EDITORIAL: Maddening uncertainty (04/23/00)

EDITORIAL

Maddening uncertainty

This guest editorial is written by Alex Kuzma, an attorney who is the executive director of the Children of Chornobyl Relief Fund.

Though it is a work of fiction, Irene Zabytko's novel "The Sky Unwashed" reminds us how great literature can sometimes get to the truth of a historic event in a way that narrowly focused research and scholarly writing cannot. Through the eyes of an elderly survivor, Ms. Zabytko's new book tells the story of Chornobyl as it impacted the lives of thousands of families in Ukraine. The novel brings to life those terrible days in the spring of 1986 when entire communities were uprooted, when hundreds of thousands of children, emergency workers and unsuspecting villagers were exposed to potentially lethal doses of radioactive fallout.

Ms. Zabytko captures the gnawing and maddening uncertainty that still plagues Chornobyl's survivors as they struggle to piece their lives together.

Fourteen years after the fact, the world still knows precious little about the overall impact of Chornobyl. We know that the accident released more than 185 million curies of radiation over a heavily populated area. We know that thyroid cancer among children has exploded to level 10 times higher than normal in Ukraine, and in some areas, more than 80 times higher than normal. We know that the accident has caused significant chromosome damage and that birth defects have doubled since 1986. Beyond that, Chornobyl remains shrouded in mystery and speculation.

Whom do we trust to tell us the truth about Chornobyl? Part of the fallout from the disaster has been a growing distrust of the scientific community that controls most of the government research monies designated for the study of Chornobyl health effects. In 1998 Dr. Bruce Wachholz, a once respected research director with the National Cancer Institute, admitted in Congressional hearings that he had concealed evidence of a large increase in thyroid cancer among Americans living downwind from the Atomic Test Site in Nevada. These revelations came about after members of Congress began asking for an explanation of the discrepancy between thyroid cancer rates in the wake of Chornobyl and U.S. bomb tests. In his half-hearted apology, Dr. Wachholz told Congress that he "didn't think the public would be terribly interested" in his findings.

From the very beginning, Western researchers associated with the International Atomic Energy Agency have been in the thick of the Chornobyl cover-up. They have betrayed a clear bias in minimizing the impact of Chornobyl and ridiculing the victims for their "hysteria" and "radiophobia." Even after they were roundly embarrassed by their failure to identify an obvious increase in thyroid cancer in children, scientists like Dr. Wachholz have stonewalled the public and maintained an arrogant, "know-it-all" posture regarding other health effects that have never been fully investigated.

We need to remember that radioactive iodine 131 was only one of many fission by-products that were spewed out of the Chornobyl reactor in massive quantities. As long as researchers continue to ignore, deny or cover up reports of any health effects beyond thyroid cancer, we may never know the full dimensions of this disaster.

The debate over Chornobyl's effects will continue for many years to come, and compromised experts may cling to the fantasy that the current health crisis in Ukraine and Belarus is nothing more than a symptom of a failing economy. Ms. Zabytko's book reminds us that behind the blur of statistics and sterile academic discussions, there are real people who are living and dying proof of Chornobyl's lasting legacy. Since these are people and not numbers, it would be irresponsible for us to wait until some final consensus has been reached. It would be perverse to wait for a final body count.

Whether a birth defect or child's cancer is caused by Chornobyl or by some other environmental factor is a secondary issue. What is undisputed and far more relevant is the fact that here in the West, we have the resources, the know-how and financial clout to make a significant difference in the lives of thousands of Ukrainian youngsters and their families.

Chornobyl has opened our eyes to a whole host of other urgent health issues that have little or nothing to do with radiation exposure. It is obvious that Ukraine is facing a major health crisis. It has experienced a net loss of close to 2 million people in the last decade as death rates have outstripped live birth rates at an accelerating pace.

Fourteen years after Chornobyl, we cannot put the nuclear genie back in the bottle. We may not be able to undo the damage that Chornobyl has already done. Yet the Ukrainian diaspora - especially the medical community can have a much greater impact on rebuilding Ukraine's shattered health infrastructure. Clearly, the primary responsibility lies with the Ukrainian government and the Ukrainian people themselves. But we can raise the standard of care by introducing technology, training programs community organizing models that can radically transform the way that health care is administered, financed and sustained.

Contrary to popular myth and contrary to the stubborn fatalism that has crippled many medical aid efforts, the diaspora still does not appreciate how much has been done to save the lives of children - how much more can still be done to improve the health of Ukraine's future generations. In just the past two years we have seen model programs that have reduced infant mortality dramatically in hospitals in Dnipropetrovsk, Lutsk, Poltava and Lviv. We have seen Ukrainian and American doctors work miracles in repairing cardiac defects, cleft palates and facial deformities.

Beyond the treatment of diseases, important strides have been made in disease prevention. According to Dr. Olesya Hulchiy, a leading health researcher and professor of obstetrics at the Kyiv Medical Institute, we are beginning to see the first hopeful signs of changing behavior patterns and effective preventive health programs with significant drops in teenage pregnancy and sharp decreases in abortions.

These are issues that may seem far removed from Chornobyl's aftermath. Yet, in the long run, the tragedy of Chornobyl can be mitigated if it can serve as a catalyst for the radical transformation of Ukraine's health care system. We may not be able to avert the next industrial disaster but, from a public health perspective, we should begin to look objectively at other major health issues that threaten to decimate Ukraine's population.

For example, Ukraine now has the fastest growing rate of HIV infection in Europe. If Ukraine is "lucky," it will lose fewer than 500,000 to 1 million citizens to AIDS over the next 15 years. If more effective preventive measures are not taken, Ukraine could easily experience an epidemic of horrific proportions on par with the public health disaster sweeping Thailand, India and South Africa. This is a crisis that threatens to overshadow the impact of Chornobyl and to overwhelm Ukraine's meager medical resources.

The Ukrainian diaspora can play a critical role in either combating or ignoring the health challenges facing Ukraine. We cannot expect Ukraine to recover economically or to thrive politically if its health care system is left in shambles and its children are left to die without proper medical attention. The Ukrainian community has been extraordinarily generous in supporting the restoration of churches, museums, embassies and historical monuments. In our preoccupation with restoring the past, we cannot afford to turn our backs on Ukraine's future.

We need to show the same kind of commitment to life-saving institutions that can help safeguard the next generation of Ukrainians.

If we make that commitment, the ultimate legacy of Chornobyl could become a strong affirmation of our collective will to live and a triumph of the Ukrainian spirit.

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