Friday, May 12, 2017

Keep Calm and Wash On - Coping with the Fear of Rat Lungworm Disease

Keep Calm and Wash On.
I’m ruthlessly washing lettuce leaves, checking each leaf, massaging it in running water, turning it over, washing it again. Washing the base of the leaf, and removing any brown spots or spoiled edges, then washing it again for good measure.
Maybe there’s a room in purgatory where people like me wash lettuce leaves endlessly, trying to wash off any traces of slug or snail slime or even baby slugs. “No time for slime” is one of the catch phrases for preventing rat lungworm disease, which can be contracted by eating contaminated produce.

Maybe I shouldn’t be eating local lettuce. Maybe I’m risking my life. Maybe it’s hysteria. Maybe

it’s like all the other scary tropical diseases out there.   


In the murky depths of my childhood memory, I remember being afraid of a disease called leptospirosis. No one I knew had it, but it didn’t make me less afraid. I eyed beautiful waterfall pools and streams with suspicion. Maybe they were contaminated with a parasite. Maybe if I waded in the pool at the base of the waterfall, I could catch it. Maybe I would be the first person at my school to have it.

I imagined innocent hikers catching it by drinking fresh stream water or plunging in the pool at the base of the waterfall and splashing upwards in ecstasy, like in a Hollywood movie. So what if I rarely went on waterfall hikes? In my childhood hypochondriac mind, I was at risk. The details of how the parasite was transmitted are fuzzy now, maybe it’s in the poop of wild pigs that drink at waterfalls. I remember thinking how gross. Just looked it up - it’s transmitted by urine. Ewww. 
A few years ago, there was concern about dengue fever, since a few cases were reported on Maui.  Since dengue fever is transmitted by mosquitoes, if anyone was going to get it, it would be me, since mosquitoes love me. My husband calls me his mosquito repellent because when I’m around, they will bite me, but not him. I’m not one of those gurus who can repel mosquitoes with the power of their mind so I am grateful when the trade winds blow hard. But, knock on wood, I have not contracted dengue fever…

Last year, there was the threat of zika virus on Maui, also transmitted by naughty mosquitoes.

Now, this spring, there is active fear about rat lungworm disease. It comes up in every conversation I’ve had. It’s been on the news. It received mainstream media coverage especially since a honeymooning couple was infected in Hana.

But it’s not a friendly disease. There’s no cure, and it affects the brain and spinal cord. Rat lungworm disease or angiostrongyliasis is a rare form of meningitis. People who have it report intense and crippling pain, headaches, and nausea among some of its symptoms. Pain can last for weeks, months or even years. A lucky few may not notice any symptoms and therefore be undiagnosed. 

It’s disturbing, because it’s scary and the method of transmission is something a science fiction writer might concoct after a heavy night of drinking: Rats host the adult version of lungworm, often in their pulmonary arteries, hence the name. Rat feces may contain the juvenile version of rat lungworm. Slugs and snails will eat rat poop, the way some dogs will explore the cat litter box for gourmet doggy snacks. Nature doesn’t like to waste anything.

Snails and slugs may leave contaminated slime trails on plants, which can then spread the disease to humans. Or one could ingest a tiny baby slug accidentally. According to Hawaii’s health department, you cannot transmit this disease person to person.                                   

Since being involved with the community garden, I’ve known about the disease for a few years, after an outbreak on the Big Island became well-publicized. On Maui, we were relaxed but vigilant. At the time, there weren’t any significant cases on the island, and it seemed to be an issue of hippie farmers eating unwashed produce. We reasoned, if we wash our produce, it should be fine. 

This is a 2014 photo of a slug on organic lettuce that I purchased in the store. I don't know if it was local lettuce or mainland lettuce. It was the only time I ever found a baby slug in store-bought lettuce in the 10+ years I've lived on Maui. (I have had slugs in my salad greens that I grew in the community garden.) I washed the lettuce well and ate it, and was fine. This was all prior to the current rat lungworm outbreak.

But somehow the disease made its way to Maui from the Big Island or from Asia. It was only a matter of time with travel and transport between the islands and the rest of the world. The rise of a new invasive slug, called the semi-slug, an effective carrier of rat lungworm, is associated with the recent outbreak. Rat lungworm is also found in California, Florida and the Gulf Coast states, and with warmer climates, may be spreading in the continental US

After talking with staff from the Hawaii Department of Health, which had a booth at the Haiku Flower Festival this April, I found out that rat lungworm disease has been reported on Oahu since the 1950s. Some people had been eating raw African snails that contained the parasite and caught the disease. In their culture, eating raw snails was normal.

I know of people who are avoiding eating at restaurants and won’t eat salad or raw vegetables prepared by anyone anywhere, because they want zero risk of exposure. Some parents are keeping their children from playing in the dirt or on the grass. Some people on the Big Island even got sick from drinking kava, a traditional Polynesian drink, that a slug crawled into and drowned. 

At a recent Hawaii Farmers Union potluck, there were big bowls of locally grown salad. I had decided prior to the meeting that I wouldn’t eat any salad, and then I changed my mind and ate some salad. If anyone is going to be vigilant about washing local produce they provide at a potluck, it’ll be the local organic farmers whose livelihood is based on growing local produce. It’s a risk, one that I’ve decided to take.

