Global Health Exam 2
Scenes from the Life of Job unknown Flemish painter 1480-1490
"There was a man in the land of Uz, whose name was Job; and that man was perfect and upright, and on that feared God and eschewed evil." Satan tests Job's faith through trials and tribualtions the world makes no moral sense - Job loses his crop/living stock and his whole family dies Abandonment and endurance: - "Though he slay me, yet will I trust in him." Interpreted as an allergy of Jewish suffering and--in the postwar decades--the "meaning" of the Holocaust The potential value and meaning of suffering
Cultural competency
"for the provider of health info or health care, culture influences beliefs and belief systems surrounding health, healing, wellness, illness, disease, and delivery of health services. the concept of CC has a positive effect on patient care delivery by enabling providers to deliver services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients" - National Health Institutes of Health
Highest level of education among AAs 25 years and older in STL
** rates are about the same but women are higher in grad and college while men are higher in high school GED or lower ** Some college = 28% High School = 24% Grad School = 8%
The Spirit catches you fall down - Anne Fadiman
- Hmong migrants in Laos - Lia Lee (main character with epilepsy)
Lia Lee
- drug side-effects and strained doctor-patient relationships lead to worsening symptoms and episodes - social workers suggest that Lia be removed from parental custody** - they take Lia for medical tests and find that she was not receiving this full dose of treatments.. so they put her in foster care for months - parents criticize US legal system - Lia's parents insist that she needs spiritual treatment and that meds diminish the effects of spiritualism
Racialize Katrina
- due to large Black population - Shared suffering - Kanye West - Super done wasting used as a a Refugee camp -> wasn't enough water, Children were getting sick, Diarrhea diseases couldn't live in New Orleans anymore
Haiti and Blame
- genetic analysis of early samples shows that HIV was probably brought from central Africa to Haiti in the 1960s through migrant worker routes - complex and multifactorial spread in 1970s-1980s - blood donation circuits, international sex tourism, international business travel - discrimination and stigma against Haitian immigrants and opposition to immigration
Process by which segregation leads to poverty
1. Policies that led to: white families moving away from city centers and into suburban areas and housing discrimination against AAs 2. SEGREGATION 3. Fewer banks invest in AA areas, lower house values, separation from people who can influence policy 4. lower tax base, less funding for education and services like job training, poor job opportunities, businesses move out and fewer new businesses start 5. HIGH POVERTY
3 ways of sharing social suffering
1. interpersonal suffering 2. community-based suffering and coping 3. societal level suffering
life span of kidney donation
10-15 years of life span of a kidney from a deceased donor 15-20 years life span of a kidney from a living donor commodification of kidneys sourcing is itself a kind of structural and physical violence
Damage of Katrina
1300 Deaths 300,000 homes destroyed $96 Billion in property damage 3x that of Andrew (92) , even more for Ivan (2004) and Camille (69)
Household income for AAs in STL
16% (the highest percentage) is less than 10,000 and 15-25,000 <1% makes 200,000 or more 1% makes 150-200,000 14% makes 25-35,35-50,50-74
Federal Funding for the Ryan White Program
1991-2012 .2 billion --> 2.4 billion
Emmanuel Levinas
1st order - "useless suffering" 2nd order - "meaningful in me", "being-called" Survived Labor camps and went on to have a minorly successful career Writing in the 60s and said I am done with theodicy - no meaning to this, no justification for this suffering , community suffering
Hurricane Katrina
2005 Category 4 hurricane hit New Orleans became a symbol of social suffering
Syrian Refugee Crisis
2011 to 1015 - 1,250 --> 3.8 million people displaced They live in UN refugee camps Quality of life in these camps is sketchy NGOs need to supplement food, water, nutrition, medicine
High school grad (Indig vs. Nonindig)
25% for indigenous 52% for non indigenous
Inpatient hospitalizations per 10,000 for mental health conditions under 15 in St. Louis 2011
55 AAs (77% higher) 32 Whites
For the Sake of All
A report on the health and well-being of AA in St. Louis and why it matters zip codes have a huge difference in life expectancy - downtown is 67 (almost 20 years younger)
Homeownership among AAs and whites in STL
AAs - 58% rent and 42% own Whites - 74% own and 26% rent Lauren: this has history to it
ACT-UP
AIDS Coalition to Unleash Power 1987 silence = death 1. release aids drugs now 2. emergency federal program to end aids now 3. end HIV related discrimination 4. quality health care for all
Number of children receiving ART globally, and by WHO region
African region increased enormously compared to any other region
Great Leap Forward 1958-1961
Communist Party - 3 years - they wanted to transform China from a peasant society to high industrial one (tractors instead of shovels) Smelt --> steal products --> machines Villages had smelting devices and everyone in the village had to come bring their shovel and pitch fork and put it in these big flames Agriculture suffered because they had no tools People say it's the worst decision they could have made "Three Bitter Years"
