Indeed, Michael, as I noted in my reply to Ann, the border fence is only one small part of the CBP's official three-pronged approach to border enforcement. And so, if we spend ALL of our money on just one aspect of this, are we really doing an adequate job of enforcement? And of course, you raise broader questions about framing. Since 9/11, the Bush Administration has reframed the entire issue of immigration in terms of national security, narrowing the scope of debate and turning every border crosser into a potential criminal. In fact, labor migration is common worldwide, and even I, as a university professor, have many opportunities to leave the United States and make far more money elsewhere in the world where universities don't suffer from lack of funding and dwindling public confidence. Can we blame people for seeking a better life for themselves and their children, as our own ancestors did?
Serge Dedina:
Serge, you make a great point here about lack of good media coverage. I think I saw a program once on PBS about strip mining and mountaintop removal in Appalachia. But who thinks of that happening here in sunny southern California? We definitely associate these practices with poor areas or developing countries, and perhaps this is why it is so hard to take it seriously in San Diego County. But yes, the construction sites are shocking and the devastation is irrevocable at this point.
Jesse:
Wow, I hadn't heard about the southbound inspections. That does sound very Cold War to me. And you're right—should the US be using its resources to do a job that legally ought to be a function of the Mexican state? To what extent does the US guarantee that it is respecting the interests and legal rights of Mexico? Not to mention the violation of the rights of travelers, who, ostensibly, have the right to leave the U.S.
S. Nicol:
Absolutely. That's what really bothers me most about the exorbitant funding that the feds are putting into this border wall. In fact, the wall is not working. According to a study by Wayne Cornelius, director of the Center for Comparative Immigration Studies at The University of California, San Diego, 92 percent of Mexican migrants trying to enter the U.S. illegally eventually succeed. People do keep trying, and the border patrol knows that all too well. I was down at the border fence one day interviewing some migrants who were waiting to cross back into the U.S. One of them had worked for eight years as a roofer in Seattle, and was suddenly deported this past year (hmmm ... maybe the downturn in the housing market had something to do with that sudden enforcement of the law?) Anyway, he told me that he was deported all the way out to Nogales, and he had made his way back to Tijuana, and had been waiting there four months to cross back. His wife and kids are back in Seattle, and after eight years, his life is there.
Indeed, Michael, as I noted in my reply to Ann, the border fence is only one small part of the CBP's official three-pronged approach to border enforcement. And so, if we spend ALL of our money on just one aspect of this, are we really doing an adequate job of enforcement? And of course, you raise broader questions about framing. Since 9/11, the Bush Administration has reframed the entire issue of immigration in terms of national security, narrowing the scope of debate and turning every border crosser into a potential criminal. In fact, labor migration is common worldwide, and even I, as a university professor, have many opportunities to leave the United States and make far more money elsewhere in the world where universities don't suffer from lack of funding and dwindling public confidence. Can we blame people for seeking a better life for themselves and their children, as our own ancestors did?
Here's my third response -- to Serge Dedina :
Serge, you make a great point here about lack of good media coverage. I think I saw a program once on PBS about strip mining and mountaintop removal in Appalachia. But who thinks of that happening here in sunny southern California? We definitely associate these practices with poor areas or developing countries, and perhaps this is why it is so hard to take it seriously in San Diego County. But yes, the construction sites are shocking and the devastation is irrevocable at this point.
Here's my fourth response -- to Jesse:
Wow, I hadn't heard about the southbound inspections. That does sound very Cold War to me. And you're right --should the US be using its resources to do a job that legally ought to be a function of the Mexican state? To what extent does the US guarantee that it is respecting the interests and legal rights of Mexico? Not to mention the violation of the rights of travelers, who, ostensibly, have the right to leave the U.S.
Here's my fifth response -- to S. Nicol:
Absolutely. That's what really bothers me most about the exorbitant funding that the feds are putting into this border wall. In fact, the wall is not working. According to a study by Wayne Cornelius, director of the Center for Comparative Immigration Studies at The University of California, San Diego, 92 percent of Mexican migrants trying to enter the U.S. illegally eventually succeed. People do keep trying, and the border patrol knows that all too well. I was down at the border fence one day interviewing some migrants who were waiting to cross back into the US. One of them had worked for eight years as a roofer in Seattle, and was suddenly deported this past year (hmmm.... maybe the downturn in the housing market had something to do with that sudden enforcement of the law?) Anyway, he told me that he was deported all the way out to Nogales, and he had made his way back to Tijuana, and had been waiting there four months to cross back. His wife and kids are back in Seattle, and after eight years, his life is there.
On Thursday, Sept 18, Border Meet-up Director Dan Watman was detained by the Border Patrol in Friendship Park, a small concrete plaza up against the border fence in Border Field State Park, the site where the U.S.-Mexico border fence descends into the ocean. Watman was conducting a press conference in preparation for a two-day bi-national event scheduled for the following weekend, Sept 20-21, to include a beach clean up, kite flying festival, cross-border yoga and mediation at Playas de Tijuana and Border Field State Park. His crime? One of the five Mexican journalists who joined Watman at the border fence for the press conference passed Dan his business card through the fence. According to the border patrol, the passage of unregulated goods through the border fence constitutes a customs violation. Yet, if Dan Watman's actions truly constituted a crime, why was he not arrested? While it is easy to read this situation through the familiar narrative of the innocent man victimized by an abuse of state power, are we being fair to the border patrol when we portray them as "bad cop?"
