Halifax's Camp Hill Medical Centre

[Guest guest]

http://www.chatelaine.com/read/health/air.html

September 27, 2000

Something in the air

Between 1989 and 1993, 800 workers at Halifax's Camp Hill Medical Centre

fell sick because of chemically contaminated air. More than 100 are still

off work--and a fight is raging over the reasons why. Kim Pittaway explores

the modern fears and slippery truths behind the environmental illness debate

First published in Chatelaine's November 1995 issue.

© Kim Pittaway

It's just after 7 p.m. and the third-floor lounge at Dalhousie University is

filling with nurses, occupational therapists and hospital support staff.

They chat about test results and doctors as they take their seats, and if it

weren't for the handful wearing white respiratory masks, the scene could be

mistaken for a staff meeting. But for most of these 26 women, staff meetings

are a thing of the past. This is a weekly meeting of the Camp Hill

Environmental Victims Society (CHEVS), and the illness they are here to

discuss is their own.

Elaine Nepjuk, the group's chairwoman, sits perched on the edge of an

institutional couch, file folders full of letters and government documents

stacked in her lap. Nepjuk is one of over 100 staffers with symptoms of

multiple chemical sensitivities (MCS), a controversial disease characterized

by allergy-like reactions to everyday compounds. A slim athletic-looking

mother of two, Nepjuk is the type of person one suspects might actually use

the running shoes she sports for, well, running. It's a suspicion that fits

her self-description: someone always on the go, into sports and outdoor

recreation, never sick. But Nepjuk hasn't been that way for more than four

years, not since what she and fellow support group members call the

" environmental disaster " at Camp Hill Medical Centre (now the Queen

II Health Sciences Centre).

Others call it Canada's worst example of sick building syndrome. Between

1989 and 1993, an estimated 800 out of 1,100 Camp Hill workers were sick

with symptoms attributed to chemically contaminated air: rashes, eye

irritations, headaches, memory loss, poor concentration, respiratory

illness, digestive disturbances and extreme fatigue. Over 300 were so sick

they went on long-term leave. And while the hospital got a clean bill of

health two years ago, after $2 million worth of repairs, more than 100 of

its staff are still off work.

As a result of her exposure to Camp Hill's bad air, says Nepjuk, the

athletic on-the-go Elaine has been replaced by a woman concerned with her

fragile health. When she goes to church, she sometimes sits alone in the

pastor's office to listen to the service, because a whiff of someone's

perfume is enough to make her dizzy and nauseous. Stopping at the gas

station on the way home, the scent of gasoline leaves her too confused to

park. The only sure way to avoid feeling sick is to avoid the chemicals, but

as Nepjuk says, " you have to live. " And retreating to your home in an

attempt to build a chemical-free bubble--as some victims of MCS have

done--is no way to live.

" This disease is a nightmare, " says Nepjuk. " But if I didn't have it myself,

I admit that I'd be skeptical. "

And some are skeptical. No one, including hospital officials, denies that

Camp Hill made workers ill. But there's plenty of debate about whether

contaminated air could have caused the chronic illness from which Nepjuk and

other members of CHEVS claim to suffer.

Proponents of the MCS diagnosis argue that victims of the disorder--some 80

percent of whom are women--are the canaries in the coal mine, an early

warning to all of us that the chemical soup of modern life is affecting

human health in ways we still don't understand. They point to chemicals

leaching from paints, carpets, caulkings and glues as proof that our very

homes and offices are making us sick.

But skeptics like Halifax physician Dr. Kempton call MCS

" gobbledygook. " And while they go out of their way to avoid words like

" hypochondriac " and " crazy, " they talk of victims who have been manipulated

by biased doctors, and of people drawn into a " belief system " that convinces

them they are chronically ill.

Nepjuk and her colleagues in the support group are more blunt. They see only

two choices: canaries or crazies. " And I am not crazy, " says Nepjuk. " Camp

Hill hospital made me sick. "

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What happened at Camp Hill wasn't the photogenically newsworthy catastrophe

of a chemical spill or a pipeline explosion. Instead, this environmental

disaster lurked in the air.

