Stop & Talk

Singer 0:00
Stop talk to me.

Crystal Page 0:11
Hello, Grant.

Grant Oliphant 0:11
Hey, Crystal,

Crystal Page 0:12
how are you today?

Grant Oliphant 0:13
I am good. I am you and I are about to share an interview that I thought was amazing. It's part of our special series on the sewage crisis in the Tijuana River Valley. I think these interviews are going to be really helpful for people in San Diego or anywhere in the country who want to know about this environmental health problem and what the dynamics of dealing with it are like,

Crystal Page 0:42
Right.

Crystal Page 0:43
And just for anyone who's not familiar with this issue, we want them to understand the Prebys Foundation cares about well-being in all of our communities. And this has impacted the region for about four decades.

Grant Oliphant 0:56
Yeah, exactly. I mean, if not longer. And the, you know, the our we got into it through our focus on community, well-being and health. And we saw that this was an acute public health problem and a chronic one. And we also got into it because of the vulnerable populations who are being affected by this. And there's just, you know, we see young people being hurt. We see people in various communities being hurt, and it's time to fix this problem.

Crystal Page 1:27
Yeah,and I felt like the interview that we're about to share, you had some really great questions, but these are two incredibly powerful women who shared their story. So would you tell us a bit about our guests?

Grant Oliphant 1:38
So many ofthe people in our series are powerful women who are doing extraordinary work. You know, we're going to be talking with Dr Mona Hanna, who kind of wrote the book on dealing with an environmental public health challenge during the water crisis in Flint, Michigan. We spoke already with a group of community advocates who are going to be part of this series. Today, we spoke with pediatricians, because the people on the ground who are seeing firsthand what some of the effects of this crisis are, are pediatric pediatricians treating kids. It's sad that we have to say that, but we heard from two women today who really have been looking at this issue and have had the courage to speak out about what they've seen.

Crystal Page 2:31
Yeah, and I think you know, we can deny certain bits of info, but these, these doctors, when you jump into it with them, they are noticing trends, and it seems like the most appropriate thing to do would be to ask our public health agencies to really take those seriously and look at those trends so that we can address this sooner rather than later, right?

Grant Oliphant 2:53
And we'll hear from them how that goes. I think, you know, we might as well dive in. We're going to be speaking with Dr Kim Dickson and Dr Vi Nguyen, both pediatricians working with the community, with a lot of history in the community, and I think their medical expertise is so important in this story. And again, the population that they're working with is children and their parents, and they very clearly know what they're seeing and know what they're talking about and and you will see that in the interview,

Crystal Page 3:32
yeah. So let's dive in.

Grant Oliphant 3:34
Let's do it.

Grant Oliphant 3:38
So Dr Nguyen and Dr Dickson, thanks so much for being here. It is a real pleasure to get to talk to you. We're going to be talking about the pollution crisis in the Tijuana River Valley and its public health effects. And this story would not be complete if we weren't interviewing doctors on the ground who, in many ways, for me, have been heroes in this story, and I want to thank you for the role that you're playing, which is not always easy, and we're going to get into that, but I want to start by asking you first about how you came to be doing this work in the first place. You know what your journey to to to being in this position has been so Dr. Nguyen, why don't we start with you?

Dr. Vi Nguyen 4:27
Oh hi. My name is Vi Nguyen. And I'm so happy to be here and so grateful. So I'm a pediatrician. I do some advocacy work through the American Academy of Pediatrics on environmental health, but I actually from the South Bay and work at Otay Mesa, that's my clinic, and where I grew up. And so I really found out about it because of Dr Dickson and Dr Anne Marie Bucha Garcia, who's on the Air Pollution Control District board. And so I she let me know about the concerns about the hydrogen sulfide gas. And then kind of it just, I. Everything clicked for me, like I had been worked in always in the South Bay, and then I had noticed definitely lots of more low bar pneumonias, you know, ear infections, asthma attacks amongst my patients. And so that's how I became aware of it, and then kind of started looking just into my own patients more, and asking around to the other nine pediatricians in our clinic, and we definitely saw a trend of things happening on our patients who live around the area

Grant Oliphant 5:26
and Dr. Dickson. How about for you?

Dr. Kimberly Dickson 5:28
It's a similar story. Everything clicked all at once. I agree with that. It was August of 2023 and my husband and I were signing charts. My husband and I have a clinic together, which is urgent care. It's right in the middle of Imperial Beach, right near Nestor, near San Ysidro and IB, and we were signing charts, and we noticed that there was an extremely high amount of patients with diarrhea diagnoses. And this was at the same time we had Tropical Storm Hillary. And we also had a spill at the Hollister pumping station, Hollister broke down, and it pumped 20,000 gallons of raw sewage onto the streets. And we didn't really put two and two together until we started signing charts. And so many patients were having diarrhea, symptomatic diarrhea. We said, Something's going on. Normally, we'd see a handful a week, but we were seeing such a high number. We said, We need to look into this is there, you know, is this related to the storm? Is it related to the failure of the plant? And that same week, we also had the boil water advisory, so patients were getting sick, we saw an increase in numbers, and that was kind of our aha moment. That's when it clicked for us. And we live in the community too. We live about a mile away from our clinic. We live in IB and so it was personal. It's personal for us, and that's why we we were involved, yeah,

Grant Oliphant 6:47
and, and it's helpful to know that, can you share with us a little bit, both of you, if you would, a little bit about why it is hard to to pinpoint an environmental factor that is driving the sort of dynamic that you're describing. You know, I'm I'm thinking that in conversation with advocates in the community, we, we all marvel about the fact that it's a well known, decades long, 100 year old understanding that living next to an open sewer is not a good idea for health. And yet, the dynamics of how that translates into public health on the ground where you all are diagnosing patients and living is more difficult. It's not it's not as obvious. So why? Why was it difficult to for the or why did it take a while for that light bulb to go off?

