The Case of the Curious Disease
Three years ago, when a strange illness surfaced among workers at an Austin slaughterhouse, state health investigators and researchers from the Mayo Clinic stepped in to search for the cause. Their sleuthing not only got workers back on the job, it also resulted in the discovery of a new disease.
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CAROLE BOWER watched as a young man slowly trudged toward her up the stairs to the third-floor medical clinic, each step an energy-sapping effort. Bower, the head occupational-health nurse at Quality Pork Processors (QPP) in Austin, treats employees’ health issues every day. Soft-spoken and professional, dressed in nursing white, she’s just the sort of soul you’d want to talk to if you were sick or injured, and QPP employees typically go to her for everything from cuts and strains to flu symptoms. But what she was seeing now was of a different order, and the young man’s condition contributed to her already growing sense of concern. ¶ It was late summer 2007, and over the past few months she and the five other nurses in the clinic had seen several previously healthy employees reach such states of incapacitation that they could barely drag themselves up the stairs. They all complained of similar symptoms—various levels of fatigue, tingling in their fingers, the inability to stand for long periods of time, pain, headaches, difficulty walking—and taken as a pattern, the complaints indicated something ominous. Bower had a hunch it was coming from somewhere on the processing floor.
She referred her patients to the Austin Medical Center, which is part of the Mayo Health System and is located across the Cedar River from QPP, just behind the Spam Museum. She also notified the medical center’s chief of staff and QPP’s senior management. As it turned out, several others with similar complaints had been visiting the center since the fall of 2006, getting care from a variety of doctors. One person, however, had spoken with almost all of them: Carol Hidalgo, the medical center’s Spanish interpreter.
Hispanic immigrants, according to the U.S. Bureau of Labor Statistics, comprise the largest proportion of workers in the nation’s meat and poultry industry. Mostly young and male, they are attracted to the industry because it requires little English. Indeed, the 1,300 workers at QPP resemble a mini United Nations, and many of them count Spanish as their primary language. Hidalgo, who regularly interacts with Spanish speakers who work in Austin’s meat-packing industry, called the doctors’ attention to a disturbing fact: All of these patients exhibiting the suspect symptoms worked at QPP.
MOST OF US WHO EAT MEAT prefer to think of beef, pork, or chicken as predictably shaped protein sources that originate at grocery stores, neatly packaged in plastic and Styrofoam. But the reality of the abattoir is far from neat. At QPP, for example, 19,000 live hogs, delivered by an endless succession of trucks, are slaughtered every day and moved through what is basically a “disassembly line,” emerging at the other end as cuts of meat. Many cuts go directly to the adjoining Hormel plant to be processed and packaged as everything from pork chops to Spam. They are then sold across the country and around the world.
The work at QPP is physically demanding and sometimes dangerous, performed in bloody, greasy surroundings marked by a pungent odor. The most common injuries in this industry are cuts, strains, and repetitive-stress injuries, such as carpal tunnel syndrome. However, the situation at QPP clearly indicated something different to the doctors in Austin: To them, it resembled a condition called inflammatory neuropathy, a general term used to describe what happens when nerve tissue is inflamed due to an immune-system response.
In September 2007, doctors at the Austin Medical Center brought in Daniel Lachance, MD, the then consulting neurologist from the Mayo Clinic in Rochester. Professorial-looking and articulate, Lachance is a specialist in neuro-oncology and neuro-immunology, especially autoimmune nervous-system disorders evaluation and research. After reviewing the cases, he recalled seeing a patient three years prior who had similar symptoms. Another patient with similar symptoms, seen in 2006, had been treated with steroids. The treatment helped alleviate the symptoms, but the patient got sick again after returning to work.
In the field of neurology, doctors routinely see individuals with puzzling symptoms. That’s especially true at the Mayo Clinic, which attracts people from around the world seeking diagnosis and treatment for exotic illnesses. Yet, this was a cluster of patients from the same area, with the same symptoms. “In the general population,” says Lachance, “the frequency of people with inflammatory neuropathy is two to five in 100,000. But we were in a town of 20,000, and there were 12 cases. We knew we had a big problem here.”