Well, it turns out that federal laws governing what can and cannot be done at the border fence are not entirely clear. Indeed, as anyone knows who has tried to cross back across the border into the U.S. with an unregulated American granny smith apple in their backpack, the passage of "unregulated goods" from Mexico to the U.S. is expressly forbidden. Yet, other activities at the border fence subject the innocent wayfarer to arbitrary and random questioning, harassment and detention.
When Dan Watman reached out and took the journalist's business card that had been slipped though an opening in the border fence that day, the border patrol agent on the scene was prompted to enforce this policy forbidding unregulated goods. As Watman noted in an official statement, the agent asked to see what had been passed through the fence and Watman complied, showing him the business card. The agent then asked Dan to step away from the fence. Dan asked why he needed to do that: as far as he understood, it was not illegal to talk to people at the fence. Then Watman explained further that he was conducting a press conference and so needed to remain within conversational distance with the journalists gathered on the other side. At this point, the situation escalated, the border patrol agent threatened Watman with arrest if he refused again to step away from the fence.
In an effort to clarify the law, Dan pointed to the contradictory situation in progress: "I told him that he could arrest me right where I was for passing something through the fence. And so, why if I stepped away would I no longer be arrested?" The agent then asked Watman to place his hands on his head and remain silent, and Watman was then detained while three additional border patrol vehicles and 8-10 agents arrived on the scene. When Watman asked again why he was being asked to step away from the fence, one of the agents acknowledged that Watman had done nothing illegal in gathering with a group at the fence: "You are right, you have a right to be here you just can't pass things through the fence." After 20 minutes, the agents left and Dan Watman, undaunted, continued on with his press conference.
What Dan Watman's brief detention, and many others like it illustrate, is that enforcement at the border fence can be random and arbitrary, raising questions about the shaky legal foundations of our basic civil rights. In an effort to clarify the law regarding gatherings at Friendship Park, I recently spoke to Mark Endicott, Public Affairs liaison for the San Diego Sector of U.S. Customs and Border Protection. When I asked him if there was an explicit policy preventing people from standing next to the border fence and chatting with people in Playas de Tijuana, Mexico, Endicott affirmed that as a public park, its purpose was to allow people to gather and enjoy themselves, and there was no policy preventing that. Endicott added that he had heard of no instances of agents telling people to stand away from the fence.
Yet, such instances are commonplace in Border Field State Park. I myself have been interrupted mid-conversation and asked to step away from the fence on at least three different occasions by border patrol agents who then explained that it was easier to do their job if I wasn't talking to people through the fence. According to Christian Ramirez, National Coordinator of Project VOICE, the American Friends Service Committee immigrant rights initiative, there has recently been a significant number of complaints about random detentions from the ranches out near Border Field State Park. And so, this left me wondering once again, what exactly is the law in this case?
Over the decades, Border Field State Park and the Tijuana Estuary have enjoyed and benefited from genuine bi-national efforts on the part of Mexican environmentalists and San Diegans to protect and improve this invaluable resource. Since 1995, the city, county and state have jointly invested over half a billion dollars--$500 million -- in acquisition of lands and restoration of this rare and wildly beautiful California coastal scrub estuarine habitat. As California's coasts are subjected to increasing residential and commercial development -- over 90 percent of Southern California wetland habitat has already been lost to development -- estuaries and natural spaces like this one are becoming more and more rare.
Not only is the spirit of friendship in peril with the loss of accessibility to Friendship Park up at the top of Monument Mesa. The border fence project threatens to contaminate and damage the entire Tijuana River National Estuarine Research Reserve, one of only a handful of sites worldwide designated by Ramsar as "wetlands of international importance." Winter rains will cause loosened canyon walls to erode, and tons of soil and sediment will wash down into the delicate estuary lands. The Estuary is an essential breeding, feeding, and nesting area for resident birds and for the thousands of migratory birds moving along the Pacific Flyway. Over 370 species of birds have been documented in the Reserve, some of which are endangered and threatened. The light-footed clapper rail, a resident bird that depends on marsh cordgrass and may be the most endangered bird in Southern California, is found here in numbers unlike any other wetland is San Diego County.
Already we have seen the results of soil erosion in Lukeville, Arizona, where the border fence was built through Organ Pipe Cactus National Monument, blocking a natural wash and floodplain. Panels in the border fence designed by Kiewit Corporation of Omaha, Neb. to accommodate ordinary summer flash flooding did not work. Massive backwater flooding occurred along the border fence, driving rapid flows of water and debris up to 7 feet deep, and severely eroding the foundations of the fence itself. When the winter rains commence in San Diego this year, we can expect the same kind of flooding and erosion that we always have, but weakening and loosening of soil on the canyon walls of Smuggler's Gulch, Goat Canyon and Yogurt Canyon will bring tons of soil flooding down to this area. In spite of commitments to BLM and other agencies to exercise "Best Management Practices," Kiewit Corp. has charged forward with the construction in San Diego, leaving a path of destruction in its wake. No funding has been provided by the Department of Homeland Security to mitigate this damage, and San Diego city, county and state resources will be strained in the future for the restoration that will certainly be necessary.