Dr. Kimberly Dickson 7:45
Right.Well, I think a lot of patients maybe weren't seeking care. They had symptomatic diarrhea, and they were toughing it out. We have a marginalized community down by the border. They needed a voice. They maybe would seek care across the border, or they wouldn't seek care at all, or we would see a few in our urgent care the community clinics may see a few, and so the patients were scattered about, but the patients weren't ending up in the emergency room, and the health department has a system in place where they look at chief complaints of patients coming to emergency rooms, and the chief complaints weren't triggering an alarm for the health department, and so it kind of,

Grant Oliphant 8:23
and usually, you would expect the health department to sort of be the front line for raising that alarm bell. Is that right?

Dr. Kimberly Dickson 8:23
You would, you would expect it. And let me give you an example. For instance, we had a community member who went to the emergency room with the chief complaint of fever. He and that's not an alarm that they're looking for. The Health Department's not looking for the chief complaints of fever. They they would be tracking diarrhea cases, let's say, to see if it's associated with the sewage. He went with fever. He did a hospitalized with an abscess in his lung, and in the ICU, it was never attributed to the sewage, and the health department didn't pick up on that case, because they're watching chief complaints that didn't get associated with his illness that was sewage related. So it's going under the radar and it's not being picked up.

Dr. Vi Nguyen 9:13
Yeah, I think it's interesting, because, you know, I'm talking to my friend, Dr Garcia yesterday, because we're speaking at UCSD, and then I was telling her, like, I we grew up there. How do we not know? Like, I was grew up in Bonita? I mean, it's, it's not close to the beach, so maybe that's why. And then I think that now, because I do a lot of environmental health legislative work, and you think about we just got lead out of aviation fuel. I mean, everyone knows lead is bad, right? So there's and what I realized kind of working, and now the world knows, is that there's layers of layers of pollution and and just heaviness that this community has a deal with.

Dr. Vi Nguyen 9:53
And so it, yeah, it makes me upset, because it's not fair, you know, like, you know, the lead. The Solid Waste now the Tijuana sewage crisis, you think about the environmental pollution of years of industrialization, it affects the same kids the same communities. And honestly, my patients don't complain. They blame themselves when their asthma gets bad. And we're, you're, we're, you know, thinking about giving them steroids in clinic and nebbing them. It's often that you blame the patient, and it's a new thing to say, it's not your fault. The pollution is not your fault. You did not create the Tijuana sewage crisis. And so just to be able to be here, to be able to tell you, this makes me like, lifts the burden off me a little bit, and for the patients be able to tell us in clinic, gosh, maybe it's something else. Maybe it's not my fault. I think is so it's so powerful, and empowering to them, you know, and to for them to be able to tell us in clinic that this is where I live. I live near there. I smell this. Dr Nguyen, maybe that's it. Maybe because I didn't get the air purifier in time. You know, I have stories too, that it's horrible, like a grandmother died during the heat of the heat wave during the hydrogen sulfide peaks and gas of COPD because they didn't get an air purifier on time. I don't know what's causative. I'm sure it wasn't good and so, but when I talked to them, I said, Do you want me to call public health about and it's like, Oh, no. Dr Nguyen, you know it happened, and I just It breaks my heart, you know?

Grant Oliphant 11:26
We have heard that a lot, and we've observed it as well, that there is a that that this community is quiet and reserved in in vocalizing its concerns and needs. What do patients say to you when you tell them, hey, this is or maybe environment related.

Dr. Kimberly Dickson 11:46
Sometimes they tell us, they come in and they say, I've been having consistent headaches. It's worse because of the smell outside. Now we know about the hydrogen sulfide, and they say, I think the sewage is making me sick. So when the researchers was it back in September, when they came out with the hydrogen sulfide levels that were extraordinarily high. We all had been smelling it for months, right? We just didn't know what it was. So they were able to help us figure out it's hydrogen sulfide. And now the patients have the power they know. They say, Okay, this is what's causing my headache. And they can come to us and they say, I'm sick because of the sewage, whereas before they didn't know. So the education and the information has given them power.

Grant Oliphant 12:26
Dr. Nguyen?

Dr. Vi Nguyen 12:28
yeah, it's, I know it's, I tend to get a lot emotional these days.

Dr. Vi Nguyen 12:33
You know, these, this community has been there for generations. They're not going anywhere. These are not folks that just moved in. You know, the smell is bad, they can go, they won't leave their community. And it's, it's right, because this is their home. And you know, the what brings me to tears is they thank me. You know, they're the ones who living through the pollution. They're the ones who kids are upping all their medications, and they see us on the news. They see dr Dickson being an advocate for for so long on this, and rather than blaming, you know, they do, you know, want to raise their voice, but they thank me, and I just think to myself, like, what have I done? Like I have regrets, right? Like I did I know, like, I wish I had spoken up long time ago, but I don't think the world knew. And I think that it's one of those things when you start seeing you can't unsee it, and I hope the world doesn't unsee it, because it's not going away, and it's not fair.

Dr. Kimberly Dickson 13:27
Rigt? And they don't have the opportunity to escape it either. So these kids who live down in Nestor that maybe they go to Barry elementary school, and we have the monitors down by Barry elementary school, so they're exposed to hydrogen sulfide during the day, and then they go home and they're in their community, and they're exposed to hydrogen sulfide during hydrogen sulfide during the evening, and they don't have the ability to go anywhere else, right? And so the Air Pollution Control District will say, hey, the levels are high. Stay inside. We don't want our kids staying inside. We want them outside playing, right? And so they're really getting a raw deal by this, and it frustrates me that we're not able to protect them any further. We can speak up, but we can't protect them, and we that onus is really on our politicians to make these changes to protect these kids.

Grant Oliphant 14:12
So I want to, I want to follow up on the on the decision to speak up, because that's not typical for people in your profession to have to face that choice and and I think it is telling that you become emotional in talking about it. I think that's part of the equation, or the answer to my question. But my question is, what is it that made you decide to speak up in the first place? Because in the in the long and sordid history of environmental health issues in the United States, the rewards for speaking up aren't great. So can we? Can we? Yeah, so, so talk to us about about why you did this.

