we’ve got your back. We will fight side by side with you for justice. Your lives matter to us. 

This is About Black Lives

We are writing this as two white NPs, specifically to our white nurse and NP colleagues, and also to all of our colleagues in healthcare, in every role, who work tirelessly to save lives. We are not experts by any means, on the contrary, we feel like we’re only dipping our toes in as we try to figure out how best to show up. We also want to be clear about what this article is about – supporting Black Lives – Because They Matter. This is about starting an uncomfortable and necessary discussion about the inequitable systems that may be invisible to us as white people and examining the realities and impact of our own internal biases and the realization that our actions or inactions are contributing to and perpetuating racism. 

Our Collective Discomfort

If you’re feeling uncomfortable, let us reassure you that we are too. We don’t pretend to have the answers, but we do know that diving deep into the pursuit of more understanding and the difficult work of honest, inward reflection are essential steps. And while it’s ok to acknowledge that this is hard, we must also admit that we as white people and white clinicians, we get a pass. We are so used to deferential treatment that it seems like the norm and well, just the way it is. Most of what we take for granted is not experienced by Black, Brown, or other People of Color – this is our white privilege and it’s real and it’s pervasive and it’s unfair.

As white healthcare providers and as white people, we have been wearing some pretty thick blinders that have been shielding us from acknowledging tragic truths for far too long. For some, it feels right to rip off the blinders and completely immerse yourself in this work of changing the status quo, while others may start with a deep dive into examining their beliefs and biases and start with the tough internal work. There are many paths leading toward justice. No matter how you walk this path, the goal is the same – We as white nurses, clinicians, and providers, must confront racism and do the hard work to change this reality.  

For white people, confronting racism is uncomfortable; for Black people it’s a battle far too often resulting in death. For those of us who are serious about doing our part, experiencing some discomfort is the least we can do to show solidarity with Black, Brown, Indigenous and other People of Color who are friends, family, colleagues, patients and our larger community. It’s a choice for us, it’s not a choice for them. Merely thinking and reading about this is not enough – We are calling upon you to take action. 

The Problem with “All Lives Matter”

Of course, all lives matter. We wouldn’t have dedicated our lives and careers to helping others if we didn’t believe this statement.  However, as white healthcare providers, we never have had to question or wonder if our lives matter. We take this for granted. Black Lives Matter does not mean that “only” Black lives matter, but rather it draws direct attention to the fact that America has repeatedly implemented structures to oppress Black people starting with slavery, then Jim Crow Laws, police brutality and the alarming reality that Black people are imprisoned five times more than whites. 

Black people get disproportionately profiled, targeted and killed by the police, face housing discrimination, and earn less pay.  As clinicians and people entrusted to care for others especially, we must examine the science and admit that Black, Indigenous, and People of Color (BIPOC) experience worse health outcomes, more maternal mortality, more illness and premature death compared to white people.1,2  Remember, what’s happening to Black folks is not new – the movement is gaining traction and more white people are waking up to these realities. This is why we explicitly say “Black Lives Matter” because this is where our attention needs to be focused. 

Here are a few analogies. When nurses’ unions fight for better pay, they are not suggesting that social workers shouldn’t also get better pay, they are focusing on a particular issue that needs attention. Think of it like triage. Right now, there are many critical needs in the Black community which need to be addressed immediately because people are literally dying and being killed. This doesn’t negate essential issues in other communities, rather support for the Black community should be a priority when considering energy and resources. The reality is our lives are not equal and our experiences are far from fair. 

Letting Go of Denial

Pervasive racism might be difficult to grasp, but it is our shared reality. Fortunately, there are many resources including Brené Brown’s podcast with Dr. Ibram Kendi, the author of How to be an Antiracist to help illuminate many of the issues.  To paraphrase Dr. Kendi’s wisdom “You have no umbrella, and you don’t even know that you’re wet with those racist ideas, because the ideas themselves lead you to believe that you’re dry. Then someone comes along and says, ‘You know what, you’re wet, and these ideas are still raining on your head. Here’s an umbrella.’ You can be like, ‘Thank you! I didn’t even realize I was drenched.’”

As white people, we have the privilege of being able to “look the other way” when confronted with the harsh realities of racism or disengage when we feel it’s magnitude. Perhaps, like many, you find your mind searching for thoughts to make you feel a little more comfortable like “slavery was a long time ago” or “I’m not racist, I have Black friends” or “I didn’t do this, why is it my responsibility to fix it?” 