Concerns about environmental damage continue to be voiced by state agencies. In October, the State Water Resources Control Board sent a letter to the U.S. Army Corps of Engineers, reiterating their concerns about the environmental impact of the Smuggler's Gulch in-fill project, a major portion of the San Diego Sector VI fence corridor. The letter cites statements of Michael Chertoff, indicating the commitment of DHS to actively solicit public input on the environmental impact of the project and to exercise good environmental stewardship throughout the construction process. Yet, to date, the State Water Resources Control Board notes that they have not seen evidence that these commitments are being carried out. Upon inspection of the site, the board observed complete lack of temporary erosion control measures, failure to implement the storm water pollution protection plan, poor drainage and shoddy grading practices on construction access roads. In addition, there appears to be no post-construction maintenance plan, nor has DHS been forthcoming about funding such a plan. The board anticipates that a number of consequences will follow including severe erosion when winter rains begin, sediment spill and damage to the estuary, high environmental costs in the form of lost hydrological function in the watershed, and expensive remedial maintenance costs which will no doubt be borne by local, county and state agencies. Perhaps most ironic, the board notes that these problems will create hazards for the border patrol agents using the roads for whom they were designed and built.
Natural habitats know their own boundaries. Encompassing 2,500 acres, the Tijuana Estuary is the endpoint of the bi-national 1,735 square-mile Tijuana River Watershed, three-fourths of which is in Mexico, including most of Tijuana and all of Tecate. Three reservoirs in this watershed store precious water for the residents of the San Diego border region. For the sake of our own survival, we cannot afford to destroy this precious resource.
As we speak, a costly federal project is in progress at the southern tip of San Diego County: Sector VI of the new triple border fence, more accurately called "the border wall" in Texas, is carving a deep scar into the California coastal scrub landscape from San Ysidro west to Border Field State Park, where the primary border fence descends into the beautiful blue waves of the Pacific. The reported cost of the project nationally is a mere $1 million per mile, not including cost overruns, of course. In May, the San Diego Union-Tribune reported that contractors estimated the cost for the 4.5 miles of San Diego Sector VI at $48 million.
Yes, this is the same border fence project that we have been hearing about since the border fence was a mere twinkle in the eye of our own 52nd District Representative Duncan Hunter back in the late 1980s and early 1990s. And so, why should we pay attention to this now? The triple fence project became the object of mockery last Thursday evening at the Orchid & Onions Awards, where an Onion Award and slide presentation of the project was accompanied by Green Day's punk-pop anthem "American Idiot." But what I hear from most people is resignation: "Well, they're going to build it anyway." I'm hoping to give you a few reasons today to pay attention to this construction project. It is costly, it may not be particularly effective, there has been considerable resistance to the federal land grab in San Diego and other parts of the country, and finally—we are paying for this. Thus, we may have an interest in knowing where our tax dollars are going.
The Department of Homeland Security hit the ground running earlier this year, and Kiewit Corporation, a contractor out of Nebraska, has been going gangbusters, six days a week, ever since April. Driven exclusively by a narrow focus on the national security implications of the border fence project, Homeland Security chief Michael Chertoff waived over 33 environmental laws in April of this year—to fast track the construction of the border fence in the San Diego sector. Many argue that this represents not only an abuse of the Executive Branch's constitutional authority, but amounts to a big land-grab by the federal government. At least 100 acres of San Diego county land and California State land, dedicated for public use, have now been condemned for exclusive federal government use.
Decades of knowledge and expertise of our environmentalists and scientific community members have been disregarded, and the local community has not been consulted throughout this process. To date, DHS has refused to submit their final construction plans for congressional oversight or release these plans for outside review or public scrutiny. The result is a misguided effort to grade, flatten and fill in canyons to create a "fence corridor," a swath of 150-300 feet of no-man's land, a massive 20-foot wall of smooth concrete cylindrical pylons, topped by metal mesh, lined with a 40-foot-wide vehicle access road lined with decomposed granite to facilitate tactical surveillance by border patrol. Three million cubic yards of dirt has been excavated and used to fill deep canyons to create a road with around a 10 percent grade all along the 4.5 miles from San Ysidro the beach.
The project is one of the largest public-works projects in recent San Diego history, and San Diego city and county agencies will bear the costs for years to come. The scale and future costs of this project to our region demand far more public attention.
With change in the air after a long, hard-fought presidential campaign, we've received lots of questions of what the implications of the new Obama presidential administration are for the biotech and medical device community, which is the largest technology cluster in San Diego.
The San Diego Union-Tribune did a good job Sunday of summarizing how different technology clusters in San Diego expect to be impacted by the change in administration, including info from BIOCOM.
Basically, there are two main issues that people in the life sciences are talking about and have their eyes on now.
First off, the industry and research community are very excited to have a president who actively supports science, and is expected to rescind President Bush's federal restrictions on embryonic stem cell research, especially after this Wall Street Journal interview with incoming Obama chief of staff Rahm Emanuel. Stem cell research is a major area of study for the big-four research institutions on Torrey Pines, UCSD, Scripps, Salk and Burnham which are working together to build the Sanford Consortium for Regenerative Medicine. California, of course, side-stepped these federal restrictions back in 2004 when the state's voters overwhelmingly backed Proposition 71 so the state could invest $3 billion into embryonic stem cell research. I'd be remiss if I didn't include a link from that earlier election year, when The New Yorker magazine parachuted a Manolo Blahnik-clad reporter into San Diego to cover the interesting origins and background of Proposition 71, which subsequently created the California Institute for Regenerative Medicine.