Dr. Kimberly Dickson 15:00
It's my community. These are all my kids. These are my neighbors. This is where I live. This is my community, and they deserve better. And it was a risk speaking up. We own our business, right? I was worried about retaliation against our business. How would other business owners in the area? How would they accept what we were saying, right? Is this going to affect their business? Will it affect the prices of homes? How will this affect the government locally, and how we're viewed? I mean, there's so many layers to this onion, but it's the right thing to do, and we tell our kids to do it right. We want our kids to be able to speak up too and have a voice.

Grant Oliphant 15:38
Did you foresee the backlash at all

Dr. Kimberly Dickson 15:42
initially, No, we just, we went in very naive, thinking we were doing the right thing. We're speaking up, right? But then it came slowly, and we realized it. I've had a lot of support from the task force members, though, from Mayor Aguirre, researchers, they've all been very supportive of of us speaking up.

Grant Oliphant 16:01
Yeah, and I know one of the people you've spoken with is Dr Mona, who has kind of written the book on on this. Has it been reassuring to hear from others about this?

Dr. Kimberly Dickson 16:13
right? And when we spoke to her, she said, this is, this is the usual journey. This is the playbook that they have. Yeah.

Grant Oliphant 16:21
I mentioned her because we're going to be speaking with her as well as part of this series. And I think that perspective is really important. Dr Nguyen, what about for you? Why? Why did you What precipitated the decision to speak up?

Dr. Vi Nguyen 16:36
I had to thank Kim, because I had seen, I had heard about, you know, the medical community here is very small. We're very connected. We all know each other. So I had kind of heard about things, because I do a lot of heat work and climate change work, and about what had been going on from friends. And so it was kind of in my radar. I was like, Oh, that's my neighborhood. And like, I wonder what's going on, you know. And then it really was, you know, having hearing you speak up, and seeing how brave you were really made me realize, like, I need to do my part. And it's really my friend, Anne Marie, like we she's on the Air Pollution Control District. She kind of knew about this, and we worked together in clinic. We had been clinic buddies for seven years. We resuscitated patients together. And you know, when there's a code you you go help your friends. And so for me, like honestly, I there is no playbook for this in the sense of, I wasn't sure. Now, the American Academy of Pediatrics was very supportive, and where I work has been very supportive of me just speaking up, but I wasn't sure. And I just, you know, I can write a letter. So I wrote a letter, kind of just put my thoughts and just sent it to my friends, saying, hey, any of you guys who have you seen the same thing, let me know. And the outpouring of like, community and support and agreement was just overwhelming. And so for me that having that letter and knowing that I need to speak on behalf of all 25 of us, which includes NICU doctors, developmental pediatricians and everyone speaking from the heart, and that's all we can do, right? And so it's just like with kids. You we have this thing called aces and pediatrics where, you know, kids have gone through hard things like divorce, abuse, discrimination, and we need to recognize what they've gone through. And so for me, reading that letter and going on the news when I was asked to was really about acknowledging what the kids had told me in clinic. Because, you know, kids don't, you know, kids can't vote, and everyone is all about kids, but honestly, kids get the short stick and everything. And so if I don't speak up for the kids, who's gonna speak up? I'm the pediatrician, and so, you know. And I tell people like, you know, we might be, we might take care of little people. We're not little internists, like, we were very passive aggressive. So, you know, you know, I'll fight. I'll fight for my kids. Yeah, so, yeah. And then, and then the day, like, you know, repercussions, yeah, I'm scared too, because I work in a big place. I wasn't sure what was going to happen, but the overwhelming support from my organization was wonderful, government relations, the media people say, go, go. You know, just go, speak, take, speak your truth.

Grant Oliphant 19:06
I don't mean to put you on the spot, but what criticism most surprised you would you say?

Dr. Vi Nguyen 19:13
You know, honestly, for me, I didn't, I think, because I came after Kim. I mean, you guys were out in front and and speaking up. I really didn't get any criticism, I think because for me, I have, I have been out and doing advocacy for a while, I have a little bit of sway in this community and so and people know I won't, I won't be quiet about stuff. So, you know, and what? What can you one do? I'm just telling the truth, right? So it's not like I'm I don't know. I don't know what the answer is. I just know I need to tell people what's happening with my patients.

Grant Oliphant 19:45
What about for you?

Dr. Kimberly Dickson 19:46
I think most surprising for me is I had a very naive perception of what would happen. I thought the EPA, the CDC, the county health department, politicians were going to sweep in and say, hey, people are getting sick. We need to jump on this. Right? It away. That didn't happen, right, right? So I had a very naive perception that was, that was my biggest surprise. And I will tell you, I've had other doctors contact me from other big medical institutions, and they say, Hey, we're seeing this too. When we try to speak up, we're not allowed to that surprised me, yeah, too. How would you not allow a physician to speak up and do the right thing? And that's part of our oath, right?

Grant Oliphant 20:27
But they were telling you, they were seeing it as well.

Dr. Kimberly Dickson 20:29
Oh yeah, they were telling me, and I said to him, I said, well, the health department's looking and they said they're missing it. The Health Department's missing it. We know they're missing it. It's out there. I mean, it's no surprise. The sewage makes people sick, right, right? You just have to want to find it. And it's difficult to find too, because I think the health department's normally looking at one restaurant that has contaminated oysters, that's causing illness, right? That you can track that down point A to point B. This is a river of sewage and toxic waste. It's very hard to track it down. This is an overwhelming job, so I think that's part of the problem.

Grant Oliphant 21:05
Yeah, do you? Well, let me, let me ask this question. I think when early on, when you were getting some of the critical backlash, particularly you and your husband, and your clinic. The the criticism that was coming at you from some pretty powerful quarters, including the health department, was, well, they're exaggerating this. They're they just run a small clinic. They don't know what they're talking about. Did that surprise you, and how did you, how did you weather that? Because that's a real leadership moment for anybody/

Dr. Kimberly Dickson 21:48
Right, right? And it's hard not to take it personally. But when you know you're doing the right thing, you're on the right side of history, right? And I actually was at a meeting with some political politicians and the health department and such, and that's what I said to them. I said, we need to all be on the right side of history. We know people are getting sick. It's no surprise. Sue which causes illness. We've known this for hundreds of years. We need to do the right thing, and that's what I'm doing. And I would suggest you're on the right side of history as well.