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It began in the mid-1980s. At the time, the hospital occupied three

buildings: Camp Hill, Abbie Lane and the newly constructed Veterans Memorial

Building. Complaints of rashes and respiratory problems first surfaced at

Abbie Lane but weren't taken seriously. Staff were assured the symptoms were

not work-related. It wasn't until 1989, when a newly appointed occupational

health doctor spotted a pattern of complaints by workers in the basement

kitchen of the Veterans building, that the hospital started looking for a

common cause.

Maintenance staff initially blamed poor air circulation, but adjustments

only made things worse. A team of air-quality experts finally isolated the

culprit: detergent-laden exhaust from the industrial dishwashers was being

sucked back into the kitchen through a nearby fresh-air vent. Instead of

getting clean air, workers were being blasted with sodium hydroxide from the

soap powder.

The vents were rerouted, and officials celebrated the solution with a party

for kitchen workers. But new complaints continued to pop up in both Abbie

Lane and the Veterans building. They had diverse chemical causes-phenols and

formaldehyde in one area, paint fumes in another, automobile exhaust

somewhere else--but all were aggravated by a poorly designed ventilation

system.

To save energy, the system shut down whenever the indoor and outdoor air

temperatures differed by more than 10 degrees--and in Nova Scotia, that's

about six months of the year. As well, staff didn't realize that dampers

automatically sealed room vents when the fire alarm went off. Some rooms

could have been without fresh air for months. Finally, a mysterious

dust-like powder was traced to the building's humidification system;

employees were adding five times the recommended amount of an antirust agent

to combat persistent rust problems.

In the end, it took the hospital four years and more than $2 million to

solve its air-quality problems. Surprisingly, administrators say patients

weren't affected, perhaps because most patient rooms had windows that opened

to the outdoors. Employees weren't so lucky.

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No one disputes that high levels of some chemicals can make you sick. But

many of the chemicals in the air at Camp Hill were present at levels still

considered safe.

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According to studies, even the amines present in the rust-proofing shouldn't

have persisted in the human body for more than 40 days. By that reasoning,

Elaine Nepjuk and her CHEVS colleagues should be back at work. But they're

not.

Nepjuk's symptoms began in 1988 with a rash. " I wasn't really sure what it

was, " she says. But one evening, as she sat writing end-of-shift reports in

the occupational therapy lounge two floors above the kitchen, she noticed

two of her colleagues absentmindedly scratching similar rashes. " That's the

first time I thought that maybe this wasn't just me. " Nepjuk reported her

rash to the hospital's occupational health doctor, and says she was told she

was the first person outside the kitchen to report symptoms.

Over the next year, other symptoms followed. Nepjuk says her contact lenses

became coated with crystals. In the morning, she would wake up so fatigued

she could hardly get out of bed. The rash spread; her hair began falling

out. Adding up a simple row of numbers for her time sheet became impossible,

even with a calculator. " I couldn't hold the numbers in my head long enough

to transfer them from the calculator to my time sheet, " she says.

At first, being off for a weekend was enough to make Nepjuk feel " back to

normal. " Then, it took a week of vacation to alleviate her symptoms.

Finally, she just felt lousy all of the time. Her supervisor tried moving

her to other parts of the hospital, thinking she could escape the source of

her problems. Nepjuk was treating patients in a makeshift setup in a meeting

room when she finally decided she couldn't carry on. She was afraid that in

her fatigue and confusion, she would harm a patient. " I wasn't able to do my

job, " she says.

That was December 1991, about the time that some other affected staffers

decided to set up a support group. It was a group born of the frustration of

dealing with a health-care system that couldn't say why workers were sick,

and had even less insight into how they could get better. Nepjuk joined the

group, and it was there that she heard the terms " environmental illness " and

" multiple chemical sensitivities " for the first time.

Both terms are recent additions to the English language. Like other entries

in the ever-expanding lexicon of modern pathologies, they are sensitive

barometers of modern concerns.

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Sick building syndrome was coined in the late '70s, when indoor air quality

became the " other " air pollution environmentalists told us we should worry

about. Then, skeptics scoffed at the notion of buildings that made people

sick.