The other big question mark for the industry is who will lead the Food and Drug Administration, the agency that is responsible for ensuring the safety, and effectiveness, of the nation's food and drug supply. Here's a story from Scientific American looking at some of the rumored commissioners and leaders and here's a blog item from the New Jersey Star-Ledger's biotech reporter that has some advice on what to watch for.
Even after nine years of being both a reporter covering the biotech industry and then working for the association that represents it, there are still some days when you see "gee-whiz" technologies that could be total game changers.
Whether it's a smart-bomb drug for cancer like Genentech's Avastin, Biogen Idec and Genentech's Rituxan or Pfizer's Sutent, all of which have strong roots in San Diego, or diabetes treatments like Amylin's Byetta and Symlin, which despite recent trouble are still changing the way doctors treat diabetes, this industry and region is a hotbed for them.
This morning, we hosted a breakfast looking at new technologies life science companies are developing to help make gasoline green. Imagine using algae, wastewater and sunlight to grow "green crude" that can go directly into the nation's existing oil-refinery infrastructure to be developed into gas for your car. Sapphire Energy, a local startup that has secured more than $100 million in venture capital, says it can do just that. We also heard from Verenium, a cellulosic ethanol company working to develop techniques that could make ethanol in a more efficient manner without impacting food crops, and from Agripower, a startup that has a semi-trailer-sized biomass conversion system that generates electricity from biomass waste.
Brad Fikes at the North County Times live-blogged the breakfast meeting here, so you can check out some of his notes or click through the company links to get more information.
There are, of course, major challenges associated with dreams this big. The research and development happening now is laying the groundwork for an energy-independent future.
"We've got to do this in the next 10-20 years," says Dr. Stephen Mayfield of The Scripps Research Institute, and expert in the field of algae-based biofuels and scientific founder at Sapphire Energy. One of the major problems is how to effectively scale up the technology and processes.
"It's really tricky getting from the lab to the commercial scale," noted Verenium's Janet Roemer.
While the life science industry is famous for the long-development times many of its most successful, and important products take, these companies, and others like them, are certainly worth keeping an eye on. In an era when Detroit is asking for $25 billion from the government to help innovate its way to fuel-efficiency, it's great to see we have some of our own experts in the field, right here in our backyard.
As a native San Diegan who returned home after college, there's an image that always pops into my head as I go about my daily business of doing media relations and producing publications for Biocom, the Southern California life science association.
I'm sure anyone who was in San Diego in the early 1990s can remember the dripping faucet series of commercials aimed at getting citizens to conserve water. These stark, almost black-and-white commercials consisted of a slowly dripping faucet, with each drop echoing thunderously, urging people to do their part to conserve water by checking leaks and not letting the tap run. Clearly, these commercials did their job with me, as pretty much every time I brush my teeth I find myself thinking about these ads. (If anyone has found them on YouTube, I'd love to see a link.)
Water, of course, is a major topic on the pages of voiceofsandiego.org recently, and living in a city that imports 90 percent of its water and is in the midst of a major drought (and rationing like was threatened in the early 1990s), it isn't something that is going to go away.
And with something as contested as water rights, there have been some major pieces of both journalism and art that have looked at this issue from all sides and left a major impression on me that I wanted to draw some attention to.
There have been some excellent bloggers who have addressed this issue here on the pages of Café San Diego, including this look at our neighbors to the north in Orange County who recently opened up a massive groundwater replenishment water recycling facility, and this look at the process of indirect potable reuse.
The New York Times Magazine ran a recent story with the tough-to-swallow title of "A Tall, Cool Drink of ... Sewage?" taking a look at the half-a-billion dollar Orange County Groundwater Replenishment System and coming to the conclusion that "no naturally occurring water on earth is absolutely pure. And most everything that's in Orange County's reclaimed water is in most cities' drinking water anyway." Coincidentally, Elizabeth Royte, the author of the piece, recently wrote a book about bottled water, called Bottlemania, a subject of another eye-opening New York Times magazine story on waste associated with those ubiquitous plastic bottles of water.
There are two granddaddy pieces of art in the water wars of California, Roman Polanski's 1974 neo-noir film Chinatown, complete with Jack Nicholson as gumshoe detective, Faye Dunaway as the femme-fatale and John Huston as the twisted magnate. The other is Cadillac Desert, Mark Reisner's entertaining and authoritative history on all the water politics of California, which took several years to research and write, and was eventually made into an excellent PBS documentary. If you've ever driven up the 395 to Mammoth and wondered why, 300 miles north of Los Angeles, the chain-link fences and land behind them are noted as property of the Los Angeles District of Water and Power, you'd be hard pressed to find a more entertaining, or interesting, answer to that question.
Concerned SD Resident, you are absolutely correct on the concerns you've expressed, the first issue being the more difficult one. This is where I recognize that others need to get involved to reach positive change, that it's about more than a new street or apartment complex, but about people and their daily needs. About four years ago, Casa Familiar re-engaged in developing programming for youth to be able to provide another option for active, positive involvement in youths' lives, particularly young women. It developed a program that is still running today called "Young Leaders," which brings in guest speakers and addresses youth issues. The program involves youth in community events like the community Thanksgiving dinner that will be held at Casa on November 20th where the biggest volunteers are our youth.