Grant Oliphant 22:04
And do you think that message has resonated?

Dr. Kimberly Dickson 22:27
I've seen some change. I don't think it's because of the message. I think there's political will that's made the message that's made it change. I mean, I'm just a little guy here, right?

Dr. Vi Nguyen 22:38
I think for me, it's like, I'm so, you know, I think, for physicians and I only care what my patients think about me. I only care what the toddlers think. I mean, their opinion is really important. When the toddler thinks my outfit's cute, that's true, right? And I'm, I'm, honestly, I'm like, I have to work every day this holiday season, and it's not my job to fix the sewage crisis. Like, I'm busy. I'm working. I'm like, doing all this stuff, right? And so I think that knowing how much I do, and physicians, do you know those people are supposed to do this is their job. You're supposed to make my job easier, because I got other stuff to do too. So I think that really just, like, for me, like, what happens if, what are they going to do to me, not make me go to work? Then I don't say call, yeah, you do my job, you know. So for me, I don't know. Maybe it's just like my you know. I think a lot of physicians we, you know, we're just so, you know, we're like, we do a lot for the community. I think that we did. I don't think we I realized that how important physician voices are because, after realizing how much the community had spoken up, or is speaking up, and people aren't listening, you know? I mean, you know, when I when someone like, literally, 11 abscesses, you know? And I, I like we were going over the number of multilobar pneumonias we were seeing during the height that were being sent to Rady's, third round of antibiotics. I mean, this was not normal during the summer. And then when you finally mentioned the patient, oh, it could have, you know, that correlated. And then it's like, people are like, oh, yeah, yeah, you know, the community,

Grant Oliphant 24:15
they drew the connection.

Dr. Kimberly Dickson 24:16
Yeah, right. And this has happened before, in Carson, California, I want to say, in 2020 or 2021 they had elevated hydrogen sulfide due to a it was an industrial fire killed off the vegetation, and as the vegetation was rotting, hydrogen sulfide was elevated, and they had hospitalizations due to pneumonias from the hydrogen sulfide, so much so that we knew we they were able to put the dots together, connected the dots, and they knew the cause and effect, right? Same thing's happening down in Imperial Beach, down in Nestor at Hollister and Saturn. We know the hydrogen levels are high. We're seeing patients with lung problems, right? This isn't something new. We're not recreating the wheel. I would expect the health department to have that knowledge and be able to act on it. And back back in London in the 1800s they had the big stink, which was the elevated hydrogen sulfide was in the river. It was the sewage open sewage problem. Soon sewage problem, right? Nothing changed until the smell made it to Parliament. When it started causing parliament to be uncomfortable, they fixed the problem. Right? The more we speak up, the more uncomfortable we're making people. Maybe we can cause some change. That's why we're speaking up,

Grant Oliphant 25:32
yeah, and that's why I refer to you as heroes in this story, aside from the role that you're playing for the kids, a lot of people may not appreciate this, other than they hear that it smells, they hear their odors, they hear some diarrhea issues, but you're seeing a range of issues, and you're also beginning to test for a range of issues. So would you talk a little bit more specifically about what you're seeing and and how you're beginning to look for it, how it's changed what you're looking for?

Dr. Kimberly Dickson 26:04
Oh it's definitely changed what we're looking for. Initially, we were seeing patients with diarrhea, and we thought it was associated with the sewage, but we didn't have a way to test for it. How do we know what's the cause and effect? That's the same dilemma that the health department has. We started doing PCR testing on their Peri rectal swab so we could pick up what, what pathogen is causing the diarrhea. And we started noticing some trends. Norovirus was one of our trends, E coli, some of the trends. And we give all that data just from our clinic alone to the Health Department. Here's the issue, though, none of those are reportable illness. Health Department tracks reportable illness, so

Grant Oliphant 26:07
why do you think it's not reportable?

Dr. Kimberly Dickson 26:43
The health department doesn't, doesn't count it as reportable. There are certain strains of E coli that are reportable. Those are the strains that will make you very sick you end up in the hospital. The other strains are not reportable, and most of these, most of the symptoms resolve on their own. And so nobody's, nobody's following it. I had E Coli from going to the beach in Coronado, and I picked it up. My husband picked up and our dog was symptomatic. He ended up with with diarrhea, right? We tested. We knew it was E coli. It was not a reportable E coli. It was related to the sewage, but it didn't count, right? Frustrating.

Grant Oliphant 27:26
It may be causing widespread misery, but nobody is paying attention.

Dr. Kimberly Dickson 27:30
Nobody's paying attention.

Grant Oliphant 27:32
Dr. Nguyen?

Dr. Vi Nguyen 27:32
I've been doing asthma quality work for 15 years, so my job every month is I get a list of all, the high risk asthmatics in our region. And then each doctor calls for their clinic. And so it's just something I do every month. And I definitely noticed that this summer was the worst numbers we had for the our our two clinics in the South Bay that take care of that catchment area. And so, like, just asthma numbers that you know, that's you know, think about the burden of disease that causes in healthcare costs and to the patients. And something I just want to put out there that I'm very worried about is that we know more now that air pollution, PM, 2.5 volatile organic compounds, and these things aren't noxious, right? They definitely increase the risk of developmental delay. So I have lots of babies. I'm a pediatrician. They come and see me for their well child checks, and I'm worried. I don't know what's happening to those brains, those developing babies that are being, you know, every as every heat wave comes, or every time the you know, there's a failure in the system, and they're breathing this noxious gas. I mean, they're ending up in the emergency room getting conjunctivitis, but what about their long term development? And so it's interesting, if you talk to the patients who live in the community, the teachers who are from the area, they're like, Yeah, doctor, we have lots of autism referrals those those schools, so I have to tell you that, yeah, as a pediatrician, I'm just not worried about the short term health effects, but I'm worried about development. I'm worried about early puberty. There's stuff in that water. I mean, there's drug metabolites, there's heavy metals, you know. So, you know, people are always worried about, should I vaccinate or not? I'm like, don't worry about the vaccines. Those are safe. Worry about the water, you know. Worry about all the stuff that you know. You want to talk about heavy metals, right? It's in the water.