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Now, it's largely accepted that workers' complaints of headaches and fatigue

can be a product of two forces: buildings sealed tight in pursuit of energy

efficiency, and air contaminated with a multitude of modern chemicals found

in building materials and office equipment.

Notorious cases like Toronto's Ontario Institute for Studies in Education

(OISE) and Les Terrasses de la Chaudière in Hull, Que., (dubbed 'les

terrasses shoddy air' by workers) have attracted some media attention. But

sick building syndrome remains an elusive problem. There are no hard numbers

to document its incidence. And few owners of sick buildings have been

inclined to admit--let alone publicize--their problems.

The MCS diagnosis is just as slippery. It's easy to dismiss chronic

complaints of headaches, fatigue and nausea as hypochondria. But over the

last decade, some researchers have taken them seriously enough to suggest

that sufferers were victims of a new disease, environmental illness, or MCS.

A new medical specialty--environmental health--has evolved to study and

treat the disorder. But many doctors dismiss the diagnosis, and scoff at

claims that up to 15 percent of the world's population could be chemically

sensitive.

If the medical establishment disputes the notion of MCS, the media and the

public have been more receptive. The syndrome, and other controversial

conditions like it, is a magnet for modern fears. More than one medical

journal has noted that researchers find it all but impossible to question

the legitimacy of MCS when the idea of chemically based illness has such

commonsense appeal. Remember thalidomide, DDT, Love Canal and Agent Orange.

Add Gulf War syndrome, chronic fatigue syndrome and breast-implant toxicity.

These days, it's not much of a stretch to believe that " they " --government,

industry and experts of all stripes--aren't leveling with us.

It's a suspicion that adds to the misery of MCS sufferers and sends them in

search of alternatives. Through the support group, Nepjuk discovered a

part-time environmental health clinic run out of Halifax's General

Hospital. The clinic was started in 1990 by Dr. Gerald Ross, a Nova Scotia

native who trained at the Environmental Health Centre in Dallas, Tex., a

leader in the study and treatment of MCS.

Dr. Ross offered sufferers an explanation for their illness called " total

load theory. "

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Under normal circumstances, the body is able to detoxify itself by flushing

chemical contaminants out of the system. But in people who have developed

chemical sensitivities, the detox mechanism is impaired.

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Then, each exposure to a chemical is like a raindrop falling into a barrel.

Eventually, the barrel fills up, and it only takes a single drop--like the

scent of gasoline--to cause the barrel to overflow, prompting extreme

symptoms in response to apparently minimal exposures. The prescription?

Reduce your total load by trying to take in only clean air, water and food.

And at the same time, try to jump-start your body's natural detoxification

system with nutrient therapies, saunas and other unconventional treatments.

The explanation made sense to Nepjuk and the others in the support group.

But many doctors and researchers deride it as unscientific " gobbledygook. "

From 1987 to 1992, Halifax physician Dr. Kempton chaired a provincial

committee studying growing complaints of environmental illness. He says he

was initially sympathetic to the environmental illness claim, but grew

frustrated with MCS " experts " who refused to test their theories in

controlled scientific settings.

's committee examined the cases of 86 patients who had been diagnosed

with environmental illness, and found physical and psychiatric explanations

for all of their symptoms, including respiratory ailments, allergies and

" somatic disorders " in which emotions are manifested in physical symptoms.

(Because the study was carried out before Camp Hill was recognized as a sick

building, no Camp Hill employees were included in his sample.) " These people

were sick, " Dr. says. " But we found nothing to suggest they were

victims of a new disease. "

Therein lies the problem. While environmental illness fits snugly with our

fears of a poisoned environment, objective evidence to support the MCS

diagnosis is slim. Symptoms are difficult to test for, and diagnosis relies

on patients' self-reporting of headaches, nausea and cognitive problems.

Even when large numbers of people--like the 100 still off work at Camp

Hill--report similar symptoms, critics say there's no conclusive evidence of

a new disease. They blame complaints on a form of mass hysteria, where

sufferers are drawn into an MCS " subculture " that reinforces psychosomatic

symptoms and mislabels and possibly mistreats physical conditions.