If you’re feeling overwhelmed, just try for a moment to imagine what People of Color are feeling, and they don’t have the luxury of “looking the other way.” Denial of these problems directly halts progress towards justice and in many ways reverses the arduous work that has already been done. 

What White People, Specifically Nurses and Clinicians Can Do

If you’ve come here to help me, you’re wasting your time. But, if you’ve come, because your liberation is bound up with mine, then let us work together.” – Lilla Watson

To quote Dr. Andrea Jackson, “Nurses are in a very unique position to immediately start working to be anti-racist. A good place to start is by going into work tomorrow and listening honestly and openly to your Black patients.” 

With pervasive, justified mistrust in the healthcare system among communities of color, we can start here and have a direct impact – and you know we as nurses and Nurse Practitioners are great listeners and like to have a direct impact. We must also listen to our colleagues of color and not only “make space at the table” but actually do the work of collectively redefining what the table looks like, bringing in more voices and supporting their ideas. We must restructure how things are done in our homes, clinics, and organizations because we live in a system doing everything in its power to convince us that white is superior to black and superior to brown and a little bit more special and entitled.  

We implore you to take a deep breath, call on your courage, and allow yourself to be vulnerable. Pull down your walls, forget the political soundbites, and the echo chambers of social media for a moment and tap into your humanity. Tap into the feelings you had when you decided to care for others. This work starts in the heart, not the head. From this place of courageous compassion, we can find the energy to be part of the solution and then act! 

Getting Started: 

  • Increase your awareness by listening and learning with an open mind and an open heart.
  • Educate yourself about these issues without burdening our BIPOC colleagues to teach us and make it easy or absolve us from our collective discomfort and guilt. 
  • Have difficult conversations in your home and community with family and friends. 
  • Be actively “Antiracist” by calling out racist ideas, policies and actions at home, work and in our communities (see Dr. Ibram Kendi’s book below)
  • Don’t just have the books on your shelf – Read them and then start changing your behaviors.
  • Get involved by joining a committee, professional organization, or community group that’s devoted to racial equity.
  • Work alongside your colleagues of Color as an ally to make your organization arc toward justice.
  • Listen honestly and openly to your Black, Brown, and Patients of Color to directly counter the inequities of our healthcare system and to show them that their lives matter.

Resources

We have compiled some resources that we’ve been using to help get us started and want to share them with you. These are just the tip of the iceberg in the journey toward more understanding of racism and what we can all do. This is the moment to do what is right. This moment is our opportunity to rise up and stand united against racism.  We must do better and we must start with ourselves. We owe this to our friends, colleagues, patients, and communities so they can trust and believe that we’ve got their backs. Let’s prove to ourselves and the wider world that this is who we are as Nurses, Nurse Practitioners, and Healthcare Providers. Let us stand together for justice! 

“The arc of the moral universe is long, but it bends toward justice.”  – Martin Luther King, Jr.

Podcasts:

  • Courageous Presence with Racism – Tara Brach
  • The Seeing White Series – Scene On Radio
  • Unlocking Us Podcast – Brene Brown, PhD MSW interview with Dr. Ibram X. Kendi
https://brenebrown.com/podcast/brene-with-ibram-x-kendi-on-how-to-be-an-antiracist/
  • New York Times Audio Series: 1619 – 

Books

  • The Inner Work of Racial Justice by Rhonda Magee
  • How to be an Antiracist by Dr. Ibram X. Kendi 
  • The New Jim Crow: Mass Incarceration in the Age of Colorblindness by Michelle Alexander
  • White Fragility: Why It’s So Hard for White People to Talk About Racism by Robin DiAngelo
  • Me and White Supremacy: Combat Racism, Change the World, and Become a Good Ancestor by Layla F. Saad
  • So You Want to Talk about Race by Ijeoma Oluo
  • Between the World and Me by Ta-Neshi Coates   


*And while you’re at it, we recommend buying your book from a Black owned bookstore https://lithub.com/you-can-order-today-from-these-black-owned-independent-bookstores/

Many thanks to our reviewers for their time and expertise


Dr. Irene W. Bean, DNP, FNP/PMHNP-BC, FAANP

Dr. Scharmaine Lawson, DNP, FNP-BC, PMHNP(C), FAAN, FAANP 

Dr. Andrea Jackson, DrPH

Andrew Ollero, MSW, MPA

References

  1. National Center for Health Statistics (US). Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD: National Center for Health Statistics (US); 2016 May. Report No.: 2016-1232.
  2. The Department of Health and Human Services, United States (HHS). National partnership for action to end health disparities: Offices of Minority Health. Washington, DC, 2011.