Dr. Kimberly Dickson 27:38
Right, and a lot of those chemicals that are coming from the industries down in the Tijuana on the Tijuana Valley on the other side of the border, they're banned chemicals here in United States, so they're used on that side of the border. They're jumped in the river, and then they come to our community, right? And we're ignoring it. I mean, it's the elephant in the room. We're ignoring it. And I don't think-

Grant Oliphant 29:39
So these are quite literally poisons. We would refer to them as poisons in this country. And we wouldn't allow them in the waterway, but they are coming into our our waterway and our community

Dr. Kimberly Dickson 29:51
And they're exposing our community, our kids, and in the industry that's over on the other side of the border, there's. No accountability for it. They're dumping it in and and we don't know the long term effects beyond children. What about our leukemia, our Parkinson's, our dementia rates? Are we going to look back in 20, 30, years and go Oh, okay, now it makes sense, right? But that's that's too late. We need something done now.

Grant Oliphant 30:18
To people who have thought up to this point, hey, this is, I get it that it's a water born problem, and E coli sounds bad, but now you're raising the prospect of serious chronic ailments. You're you're talking about asthma, which means you're talking about an airborne problem and awareness is growing about what may be airborne as a result of the water problem. Can you help people understand a little bit more about what we're beginning to suspect are the range of of possible effects from this and how it happens?

Dr. Kimberly Dickson 31:00
Right, so the researchers look, are looking at aerosolization, whether it's pathogens, chemicals, it's in the air, right? And we can ingest it. And that's what makes it so hard for the health department to trace these. It's, it's everywhere we live. We live it, right? I live down in Imperial Beach, very close to the ocean. And I will tell you when the trans boundary flow the sewage and industrial waste coming over the river. And we follow those numbers on a daily basis. When the trans boundary flow is very high, my car gets covered in schmut, and that's all aerosolized chemicals, toxins, bacteria, viruses, from the sewage, right? And we're breathing that in, and our kids are playing on the playgrounds at schools very close to there and touching it. It's everywhere in our environment.

Dr. Vi Nguyen 31:52
And so, yeah, I'm here speaking on behalf of myself as an individual pediatrician, I'm allowed to say that I work at Kaiser, and we and I've been the My Institution has been very supportive, and so I think that what we have to do is I ask these questions, like, I am lucky to be in a big organization that has lots of resources, and so I don't know what the answer is. I don't know. I don't think anyone knows, because no one's ever had the situation specifically, but I'm definitely asking. I'm asking our leadership, which has been very supportive of me, asking questions. I'm now asking, you know, talking to county of public health about my concerns on behalf of our clinic, talking to our research department in Pasadena, and I'm saying, Yeah, I'm worried about asthma. I'm worried about these things. How can you help? So I think the help is coming, but I just think that we're doing what we need to do, but no one person or a couple of pediatricians and family practice and urgent care doctors can't solve this, but, but certainly, yeah, if making noise means asking research questions, yeah, we'll do it. And I was very do want to mention that UCSD, the undergraduate, has been very supportive, and they're a couple students are going to be working with us now, and going to get, like, course credit for doing some stuff like this. But it's kind of, you know, kind of sad, right? Because it's like, we're not, we don't have resources. There's these students doing it on their free time for course credit, you know, I'm sitting there between clinic, trying to make these calls, and it there's like, it's kind of, yeah, we need more people.

Dr. Kimberly Dickson 33:24
We're doing it because it's the right thing to do. And it's little, little things too. I know we were recently talking about getting signs posted on Hollister and Saturn, something so simple, posting signs saying, this is sewage contaminated mud, so you don't drive through so you have to drive over the bridge to make it to their schools, to go to Barry Elementary, Nestor Elementary. And when you drive over that bridge, there's mud, and everybody thinks it's mud. Well, it's not. It's because the Hollister pump spews out sewage, so it's, it's raw sewage on the ground, right? And so we're trying to ask the city, where you post a signs there so people know that they're being exposed and contaminated mud. And it's been a year, I've been trying to get a sign for a year. It's so simple. I'm like, give me the sign. I'll go put it up myself.

Grant Oliphant 34:14
And do you think it's because it's bad optics to acknowledge that that's sewage?

Dr. Kimberly Dickson 34:19
No, I think it's probably political, because they acknowledge, further downstream at the ocean, they post the yellow sign saying it's contaminated, but upstream it's right by the Federal plant. Federal plant, it's city owned property, and then there's county property, and then there's state property, and it's a lot of finger pointing going on. And in the meantime, when they do have the big spill at Hollister, they spilled 20,000 gallons in August of 23 and shortly after that, they spilled over 100,000 gallons of raw sewage onto the street that people are driving through to take their kids to school, right? EPA didn't sweep in and say, Hey, we need to clean this up. Yeah, nothing happened. They cleaned it up with a vacuum.

Grant Oliphant 35:03
Everybody takes that home with them, and their kids have it in their clothes, and it's everywhere.

Dr. Kimberly Dickson 35:08
It's everywhere. And it would be simple to post a sign out front, but we can't even get a sign. It's, you know, everything.

Grant Oliphant 35:15
Well that's in a way, a perfect illustration of the challenges that I mean something as basic as that. I loved your example of the big stink in London and the fact that nothing happened until it began to affect parliament. That's not going to happen here, because, you know, we're as far away from Washington, DC as you can get, and as far away from Sacramento as you can get in the state. And you know, there it's, it's, it's a border town with a complicated structure that you just perfectly mapped out. So how if absent, absent, getting parliament to pay attention. How can we how are you thinking through your advocacy efforts, you can maybe force a recalculation around this.

