The Stuffy Trial
By Daniel Marrin
One day while on vacation in Santo Domingo, Maria Alvarez’s son got sick with a cough. She went to a local pharmacy and asked for some cough medicine. They offered her antibiotics. Alvarez, a health researcher in New York, said, “I told you my son had a cough, not an infection!” She couldn’t tell if the worker there knew the difference between the two.
That’s a problem Alvarez has seen among New York’s Latinos as well. Now, she’s part of an effort to teach Latinos how to identify, treat and prevent family illnesses.
Alvarez works at The Stuffy Trial, a 2-year program at Columbia Presbyterian School of Nursing. It’s a program funded by the Centers for Disease Control (CDC) testing different methods of household flu prevention. 450 New York Latino households, mostly in Washington Heights, are served by the study. They are divided equally among three researchers, Alvarez one of them. The researchers visit the families once every other month. One researcher brings only educational materials. Another brings education and hand sanitizer. The last brings both of those along with face masks. As they visit the families, all three are finding reasons for both concern and hope.
The Stuffy Trial flu prevention study began in October 2006, under the direction of Dr. Elaine Larson. In a 2003 study, Dr. Larson had found that families were more likely to get the flu from someone else in their household than out in their community, so she designed a study focused on household prevention.
Part of prevention is educating Latino families about the flu, but in doing that, the researchers are finding they have to teach about sickness in general. For one thing, they have to show families the differences between flu and other illnesses.
Stuffy Researcher Maria Gonzalez said the Latinos she’s met generally don’t distinguish between a cold and flu. “Here, everything is ‘gripe’,” a Spanish word for flu. While the symptoms of a cold and flu are similar, flu can be far more serious, resulting in pneumonia and hospitalization. The CDC reports that 36,000 people die every year in this country from flu-related illness.
Despite that, Stuffy researcher Angela Barrett said, “People in general, but especially Latinos, tend to underestimate the seriousness of the flu.” That’s where their efforts can make a difference.
Maria Alvarez, 40, is the educator, offering flyers and advice to families. One thing she brings is a packet showing medications people should and shouldn’t take for flus. The antibiotics section is covered with a big red circle and a slash. Alvarez said that families are quick to take antibiotics for flus, and such drugs are easy to get at local bodegas without a doctor’s prescription. This is illegal, but it’s very common among the Latino immigrant community.
Alvarez teaches all her families that antibiotics are ineffective against the flu. Antibiotics are for bacterial infections: the flu is a virus. Antibiotics make people feel better for taking action, especially parents with sick children. However, the flu is healed best through rest and over-the-counter drugs for symptoms.
Alvarez’s first visit one Friday was to a Mexican immigrant family of eight or nine living in a one-bedroom apartment. Three children, their mother and father were living there, along with the father’s relatives. The living room is half occupied by a bunk bed.
Alvarez sat down on a low couch next to the mom and her three children, all toddlers. She read a flyer about sinusitis to the mom. Alvarez is never sure whether the families are literate and is hesitant to ask. Instead, she just spoke slowly and looked her in the eye to see if she got it. The mom nodded. She said she’d been practicing what Alvarez had taught about cough etiquette, coughing into her forearm now rather than her hands to prevent her germs from spreading. Alvarez smiled at this, left them the materials and moved on.
Researcher Maria Gonzalez brings both education and hand sanitizer to her families. Gonzalez is more frustrated with her families. She remembered coming into a house and finding a sick mom lying in bed with her children next to her. “Great!” Gonzalez thought to herself. “Go ahead and infect everybody!”
Even though she can give the families hand sanitizer, she said the products only do so much without education. “If you use Purell and then sneeze or cough into the air, what does the Purell matter?” To illustrate her point, she carries a black and white photo of a man sneezing into the air, showing all the germ particles he spreads.
One Friday she visited Clara, a mother of seven children, all living with her in the apartment. Clara said she was applying what Maria had taught her. She’s been using the hand sanitizer, and the only antibiotics in the house now were for her son’s ear infection.
Despite some improvement, Gonzalez was pessimistic about what will happen after the two years of the study are over. “They only give us 10 percent of their attention,” she said. Many of the families, she said, are involved because the hospital provides a little money, $40, for their efforts along with the products. Maria said, “We’re not a priority in their lives.”
Angela Barrett, the last researcher, agreed. “Many people are only in it for the money and the products. You have to talk slowly, patiently, and look them straight in the eye to make sure they’re taking in what you’re saying.”
Barrett handles the last group, giving education, hand sanitizer and face masks to her families. In some cases her efforts are paying off. One Friday, she visited a Peruvian mother of three living in a public housing high-rise with a view to the George Washington Bridge. Eva, the mother, reported that the family was adapting well to the hand sanitizer and the masks, even enjoying it.
When her son, 11, had started coughing one night, Eva immediately brought out the face masks, as Barrett had taught her. Eva’s little girls, 2 and 6, asked if they could wear the masks too. They thought the face masks were some kind of a game.
The hand sanitizer was also a hit. The kids all called it “la crema,” “the cream,” and all three asked their mom to give them bottles to bring to school. A large bottle of Purell sat above their big screen TV.
Barrett told Eva that if anyone in the family begins having a cough, that person should wear the mask for seven days. She also said, “You can be carrying a virus and pass it on even before you begin showing symptoms.”
“Like I’m incubating?” Eva asked.
“Exactly,” Barrett said, and she smiled. Eva was learning the lingo.