During that first year there was also a trial program called "Girls Group" that was formed to try to figure out where young girls in the community were with respect to their own self image. This also brought in knowledge through other groups like the San Ysidro Health Center, the schools and other programs. Speaking from the information that was relayed to me, the program was a hit, but it was also a difficult balance -- providing information on some very difficult issues. I know that Casa Familiar leadership would like to continue to provide youth programming, but unfortunately it has proven difficult to fund.
It's funny how people around the community still call it "the city of San Ysidro," I used to immediately correct folks, now I'm much more sensitive about it. But this being a part of the city of San Diego is one of the main reasons why I've been active in the planning group for eight years now and continue to want to see some of the work that the committee has done in the ground. We always make a case for fairness for San Ysidro community and recreation centers and other infrastructure and we make sure we are getting our fair share and that other communities also begin to take on theirs.
Finally, I always invite concerned residents to become involved or active, even if it is just with one issue, because without that person's help, one more thing would continue to remain an issue.
I have to give credit to the great capacity that Casa Familiar has built for community organizing. We get the word out through a real strong network of direct contact from our services. What has successfully brought people together is that we've gone out of our way to make sure that from the outreach, to the presentation, to our request for community participation, that our presence is not overreaching or presumptuous. And to make sure that we listen to every comment or concern, no matter how difficult, but then making a point of moving forward. The "Sin Limites" sessions are special in that depending on the topic and what we set up as goals, we always ask for some interaction. There always seems to be some expression for the list of desires you mention above and I always try to remind attendees of what it takes to get some of those ideas to become reality. We have formed coalitions across organizations and interests where each has headed up some portion of the work -- or at least as much as can be tackled.
Through the planning group I try to ensure that those community elements are at least given a chance to be integrated into development projects, whether it is a private developer, an organization or government entities. We have begun with basics, like adding street lights for better lighting and security, done several walking tours to highlight what to us designers/planners might be easy to spot issues but really highlight lack of investment or removal of impediments. Then comes the hard part -- integrating all of this work through the local committees, organizations, plans and processes and constantly checking, updating and obtaining more community participation to ensure a good faith effort.
I was asked to write a response answering the following question:
When you realized you wanted to get involved and help your community, what did you do first?
By no means was integrating my professional work and getting involved with helping the community as clear a decision as maybe other folks have made, especially since my family is extremely entrepreneurial. I remember the clearest moment of this conversation was when I was getting ready to graduate from architecture school. I realized that through an architecture degree I could, if I wanted to, work hard to get into any number of architecture firms, which have really become global. For my architecture capstone project I launched into designing a more poetic and sensible pedestrian bridge for those visitors that walk across the U.S.-Mexico border (as opposed to using existing 5 foot sidewalks adjacent to 25 smog filled vehicular lanes) over the Rio Grande and that made an impact on me. That's when I realized that we have not given prominence to our border and therefore our border communities. So, I remember deciding that I really wanted to work in bringing good design and good projects to border communities where I felt there was a void to fill and where I would use my knowledge and understanding of place for the benefit of projects and therefore, border communities. I also felt that I could use my values of hard work and entrepreneurship in community building.
I was lucky in that I was working through architecture school with an architecture firm in Tucson that had built a niche in community master planning and affordable housing development. This experience was the key to realizing how important land use and urban planning is to the development of architecture. While I was well on my way towards community development work, I made the decision and got the opportunity to apply for and work for three years through a Frederick P. Rose Architecture Fellowship. This placement of recent graduates of architecture into community and housing development organizations allowed me to come to San Ysidro and work on these important border issues. However, the most important decision I've made is to continue the work after the fellowship, see the work through and allow for some stability and continuum in the long developing work of building community which was already started by my fellowship host organization, Casa Familiar.
As curriculum director for history/social studies in the San Diego Unified School District, my goal and my passion is to bring history back into the curriculum for our students. Because history is not a part of the federal No Child Left Behind testing requirements, the district for several years de-emphasized the teaching and learning of this important subject. It may be that administrators in the past followed the adage that "If it's not important enough to be tested, it's not important enough to be taught," but such is no longer the case in SDUSD.
And, here's something else to consider: In the midst of the historic election just concluded, we actually had parents questioning why teachers in history/social studies classrooms were devoting time to teaching about the presidential election.
Charles von Gunten, M.D., Ph.D. is a provost at The Institute for Palliative Medicine at San Diego Hospice.
As a physician, I believe that our knowledge about relieving the suffering associated with serious illness has never been more powerful in the 2500 years of recorded medical history than it is now -- but it isn't a standard for health care.
Yet, the relief of suffering is a topic for all ages, as evidenced in a song I came across on YouTube -- "DNR" by Nickelback. The first verse speaks to this:
I'm through with lying in bed here in the ICU
I'm on a respirator and I have a feeding tube
This life isn't ending up the way I want it to be.
Hospice care was the first place where new approaches to relieving suffering and improving quality of life have been developed over the last 50 years. Locally, San Diego Hospice and The Institute of Palliative Medicine is recognized as a leader in the relief of suffering and is helping to promote and teach new knowledge in the field of palliative medicine. Physicians from around the world participate in the largest training program in the United States for physicians specializing in this new field. They go on to be consultants in the nation's hospitals and hospices.