Without knowing why MCS sufferers are sick, it's hard to know how to test

and treat them. Dr. Ross's Nova Scotia patients--400 of them now in

treatment, almost 800 on the waiting list--line up for skin tests, vitamin

and mineral treatments, special diets and more. But what helps one patient

won't necessarily help another. Ross says a person's chemical exposure

history and unique biochemical balance might explain the difference.

Skeptics like Dr. remain unconvinced. They're waiting for double-blind

placebo-controlled tests--like the ones new medications must clear--to prove

the treatments work.

Outside Nova Scotia, doctors carrying out treatments similar to those used

by Ross are facing more than skepticism. In Ontario, one doctor must answer

to over 70 charges related to his use of alternative therapies; his case

goes before a disciplinary panel of the College of Physicians and Surgeons

in December. Six Alberta doctors are also reported to be under investigation

by their provincial college.

For Elaine Nepjuk and the other walking wounded from Camp Hill, the

investigations are further proof that the conservative medical establishment

would rather blame them than treat them. So they've turned to clinicians

outside the mainstream who at least take their illness seriously. For

Nepjuk, that's meant a regime of massage and sauna designed to help her body

sweat out the toxins. She says that at first, her sweat was as thick as

mucus and smelled of ammonia and metal. " I knew I was getting rid of

something, " she says. " My skin would burn, like a sunburn, as the chemicals

were coming out. " She switched to organic foods and replaced household and

beauty products with environment-friendly alternatives. And she tried the

controversial immunotherapy and IV treatments offered at the clinic. She

says they've all helped. But four years later, she's still not back to

" normal. "

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It's almost 8 p.m. when Elaine Nepjuk finishes telling the CHEVS members of

a recent meeting with Guy Brown, the new provincial minister of labor, and

Stuewe, the CEO of the Workers' Compensation Board. CHEVS wants the

board to recognize MCS as a workplace-related injury, but they know it's an

uphill battle without proof that low-level exposure to chemicals causes

long-term illness.

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" Recognizing MCS would sink the board financially, and they aren't going to

risk all of the sick workers in the province to help us, " says a woman

through her surgical mask. Recently, members also began a battle with Canada

Pension over disability pensions.

Snorts of derision greet Nepjuk's report that the province, which stepped in

to compensate Camp Hill workers when the WCB cut them off, is paying workers

not out of responsibility but out of pity. " Just because we have cognitive

problems doesn't mean we're stupid, " mutters one woman. " If they keep this

up, we will be crazy by the end of it, " says another.

Laughter fills the room, but it's the jaded black humor of the battle weary,

a mask for the anger and frustration these women feel. They know that some

coworkers see them as malingerers. A colleague who saw Nepjuk out Christmas

shopping reported her to the hospital. " What people don't realize is that

you have to get out, " she says, " even though you know you'll end up sick in

bed later on. "

The question is, is all this fighting harming rather than helping them?

" It's hard to be in a fighting stance and a healing stance at the same

time, " admits Nepjuk. She suspects her health might improve faster if she

weren't fighting, but she says she can't give up the battle. " People say

'Let it go,' but I have no idea if I'm going to be better a year from now or

not. "

Canaries or crazies? It seems like a simple question, but the lines between

psychology and physiology aren't so clearly drawn. Something happened at

Camp Hill Medical Centre. One hundred people don't go off work without

reason. But is the problem one of mind or body? Clinical studies link anger

to heart disease, and depression to a depressed immune system. Is a heart

attack less " real " if anger plays a part? Are the psychological stressors of

modern life-social isolation, fear of the unknown and a sense of

powerlessness-any less toxic than chemicals?

And so the search for answers continues. Next spring, the Nova Scotia

government and the Dalhousie medical school will open a $2-million full-time

environmental illness treatment and research facility--Canada's first--in

Fall River, 20 kilometres outside Halifax. Kempton says it will make

Nova Scotia the laughingstock of the medical community. Elaine Nepjuk calls

it cutting edge.

The only real conclusion? We're still a long way from decoding this canary's

call.