Online course guides doctors on dealing with toxic exposures farm workers might encounter

Agricultural workers are confronted with many toxic substances, whether of synthetic or natural origin. This is why the Eastern Region Health Education Center offers a continuing education program called “Farm Toxicology for Primary Care: Recognition and Management of Pesticide Poisonings”.

The eight-module program is a self-paced online program that covers exposures to insecticides, herbicides, rodenticides, fungicides and toxic gases, and the short- and long-term consequences of these exposures for agricultural workers. .

Dr. William J. Meggs, professor of emergency medicine at the Brody School of Medicine, is one of the presenters participating in the online program. (picture of ECU file)

The presenting physicians represent a broad healthcare community:

  • William J. Meggs, Professor of emergency medicine to Brody School of Medicine at East Carolina University and a board-certified toxicologist.
  • Jason B. Hack, professor of emergency medicine at the Brody School of Medicine and board-certified toxicologist.
  • Jennifer Parker-Cote, associate professor of emergency medicine and medical toxicologist at the Brody School of Medicine.
  • Ricky Langley, Adjunct Associate Professor of public health at the Brody School of Medicine.
  • Dalia Alwasiyah, emergency medicine consultant and medical toxicology consultant from Charlotte.
  • Stephanie T. Weiss, board-certified medical toxicologist and former senior researcher in addiction medicine at Wake Forest University School of Medicine.
  • H. Thomas Cusick III, specialist in occupational and environmental medicine at Duke University.
  • Gayle Thomas, medical director of the North Carolina Farmworker Health Program and associate professor of family medicine at the University of North Carolina at Chapel Hill.

This is the third iteration of the program. The first dates back about 15 years, said Robin Tutor Marcom, director of the NC Institute of Agromedicine, based at ECU. Earlier versions focused only on pesticides. More recently, Meggs has added sections on other areas of concern, such as animal bites and stings, plant toxicity, and heat-induced illnesses.

On farms, not all chemical exposures come from pesticides. For example, anhydrous ammonia is a gas used as a fertilizer; this can cause burns. Rotting manure releases hydrogen sulfide, which can cause cardiac arrhythmias. Engines emit carbon monoxide.

“There are a lot more toxins on the farm than just pesticides,” Meggs said. “And many more diseases.” And illicit drug use, he added.

“Many physicians haven’t learned how to take occupational and environmental histories,” he said. “As healthcare providers, we need to be open-minded and consider all the possibilities” why someone might be sick.

Robin Tutor Marcom, director of the NC Agromedicine Institute, speaks to Margaret Spellings, then president of the University of North Carolina system, in 2016.

Robin Tutor Marcom, right, director of the NC Agromedicine Institute, speaks to Margaret Spellings, then president of the University of North Carolina system, in 2016. The toxicology program was first offered there almost 15 years. (picture of ECU file)

“It’s agromedicine 101, which makes a person go undiagnosed or misdiagnosed at all,” tutor Marcom added of the lack of work and environmental backgrounds. “It sounds basic, but it’s not happening.”

She has worked in migrant health for over 20 years and grew up in a farming family.

“Agricultural medicine is a much larger field because of all the exposures,” she said, adding that the course is unique and is part of PERCMED or PERCMED at the University of California-Davis.

“A few years ago I spoke with a doctor who worked with migrant farm workers,” said tutor Marcom. “She said to me, ‘You know, they should just phase out all the pesticides they use in agriculture. “”

But that’s not a realistic approach, Tutor Marcom said. “Soil and plants have diseases and pests, just like people,” she said. “Chemicals are necessary. If we take away this form that farmers have, they will not be able to produce the food needed to feed the United States and the rest of the world. »

And not all pesticides are highly toxic to humans. Hack points out that pyrethroids, nicotine, and neonicotinoids, for example, are natural or derived from natural sources and are very effective at controlling insects, but have relatively low human toxicity, with a few exceptions.

And it’s not just farm owners and workers who could be exposed to agricultural chemicals. Home gardeners use them; owners use insect repellent and rodent bait.

“What we’re trying to do is raise (doctors’) awareness and give them the tools they need,” Tutor Marcom said. “Our job is to say, ‘Let’s do it safely and responsibly.'”


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