Dr. Kimberly Dickson 36:07
Right, we need the political will. So how do we force that political will? You know, part of the task force, we have politicians working on it.

Grant Oliphant 36:20
Scott Peters has been very good on this issue. Are there others that you think have been really helpful?

Dr. Kimberly Dickson 36:26
Mayor Aguirre has been a superhero. I mean, she has taken on some big people because it's the right thing to do, right? You know, really the political will and then holding accountable the industry on the other side of the border because of that industrial growth, they have had the population growth, and they don't have the infrastructure in place for the sewage or for the wastewater that's contaminated by all the chemicals, if somehow we could hold them accountable. I don't think people here in the United States know that when they buy a product that was manufactured over there that they are contributing to making our patients ill, right? If we could get the word out, if you're buying those products that are manufactured on the other side of the border and they're dumping their industrial waste and their sewage into our community, we can hold them accountable. There's nothing holding them accountable for it. So they're not going to stop. And even when they do fix our plant, the industrial waste and sewage is just going to go six miles south. It's still going into the ocean. It's still making people sick. It's just the people are on the other side of the border. It shouldn't be allowed anywhere.

Grant Oliphant 37:39
Dr Ngyuen, what about for you?

Dr. Vi Nguyen 37:41
What I would say is, I'm not going away. I'm here. Yeah, I'm gonna keep on showing up. You know, this is not exactly like this is those kids I will be seeing them for their life, you know, their developmental issues, their lungs, those are my responsibility. And so, yeah, keep on showing up students, you know, and those, those kids grow up, and guess what? They go to University near town, and they'll keep on showing up. And so I think it's, you know, we're not going away with where voters. And that's the one thing you we don't we don't go away, we don't shut up.

Grant Oliphant 38:19
One thing I do want to draw out is that part of the beauty of our region is that it is a border town, and is that we do have these two countries butting up against each other and working alongside each other. And I think there's something beautiful about this super region that gets lost because of issues like this, and gets lost in the current political environment. And that's that's beyond all of us. But I think at the same time, we can embrace the notion that there's blame on both sides of the border in terms of of encouraging a fix. And, you know, Mexico, I think, quite rightly, can point the finger at the US side for not having done everything we can. And, of course, the US side can point the finger at Mexico for not having done everything that they can. Are you talking to pediatricians or doctors on the other side of the border has there? Has there been a meeting of the minds of medical professionals at all?

Dr. Kimberly Dickson 39:26
I haven't. I mean, it's as part of the task force. There are certain entities that have, they're on both sides of the border, and they are working. I think Paula Granados has contacts on the other side of the border. Do you know more about it?

Dr. Vi Nguyen 39:40
Yeah, I mean, I think we're just starting to realize that, you know, with when you get lemons, you make lemonade, right? And I you know, for for we have a lot of students, and families are binational. They have lots of connections. And I know that there was someone just telling me that there was a documentary one of the medical schools did on the other side. And so I think there's a lot of opportunity for cross border collaboration. Lot of the students who are starting to work on this now, from UCSD Medical School and the undergraduate actually have those connections. So we're you, we're we're trying, we're building it now. And I think that that's a very exciting thing. And I agree with you that San Diego, that's the I mean, that's beautiful thing about our region. We are the most bio diverse region in County, in the in the country. And so I had heard about this because I work a lot with the Autobon. And so this affects the birds as well in our wildlife. And so I think that, you know, I have hope. I mean, I think as hopefully, you know, as pediatricians, we tend to have hope. And I think that

Grant Oliphant 40:39
you're all about the future. I hope so.

Dr. Vi Nguyen 40:43
So I think I and so we're, yeah, we're building those connections. I think we have plans of doing like the community forum and working with Dr Granados and Dr Prather and whatnot. So so you'll be hearing more from us, so it'll be exciting. Yeah, yeah,

Grant Oliphant 41:00
this where we're running out of time. So I do want to actually ask that question about what gives you hope, and as maybe a little bit also about what you have learned through this process. Why don't we start with that actually, what has been your biggest learning through this process of working on this issue,

Dr. Kimberly Dickson 41:22
I've learned how to be a voice, how to speak up. You know, before I think I told you, you know, I just figured these big entities, the EPA, the CDC, would come in here and, you know, be our superhero and rescue us. I've learned that that doesn't happen, and you have to speak up and have a voice. And that's something I've always told my kids, and now I'm showing them this is the right thing to do. And as far as hope, it's interesting you say you use that word because back in August, when the hydrogen sulfide was so high and the researchers were pointing out the dangers of it, the community wasn't scared. They were hopeful. And that wasn't what I was expecting. I was expecting the community to be scared, scared for their health. They were hopeful. And they were like, Thank goodness the researchers told us about this. We knew something was going on. We knew this is our affecting our health, and now we know why, and now we have hope, because we know what it is. We can move forward and we have a fix. Maybe somebody's gonna pay attention to us. And so that was, that was a surprise for me. I would, I would think people would be scared. They'd sell their houses, move out of town. No, they didn't.

Grant Oliphant 42:30
That's really, I think, important, yeah, to note. And thank you for sharing that. Dr Nguyen, what about for you?

Dr. Vi Nguyen 42:38
Yeah, I think you know you're in the right side by the people you're around and the goodness and the energy of the community and the folks that are doing the work now in this kind of growing awareness is so beautiful. I mean, in the end of the day, the stink literally has, I've got to meet Kim. I've gotten to meet all these amazing people, like, I got to be here today. And I'm like, I never knew this existed, right? And when you do this work, and knowing the folks that are showing up and that kind of just like, what my daughter, I have a 16 year old, and we talk about, how do you get things done? You chunk it, right? You just keep on showing up. You break up into small pieces, and then you get to where you need to get. And I think when you make a lot of noise, especially when you make it with good people, people tend to want to turn to the side of light of right, and I should hope so. But, yeah, I have hope through action. Because every day I get up and I think to myself, what I'm going to do, and one of the things is, okay, what I'm going to do for Tijuana sewage crisis today. So today was show up here, and tomorrow will be send a couple emails, and then, you know, keep chipping away at it.