I don’t know if it’s a foolish risk or a brave risk. But I don’t want to live in fear and be afraid of every green leaf. I don’t want to be afraid of petting my cat who runs around outside. She doesn’t eat slugs, but she rolls around in the yard. I’ve always been an active hand washer because of tending chickens, so now I wash my hands even more and use a hand disinfectant.

There are always things to worry about in life: random asteroids, car accidents, terrorism, mass pandemic of other weird diseases like the bird flu, lightning, earthquakes, hurricanes, and other natural disasters. I don’t want to be afraid of every possible way that I could be infected by rat lungworms.  

There's been a flurry of media attention on rat lungworm disease on Maui.
People are distressed. Some people suggest the conspiracy theory that some evil entity introduced rat lungworm to Maui to strike back at organic small farmers. But the presence of rat lungworm also affects restaurants, hotels and tourism.

I haven’t heard of any new cases, but everyone I know is being super vigilant. I’ve noticed two grocery stores, Down to Earth and Pukalani Superette, have posted noticeable warnings to wash all produce vigorously.

When I talked with Takako Nakaaki of Hawaii’s Department of Health in April, I asked her about ducks.
Maybe ducks are one answer to rat lungworm. Farmers know that ducks love to eat slugs.

Would having ducks in one’s yard help prevent the spread of the disease? She answered, as far as the Department of Health knows, that ducks are not known to transmit rat lungworm disease and would be helpful in controlling the slug population. She even suggested that chickens would be helpful because chickens like to scratch the dirt and grass, and slugs and snails do not like to be disturbed constantly.  She mentioned that taro farmers in Hana were using ducks to control apple snails, but then the ducks disappeared  - maybe on someone’s dinner plate?

So my solution is more ducks, please. New ducks cannot be brought into Hawaii due to a state law that probably made sense at the time, but there are plenty of existing ducks in Hawaii, so maybe we could have more duck breeders or farmers. And maybe everyone should have backyard chickens and front yard and side yard chickens. Chickens and ducks everywhere.
Since there’s no known cure for the disease, a friend suggested a folk remedy: ingesting papaya seeds. Papaya seeds are known to be effective against intestinal parasites. How well that may work against rat lungworm is an unknown. Papaya seed dressing is easy to make and quite delicious. Or what about grinding a few papaya seeds with each meal? Papaya seeds taste peppery and probably are nutritious and full of minerals. 

Could papaya seeds help minimize the effects of rat lungworm disease? In some folk traditions, the solution or cure to an illness grows where the illness is found. Wouldn't it be great if the cure for the disease is also locally grown?

I’ve been trying to write this post for about two weeks now, wrestling with providing helpful information and not adding more fear to the equation. I’d say people on Maui are very well-informed and that fear is at an all time high. I wonder if fear is a choice and how we can respond to fear while protecting ourselves. I guess we have to be vigilant but relaxed. Aware but not scared. Alert but mindful.

Here are some prevention tips by the Hawaii State Department of Health, with my notes:

  • Never eat raw produce straight from the garden or the farmers market, or from anywhere else without washing it thoroughly. Even if you are a hippie who carries magic crystals and the lettuce leaves are telepathically calling you to eat them, you should wash them first.  

  • Wash all produce thoroughly, including individual lettuce and kale leaves, in running water. Look for any snails or slugs, even tiny baby slugs. According to the Hawaii Department of Health, you do not need soap, bleach, vinegar, grapefruit seed extract, hydrogen peroxide, or special produce washes, which may make the parasite more aggressive. 

  • Please don’t eat raw prawns, slugs, snails, crabs, crayfish, freshwater crabs, or frogs raw, which can carry the juvenile form of the parasite. I don’t know why anyone would eat any of these things raw – blech! – but I was told that in some cultures, it was acceptable to eat raw African snails. So, if you’re from one of those cultures, please boil those freshwater animals really well, for like 5 minutes at 165 degrees. If you don’t normally eat these things, then one less thing to worry about.

African snails mating. I used to pick them up with my bare hands. No more.
  • Don’t touch slugs and snails with your bare hands – use gloves and tongs

  • Wash your hands after doing any gardening or landscape work outside, especially before eating or touching your face. Always wash your hands before handling food or eating.
  • The parasite can stay alive in dead snails that are left on the ground, so the Department of Health recommends putting the snails in a salt water solution (1 cup of salt to 7 cups of water) for at least 2 days.
  • You can also kill the parasite by cooking to 165 degrees F or freezing your produce for 24 hours.
  • If you are on water catchment, take extra precautions to make sure there are no slugs or snails in it. Use a filter that is fine enough to filter out rat lungworm. Keep your water tank covered and check it regularly.
  • Reducing the rat population at home or around farms will minimize exposure to this parasite.  I’m not clear how rats get the disease in the first place. Do they eat dead slugs or get infected from slug trails?
  • Do not drink or eat food from uncovered containers outside.

Keep calm and wash on!

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