Just like other improvements developed first in the terminally ill, those discoveries don't apply ONLY to the terminally ill. Consequently, the development of palliative care programs in hospitals and clinics throughout the country and around the world has followed. Palliative care is a way to make all that new knowledge available to people before they are dying -- when they have months and years to reap the benefits -- even if they are cured!
Does it matter? As a healthcare consumer, yes, it does matter. About half of all hospitals have some aspect of a palliative care consultation service. More people are getting better attention to their symptoms and the other components of suffering.
The key to better access to palliative care is consumer demand. In contrast to the revolution in birthing that happened when women demanded that their needs be better met, there is little demand for improvement in the relief of suffering that accompanies serious illness. Consequently, there is little pressure to accelerate the pace of change.
You can make a difference. Speak up about the suffering associated with your illness. Expect that your physician will either address the pain and suffering that you and your family experience, or expect that the doctor will be able to ask for a consultation within your health system to provide the expertise.
Since the beginning of the recorded history of medicine during the time of Hippocrates in ancient Greece, there have been two overall goals of medical care: cure of disease and relief of suffering.
The relative emphasis on cure versus relief of suffering relates to both the underlying medical condition and the overall goals of the person who has the illness.
In the past 50 years, the relief of suffering as a goal of medical care was subjugated or lost in many settings in the quest to achieve cure and/or prolongation of life. In this model, the patient dies in spite of aggressive attempts to cure and prolong life. If the patient suffers, or if there can be no cure, well, it's not the doctor's fault.
Yet, who wants to suffer? Who wants to be a patient in an intensive care unit where one intensivist knows how to relieve the pain and suffering associated with being very sick, and the next one doesn't?
Because suffering is experienced by persons, its existence, character and criteria for relief is defined by the patient rather than by the physician. Suffering is caused by many factors that are rarely limited to the physical domain.
In providing whole person care to relieve suffering, palliative care addresses all dimensions of the human experience of illness that may be involved: physical, psychological, social and spiritual.
Palliative medicine is the fast growing new medical subspecialty that concerns itself with the relief of suffering. Quality-of-life -- rather than quantity-of-life -- is the chief aim of those engaged in the delivery of palliative care.
Known for providing comprehensive hospice care since 1977, San Diego Hospice and The Institute for Palliative Medicine has evolved in to one of the 10 largest community-owned, not-for-profit hospices in the United States, with the largest resource in the world for training palliative medicine physicians and other specialists.
Right here in San Diego, physicians from around the world participate in one of the most rigorous, cutting edge courses of study to learn new specialist skills, typically with a goal of pursuing a long-term career as a clinician or academician in palliative medicine. Training of physicians and healthcare professionals in the advances in this field is leading towards better care for patients and families. We are literally changing the way healthcare is practiced locally, nationally and globally. Learn more about it here.
Thanks to everyone who posted comments. It's great to see the interest in these important topics, and to see that the public (at least Voice readers) are relatively well-informed about the issues. For ease of reference, we'll try to address all the comments in one post.
Marco:
Thanks for your eloquent definition of Indirect Potable Reuse (IPR). We also describe the process in yesterday's post entitled Flushed.
Watcher:
It would seem that the City Council has at least realized the benefits of IPR, evidenced by their override of Mayor Jerry Sanders' veto of the IPR pilot project last year. Perhaps the mayor will come around after the November rate case vote for the city's pilot IPR project. This demonstration plant would process 1 million gallons per day and would be operational for two years. During that time, the plant would be subject to rigorous testing and public tours. The city's current plan is to build a full-scale IPR project the North City Water Reclamation Plant, with a 16 million gallon per day capacity. In addition to the pilot project itself, the city will conduct public outreach and distribution studies. If everything goes as planned, the pilot project phase will be done in 2013, at which point the full-scale plant comes into the picture.
One would think the lack of public opposition to the pilot project, the science behind the process, the economics of the alternatives, or the broad-based support of IPR would be a ‘perfect storm' that any politician would want to be front and center of.
Our recommendation is that the mayor use his water supply townhall meetings to educate the public about water reuse, instead of mischaracterizing the project. Allowing Water Department staff to conduct public outreach will also help in getting the word out. We applaud recent efforts by council members, Toni Atkins in particular, to help the community understand why leaders are recommending this direction.
Bottom line, in order to provide the city with a reliable, cost-effective, and environmentally friendly local water supply, the Mayor is going to have to reconsider his position.
Chris:
Our apologies on the inadvertent typo, although we're glad it made Shaun smile. As Judy points out, the process was anything but a rubber stamp. There's no need to take our word for it, or even Judy's, even though she was a participant. A comprehensive review of the process and the outcome is available in the actual study.
In terms of endocrine disruptors, please see our response to Patrick yesterday. The treatment process involves a three-step process which does remove the particles; in fact the water produced is so pure that it cannot be transported until minerals are added back into the water. This is certainly a much higher treatment level than what our current drinking supply receives.
Judy:
You are absolutely right about extending the purple pipe system. Except for a very few locations where the infrastructure already exists, it is a cost-prohibitive venture. The concept of double-plumbing an entire city or region should set off a red flag both for expense and for the possibility of cross-linkages. That's another reason IPR is so attractive -- it doesn't require a separate distribution system.