Dr. Kimberly Dickson 43:47
Yeah, I agree.

Grant Oliphant 43:49
So before we wrap up, you know, I want to share an observation, which is that I have had the privilege of having decades of work in environmental health issues in another community. But what I've seen here in San Diego is sort of textbook in terms of the same environmental health issues are not welcome when they're brought up. There is a resistance to recognizing the problem. The status quo exists for a whole host of reasons, many of which have to do with money and power and influence, and speaking up against that is threatening, and so that's hard to change, and there's a process of backlash before there begins to be a process of acceptance. And I think what you have both experienced and what you've both been talking about here today is illustrative of that dynamic. I am just curious as we wrap up what you imagine yourselves telling young people one day that you'll be speaking with about about this. And your experience going through it, what you'll tell them about, how they might translate your lessons into their own lives, fighting for their community.

Dr. Kimberly Dickson 45:09
I like that question, yeah, yeah. What I would say is the same thing Dr Prather, from UCSD said to me. She said, don't give up. It's the right thing to do, right? And that's what I would that's the message I would give to young people, don't give up. It's the right thing to do, and it's hard, and you grow the most during the hard times, right? I've grown a lot through this. I've met a lot of great people. I've grown a lot. But I'm not going to give up. It's the right thing to do.

Dr. Vi Nguyen 45:37
I would say I'm so privileged to have be part of this. And know kind of details that won't come out probably for a couple decades, because, you know, they're sensitive to details. But it was super interesting, like the players involved, and how this little beach town and, you know, forces of good and bad and evil. And sometimes I'm like, seriously, like, So and so called so and so to say so and so, wow. Well, I'm still showing up, because what are they gonna do to me, you know, so when you kind of, when I, like, and I, you know, it takes, I may have told the story just the family, and it takes about like 20 minutes just to talk about that, that meeting that happened at the Air Pollution Control District. And so, yeah, super interesting to see how the world works. And yeah, the forces of, yeah, forces of greed and or just just ignorance. And just to say that, you know, we pick the right side.

Grant Oliphant 46:30
Yeah, great. Well, I just want to say thank you both for the extraordinary work you've been doing. And I think it just illustrates that when people put the kids first, it really dictates a different mode of behavior. So thank you for your courage.

Dr. Vi Nguyen 46:46
Thank you. Thank you so much. Thank you.

Crystal Page 46:47
That was a powerful interview. What did you take away from that, Grant?

Grant Oliphant 46:56
So much, and I suspect we'll probably identify a lot and probably a lot in common between us. But you know, I think the one of the central places for me and a place to start is this issue has incredibly been treated by some and even referred to by some as a nuisance. And this is not a nuisance. This is a real issue where real people are being affected, including kids with medically significant issues. And it's high time we pay attention to it so that that, for me, was just, you know, confirmation of the fact that this is a really, genuinely, a significant public health issue came across in that conversation with these pediatricians. What about you?

Crystal Page 47:55
I think that really aligns the word, unfortunately for me that's coming up is gaslighting, like when you know something's wrong, you can feel it, you can see it, you can smell it, and then you're told it's safe. You know, some people fall into learned helplessness at that moment. And in particular, what I appreciated about Vi is she's like, I'm not going anywhere, right? And I think if we all had that spirit, we would get to versions of solutions faster.

Grant Oliphant 48:24
Yeah. Interestingly, I think that's probably going to be a theme in these conversations, because we've heard the same thing from community organizers around this and as Vi pointed out in this conversation, these are folks who can't go anywhere for the most part, and shouldn't have to. They are in and of this community for a long, long time, and they have every right and expectation that they should be able to stay safely where they are and that they will be safe, but they're aware that something's amiss, and so that was part of what came out of this. I, you know, I was struck by so many other things. I was, you know, I think I was struck by the courage of these two doctors. And yes, they're medical professionals, but they have encountered the phenomenon which is so much part of the Environmental Health backlash playbook where just by speaking up, they have found themselves being criticized by politically powerful people and organizations. They have found themselves being dismissed their their credentials, being questioned and treat it as though they're trying to panic people, when, in fact, what they're trying to do is make people aware of what's going on and the fact that they Well, I think it was Dr Nguyen's comment about when, when you see when there's a code, you go to the aid of whoever is in trouble and and. That is what they're doing. So I really appreciate that about them.

Crystal Page 50:03
I appreciated that and something they said that I wish every civic leader would pay attention to. They both said that they wake up every morning saying, What am I gonna do on the Tijuana River Valley today? I don't know if our leaders wake up that way. I hope they do. But she literally talked about Dr Nguyen, talked about my 16 year old daughter, and I talk about the way to accomplish anything as you chunk it out, right? So one step at a time, she wakes up and says, I'm going to write a letter today. I'm going to go look at trends today, or whatever. And I think that is the most proactive thing anyone could do. But it shouldn't just be the pediatricians and the community organizers. It needs to be all of us, anyone who can help solve this problem.

Grant Oliphant 50:45
Yeah, and I think what that brings up for me is, and we hear this over and over again in our conversations with people in the Tijuana river valley that this issue is personal for them now, in their case, it's because of connections they have with the community and living living in the community, but it's also that they are treating kids in the community, and their sense of passion clearly comes out of their devotion to as doctors, to treating these young kids and and also helping their families answer questions. I i found it so powerful, and I know you did as well, because we talked about it briefly afterwards, that when they, when they when they talked about how patients were blaming themselves or families were blaming themselves for for being sick, which, by the way, is very common generally, but it's even more common in patient populations and in vulnerable communities. And there is a tradition of just quietly taking whatever is going on in a lot of these communities. And so here we are sitting in a situation where community patients have literally been thinking they're to blame for something which doctors are now realizing and telling them, No, there is something else going on, and we should be paying attention to that which it turns out, contrary to, I think, the way, the the kind of patronizing view, frankly, that that has come from other quarters that, oh, people have to be protected against that knowledge, it actually is liberating for them. At least that's what the doctors are sharing with us that they're experiencing that community is feeling liberated by this knowledge that tells them they're actually not to blame. There actually is something going on that what they're suspecting is real, and maybe finally, it will be addressed.

