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.>
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