Thanks Patrick for the question. You're not the only one wondering about this issue. In fact, there's been a lot of concern lately about emerging contaminants in local drinking water supplies. The pharmaceuticals and cosmetic goods that find their way into our water supplies are present at very small concentrations. However, the cumulative impacts of years of exposure are unknown and there is evidence that even trace amounts cause reproductive problems in marine organisms and create antibiotic resistant bacteria.
The current methods used to treat our drinking water do not remove those contaminants. The same is true of types of bottled water which is much more loosely regulated than drinking water. The only real method known to remove those chemicals is reverse osmosis, which just happens to be the technology used in IPR. Coupled with microfiltration, UV radiation and hydrogen peroxide treatment, the IPR process creates pure water, free of pharmaceuticals and any other contaminants. The water is so pure, that minerals have to be added back in. The first part of the process, microfiltration is actually used in commercial industries to process baby food.
As an added bonus, by treating sewage through IPR, we'd be keeping the sewage out of the ocean, where it negatively impacts marine organisms.
With all the scientific advances we've made in the last century, we're sure to discover more unanticipated side effects of chemical and manufacturing processes. But by using the best technology available to treat our water now, we'd be safeguarding our water supply against any contaminants discovered in the future.
What's the difference between San Diego and Orange County when it comes to water? Same drought-prone climate, same end-of-the pipeline fears for supply reliability, arguably the same general conservative political atmosphere. So what's different? Orange County has a well-planned, well-researched, and well-regarded groundwater replenishment system.
Despite politician-driven fears over "toilet to tap" in San Diego, Orange County has been doing it for years at Water Factory 21. Since the mid 1960s, the plant has injected treated sewage into the ground to create a seawater intrusion barrier to protect aquifers used for drinking water. More recently, the Orange County Water District (OCWD) has been using the treated water to directly augment groundwater supplies. Since January of this year, OCWD has been turning sewage into drinking water and injecting it into the ground. The project has been a huge success, earning the OCWD the Toshiba Green Innovation Award and the Stockholm International Water Institute Award, which some consider the Nobel Prize of environmental science.
OCWD uses the same technology that would be used as part of San Diego's IPR. The only difference is the storage of the purified drinking water. Orange County has the luxury of plenty of groundwater storage availability. San Diego doesn't have the same groundwater aquifers to rely on, so local water supplies are stored in above-ground reservoirs. Instead of injecting the treated water into the ground, San Diego would store IPR water for at least a year in reservoirs, augmenting our (dirtier) imported water supplies. Before reaching your faucet, the water would be treated again. There's no distinction in the clarity or safety of the water between groundwater recharge and reservoir augmentation, the treatment is exactly the same. It's the storage of the water which explains the different nomenclature.
OCWD has also received numerous grants and aid to help fund its project. The district received $92 million in state and federal grants and $86 million in subsidies from the Metropolitan Water District. The Orange County Sanitation District also paid for half of the project costs because it saved them from building a second ocean outfall for its partially treated sewage. The result is drinking water that is more pure than our current supply, at half the cost.
Through the Groundwater Replenishment System, OCWD produces 72,000 acre-feet of water, enough for 500,000 people each year. With reduced pumping of the San Joaquin Delta and increasing global warming impacts, that makes quite a difference. But OCWD isn't alone. The same technology is used around the world to provide drinking water to people living in arid climates. Singapore and several cities in Australia also turn sewage into drinking water for their residents. As a fellow arid city, San Diego should look to these places for guidance and follow their lead.
No one is arguing that we can conserve our way out of the water crisis -- although that is where we must start. But if we move to the next tier, what does that look like? Call it water reuse, recycling, indirect potable reuse (IPR), reservoir augmentation, even the rather simplistic but catchy toilet-to-tap.
However you label it, the concept is simple: treating sewage to a level that's cleaner than our current drinking supplies, using the same technology as desalination plus a few steps to make the result even more pure. There has been a huge outpouring of support for taking water out of the ocean and treating it to a level suitable for drinking. But that's exactly where our slightly treated sewage is currently being disposed of -- in the ocean. And make no mistake; our sewage is not treated to federal standards before disposal.
It makes much more sense to treat sewage directly rather than dumping it in the ocean, then pulling it out a few miles away for treatment. IPR uses reverse osmosis, the same process involved in desalination. The problem is that desalination involves ocean water, which is four times more saline than sewage. Reverse osmosis requires far more pressure to treat the higher salt content of ocean water, the main reason for the energy (and cost) discrepancy between IPR and desalination.
From a purely economic standpoint, IPR makes sense. That's why businesses, trade associations like BIOCOM, and the San Diego County Taxpayers Association support it. Using the same state-of-the-art technology as desalination, but at a lower cost and without as much environmental impact, makes IPR the best choice for planned recycling.
In Orange County, the water district provides its ratepayers with drinkable treated wastewater at half the cost of imported water and half to a quarter the cost of desalinated water. One economic argument used against IPR in San Diego is that local governments would have to build the infrastructure. Desalination is a commercial enterprise, which means no up-front expenditure by local government. But therein lies the fallacy -- there's no such thing as a free lunch. If a private corporation is willing to build, it must be profitable, and the ratepayers (you and I) will have to pay for it down the road. Our locally proposed plant, in Carlsbad, is tied to the cost of imported water. The plant's owners are betting that the cost of that water is going to go up, meaning they can charge more for their water and eventually be profitable.