Crystal Page 52:55
Yeah, I hadn't realized before I know the government protocol right is you don't tell people, or you maintain calm, but these folks receive this information, and it gave them hope, you know, and I think that that's incredibly validating. Hey, we see what you see, so to be seen, then things can be addressed. I think Dr Nguyen said it when she said, I hope the world doesn't unsee this. Right? We want to make sure that this stays seen, so that we can chunk it out and take those steps. So I think that's all mind blowing for me. But the other thing, and what you were saying, grant that, I want to pull out a little bit. You've talked about the playbook, and they've talked about the playbook. Would you say just a little bit more? What you mean when you say the playbook?

Grant Oliphant 53:38
Sure, it's just, you know, in in, in the history of communities trying to deal with environmental health issues, there's kind of a standard thing that happens when people start raising environmental health concerns. Medical professionals find themselves being criticized, threatened, and their credentials being called into question, and their businesses may be being threatened as well. Scientists who are working on the issue find their credentials being questioned in the caliber of their research. The community organizers who are working on these issues find themselves at the other end of pressure tactics from very powerful people who would prefer that they not raise this issue. And it actually we've seen it over and over again. If you think about climate change as the meta example, what has happened over the course of 60 years on the climate change front is exactly this, but this feels even more personal often for people, because it's in their community and it's close to their home, and it may be their personal business and their their credibility as a professional, it's a really tough thing to encounter, and that's why I have all the. Or admiration for anybody who has the courage to speak up against it.

Crystal Page 55:03
Yeah, yo go further on the business piece Dr Dickon talking about the threat to her her business, like she was scared, and instead the community saying, we're with you. We have your back. Yeah, I think that courage is something we always talk about as Prebys as an important value in leaders in the community. And here you have Mom and Pop urgent care. Didn't even know that was a thing, but you have Mom and Pop Urgent Care saying, Hey, we're noticing a trend, and they choose to just speak up and point it out, because they want to do the right thing. We heard that I would like to go back and count, but several times we heard them talking about, what is the right thing to do, and we hope that our moral compass, that's what guides us the right thing to do. But instead of taking it seriously, it feels like it's being punished. Like you said, this playbook is is thwarting the truth, and people just want to be happy and healthy and well that these little babies that Dr Nguyen sees, I'm concerned. She was pointing out the long term impacts that we don't even know but, but this is our future. These are the people who will be working in our communities and taking care of us when we're old, and if we're not looking at those long term impacts, you know, what does that mean for the future of our region?

Grant Oliphant 56:13
Yeah, I am. I am. You mentioned a moment ago in your comment about the comment Dr Nguyen made about I, you know, I hope that we cannot unsee this. So part of the playbook is deliberately finding ways for people to unsee this or not see it in the first place. And we're already seeing that, if you'll forgive the phrase, you know, we have people who who don't see it because it would be, it's not the issue they want to focus on and and by the way, some of this is not always because of malice. It's because of of just different views and priorities. But it all adds up. And you know that this is, this has happened in lots of places around the country, and sometimes people become extraordinarily adept at unseeing a reality that is there. So if you think about cancer alley on the Gulf Coast, that's exactly what has happened over generations now, where there's very clear evidence about the impact of certain types of industry on certain communities in what is referred to as cancer alley, and yet it's repeatedly unseen as a priority or denied as a priority in the first place. So there really it is important in San Diego that we not allow that to happen here. And I think what I'm seeing is because there is this focus on, let's let's focus on doing what's right, and we're not going away, that we have a much higher probability that we can, we can head that off before it becomes chronic.

Crystal Page 58:08
I appreciate what you said just now grant about there not being malice tied to this in all cases, in all cases, yeah, but I, and I think that's, that's the point of all of this, that I, I hope we all walk away with is it's not about one individual. It's about systems, right? These systems are so hard, and I'm a person who worked in one of those systems, two of those government systems, and sometimes there's so many layers to get help, and the ships not moving the same direction for everyone. And so how do we make it easy to help and be helped? Is, I think where, where we need government, but just as we collaborate as a value of this region, how do we collaborate better to keep everyone happy, healthy and safe,

Grant Oliphant 58:49
right? And it's one of the things that I hear the doctors trying to do in their conversation. I hear you and I trying to do it right now. I heard the organizers that we interviewed doing the same thing. It's, it's easy to name names and point fingers of blame. It's but, but maybe that's the wrong thing. You know that that what we what we really want is everybody to rally around the solution, and so, you know, in a system that is already complex, that already allows everybody to point the finger of blame somewhere else, it's Mexico's fault, it's the federal government's fault, it's the state government's fault, it's the county government's fault. It's this department. It's that department. No, what we know is it's not the kid's fault in the community, and if we make that our focus, and we think about the well being and health of this community, then maybe all of those players can really focus on what we collectively see and jointly figure this out. And we need them to

Crystal Page 59:57
Right on. I'm with you on that.

Grant Oliphant 1:00:00
Perfect. Well, Crystal, thank you so much. I think this series was your idea. Let's continue it.

Crystal Page 1:00:07
It's always a team idea. But yeah, right on. And we just want to send our love and support to the community leaders. We hope that they stay strong and thanks for being brave.

Grant Oliphant 1:00:18
Thank you all you.

Grant Oliphant 1:00:25
This is a production of the Prebys Foundation

Crystal Page 1:00:29
hosted by Grant Oliphant

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Co-hosted by Crystal page

Crystal Page 1:00:34
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Grant Oliphant 1:00:38
engineered by Adam Greenfield

Crystal Page 1:00:41
Production coordination by Tess Karesky

Grant Oliphant 1:00:44
Video production by Edgar Ontiveros Medina,

Crystal Page 1:00:48
Special thanks to the Prebys Foundation team.

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The Stop and Talk theme song was created by San Diego's own Mr. Lyrical Groove.

Crystal Page 1:00:57
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