I didn't find that Paul Farmer, MD was saying so much unique in the Chapter 2 excerpt taken from his book. Most people already know that poor people are going to be faced with more disease, whether it be AIDS, tuberculosis, stress, or the common cold. But the unique modern source of rising evolution of new infectuous epidemics is due to more than just poverty. It is due to..... < it's not just an absence of resources. It's an absence of resources around those who do have resources.> Here, Paul Farmer HAS identified the dangers of the combination of a multi-tiered world medical system, in the production of dangerous evolution of new infectous epidemics. It's the contrast, not just one extreme structural problem (poverty) that produces disease. Let's elaborate some..... Farmer uses an example of isolated poor in Haiti that have one set of disease- tropical sprew, as compared to those poor in the city that come into contact with the better off. He finds that that is the combination (resource -side by side with non-resource) that produces a greater likelihood of a diagnosis of AIDS. From the same set of symptoms.... initially, comes two set of outcomes, resulting from separate social circumstances in collision. Inequality, not just poverty. It is this clash of two worlds, that is worse at producing disease, than just the problem of poverty in isolation. There is something in the clash of contrasts that is overwhelming medical resources. The problem appears to be the overlap of two treatment models... not allowed their fight against infectuous disease in a singular circumstance. Living on the Texas/ Mexico Border, one can see this contrast acutely. One side has patients receiving, oftentimes, hundreds of thousands of dollars of treatment, with the other side having about a $4 per day minimum wage ...and pennies for treatment! That effects how antibiotics are prescribed; an overuse used in excessive care, vs an underuse combined in non-care, or erratic intervention. It is this mixture of methodology on a world scale, that is even more dangerous than just the non-treatment that might arise from poverty alone. Medicine must 1) either use antibiotics consistently or 2) not use them at all; but not 3) do both at the same time in an arbitrary manner based not on science, but rather social circumstance. Not to do so, is to invite a world medical breakdown through promotion of new, ever-evolving, infectious disease. Tony --------------------------------------------- Here below, Farmer has presented a deeper insight into the nature of the problem of fighting infectuous diease, beyond just the obvious. <if you come in, let me put this way -- I'll put it in the negative and the positive and I'll stop. If you come into the clinic and you have a chronic enteropathy. You've had diarrhea for two weeks. And you say, I have fevers and chronic diarrhea. And you have the wasting disease. It's called various things like Slim Disease. Or we were calling it The Look back in the 80's. Literally in English I saw it called The Look. I don't think it's what Twiggy had in mind. But in any case, you would say, where do you live? And they'd say I live in Village X. And have you ever worked in Port au Prince? No. Who's your daddy? Just kidding. Who's your partner? And they would say, well, he's a peasant. And you'd say, he's not a truck driver? No. Not a soldier? No. Ever had a partner who was a truck driver? No. I would say to that person you have Tropical Sprew. It would not be HIV. And then I'd talk to you about this only later on after sending off all these tests. You'd get a social history if you were good at it. And then the HIV test would be negative. Now if you got the other social history, that is, I lived in Port au Prince, I worked as a maid, then you start worrying. So these women work as domestic servants in Port au Prince. And/or they have as partners truck drivers or soldiers. Now in sociographically flat rural Haiti, that is everybody shares the same socioeconomic status, which is miserable. Misery as they call it. And none of them have any money, with two exceptions at the time. Soldiers and truck drivers. So then in the end you could say okay, well, this is really the story of gender inequality and poverty -- that is, social inequalities. Because it's not just an absence of resources. It's an absence of resources around those who do have resources. It's not enough to say, "It's poverty, man." It is, but it's also poverty cheek and jowl by wealth -- or lack of poverty. In other words, the steeper the grade of social inequality, the more risk for HIV. So it's not enough to say, "It's poverty, man." It is, but it's also poverty cheek and jowl by wealth -- or lack of poverty. In other words, the steeper the grade of social inequality, the more risk for HIV.> _______________________________________________ Crashlist website: http://website.lineone.net/~resource_base