If the city of San Diego built a full-scale IPR project, or several satellite projects, it would save ratepayers money in the long run, given IPR's lower than desalination or imported water costs. The IPR hurdle isn't public support or technology; it's a failure to take the long-view.
The hot topic these days -- in the news, at the debates, even at the water cooler (pun intended) -- is water supply. The Colorado River is literally drying up due to climate change and over-allocations. A recent legal decision to protect an endangered fish (the Delta smelt) in Northern California will result in less water coming from the Delta to Southern California, while climate change conditions have reduced the Sierra snowpack, the primary source of water for that river system. Our own region is in a near-historic drought that has reduced even the little local water the region usually relies on, and increasing population in the southwest is adding demand for water at the same time supplies are rapidly diminishing.
As a water quality focused organization, San Diego Coastkeeper has been drawn in to the debate over water supply because the way the water gets to our tap or sprinkler or ocean has a lot to do with how clean our rivers, bays, and beaches are. That's why we've developed own water supply hierarchy -- what sources to look to and in what order.
First is conservation, the cheapest and most environmentally friendly way to increase water supply. While this may seem like a truism, and strides have been made over the past 15 years, more must be done to make conservation a regional priority. Whether that looks like mandatory restrictions, a water rate structure that prioritizes conservation for all customer classes, or enforceable water supply assessments for new development, we must do more with what we have.
Next in line is water recycling and water reuse, both potable and non-potable. We've been intimately involved in the City of San Diego's Water Ruse Study and are helping the City implement a plan to maximize the beneficial use of recycled water at the lowest per-unit cost. More about the Water Reuse Study's new water reuse pilot project in a later post.
Last on the list is desalination, done in an environmentally responsible manner. Contrary to some media portrayals, Coastkeeper isn't anti-desalination or anti-progress. However, current open-ocean intake desalination is extremely energy-intensive, which means trading water security for energy insecurity. Exacerbating global warming will simply accelerate drought, so we've consistently advocated for a holistic process to evaluate desalination's place in our water portfolio.
It means something different to everyone. If you're a builder, the key issue related to water is getting through your Water Supply Assessment so you can break ground, keep your crews busy, and begin building homes or commercial property. If you're a water agency, the relationship to water is source and supply based, securing a steady supply from the layers of wholesalers above the agency so the end users (homeowners, HOAs, businesses, the city, etc) have a supply of clean water. A surfer, sailor, and environmentalist like myself relates to water in a more visceral manner; we spend more time than the average person in and around water, and do not find sinus infections, sore throats, and gastrointestinal problems as a result of recreation time in the ocean acceptable (akin to getting sick during every trip to the gym). Environmentalists are frustrated that the Mayor's Office continues to turn a blind eye to the dumping of more than 180 million gallons of under-treated sewage into the ocean every day, the fact that our city has spent millions of dollars on 301h waivers from the Environmental Protection Agency to continue doing so, and refuses to take a serious look at purifying that water.
For the Colorado River guide, or the Northern California citizen and farmer, they have their own opinion of a city that continues to encourage rapid growth and does not look to solutions to minimize the amount of water it wastes. They do not understand how we can happily buy 486 million gallons of water a day from water sources that contain hundreds of millions of gallons per day of treated sewage, and industrial and agricultural runoff, to turn around and dump close to 200 million gallons of that as wastewater off of the coast without purifying and reusing that water. They do not understand how we would first turn to sucking water out of the ocean to create drinking water before we would purify our waste water for re-consumption and reuse as our neighbors in Orange County, in Scottsdale, Ariz., El Paso, Texas, and Fairfax, Va. do.
So what are we going to do about it? There are a number of issues at hand, all interrelated. We need to encourage conservation at home, in business and on the city level. This doesn't mean "20 gallon challenges" or asking the homeowner to bear the burden of conservation. It means we need to change certain laws and standards. High water consumers must not be allowed to continue to share their cost of overuse with neighbors who conserve, as the current HOA structure allows. The family who uses twice the amount of water as their neighbor should have to pay twice as much as their neighbor, not the same rate. Building codes need to be updated to require grey water systems in all new homes and buildings to clean and reuse waste water, and proper regulations and incentives need to be put into place to require all property owners to install grey water systems in their existing homes and buildings. Commercial property owners must be given the mandate and incentives to do the same. The Mayor's Office needs to do far more than rely on numbers that ignore the concept of waste water. His assertion that we should not purify our wastewater is based on the assumption that after you drink a glass of water you will never urinate it out; as if there is no drain or outgoing plumbing.
Rather than pursue another costly 301h waiver (which allows us to keep dumping under-treated sewage and wastewater into the ocean and making ocean enthusiasts sick), our hard-earned tax money would be far better spent upgrading our North County and South Bay water reclamation plants so that they can purify waste water. If we maintain the status quo, there is a good chance that in 2025-2030 we will either be forced out of San Diego by high costs, or our beautiful tourist-and business- attracting coastline will be littered with desalination plants and dead marine life from their intake pipes and briny solution dumped back into the surf zone.
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Hosting Café San Diego is Jill Holslin, Department of Rhetoric and Writing Studies at San Diego State University.