Merced Hmong Story
Community engagement exhibit at Merced College Related to refugee camps, the war, experiences in Laos
Structural competency (article)
Culture itself narrowly stigmatizes our understanding of how to treat When is something structural? ex. diabetes -- is a more complex issue than consumption
China's Death Rate and Calories/Day
Death Rate - sky rocked up from 12% to 26% from 1958 to 1960 and began to decreased around 1961 back down to 10% at 1962 Calories/day - decreased in 58 from >2000 to 1500 by 61 and began to rise back up to 2000 by 64 18-55 million deaths
Concepts of AIDS in Haiti
"sent sickness" associated with sorcery "city disease" associated with sex work, travel, and exposure to the capital "natural" sickness preventable via condoms
quag dab peg
- condition of distinction - afflicted people have special powers epilepsy = seizures --> special powers/spirits
Poverty in STL 1980-2010
AAs - 27%->29%->25%->30% Whites - 5%->5%->6%->8%
ER rates due to chronic diseases and conditions by race in STL 2011
EVERY disease was more prevalent in AAs than Whites Heart Disease - 25:8.6 Asthma - 20.2:2.5 Arthritis - 14.9:4.4 Hypertension - 6.8:1.0 COPD: 5.3:1.8 Diabetes - 4.3:0.7 Stroke - 0.5:0.1 Cancer - 0.3:0.1
UNAIDS graph
HAARTs were discovered way before (1996) they were introduced PEPFAR 2003 - number of people receiving antiretroviral therapy (ART) deaths by AIDS starts decreasing around 2005 7-8 years where the death rate is climbing (NOT in US) Access to meds is not quite there yet
New Orleans ground elevations and area maps
Levies built in case of flooding in 1969 - Did it on the cheap, tried to save money - Structural violence built into infrastructure - Levies broke and entire city flooded
Hurricane Maria and Puerto Rico
Media coverage - Puerto Rico = under reported compared with Texas and Florida - 86% of people are without electricity - 70% are without internet - The idea that Puerto Rico is not American comes into play - We cant really say that we relate, it's not a states, it's a colony
Race differences after Katrina
NOLA got Whiter (28% to 43%) - AA's were affected the most and displaced as Katrina refugees
Projected Life Expectancy
Non-Aboriginal = Highest by 10 years of so Inuit = lowest First Nations and Metis are about the same = fall in the middle *higher overall for females
Hmong-Mien languages
Spoken throughout south/southeast Asia
Postsecondary Education Level (25-54 year old Canadians)
Trades = metis is the highest at 16% the rest are around 12-13% College = Non-ab and Metis are about 22% the rest are about 18% University = non-ab is 25% where the rest are 3-9%
common barriers to condom use
cost & poverty embarrassment purchasing condoms in stores religious proscriptions masculinity, prowess, pleasure men often make decisions about condom use in relationships and sex work exchanges women often lack power or agency to discuss condom use alcohol or drug consumption
African AIDS related complications
deaths began to decline in the year 2007 Why the gap? drugs were too expensive 10,000 a person per year
People with HIV in Haiti
increased from 1990 to 1994 stayed constant until 2001 and then slightly lowered until 2009
Hmong participation in Vietname War in 60s/70s
war led Hmong to cling even more tightly to culture and identity.. but led to loss of self-sufficiency and a need to migrate as refugees The Ban Vinai (Thailand) camp
One World, One Hope
Discovered HOVs - Came out of funding from ONE WORLD, ONE HOPE - It came down to access to medication Global nature of HIV/AIDS It increases in Africa in the 80s
Aids & Accusation: Haiti and the Geography of Blame - Paul Farmer
Does the scientific "theory" that HIV came to North America from Haiti stem from underlying attitudes of racism and ethnocentrism in the United States rather than from hard evidence? Physician and anthropologist Farmer studied the impact of AIDS on the impoverished people of Haiti, and his portrayal for his doctoral dissertation, of a small rural village--its clinic, religious life, folk healers, and voodoo beliefs--brings Haitian culture powerfully to life. He provides an extensive history of the country, finally exploring the connection between suffering and blame: Americans have blamed Haitians for "causing" AIDS, while Haitians have accused one another of "sending" it through sorcery. Rarely is a book based on a dissertation so engaging. Highly recommended for academic and subject collections.
Politcal violence, ethnic conflict, contemporary wars: broad implications for health and social well-being
Duncan Pedersen USA = 500/600 million dollars a year exported weapons to other areas (largest arms exporter) arms trade is the largest economy in the world ($800 billion annually) and detracts from health spending diminished war between advanced democracies... but increased and conflict in postcolonies wars have significant social and health impacts... and there is not enough attention paid to "the local patterns of distress being experienced and the long-term health impact and psychosocial consequences of the various forms of political violence against individuals, communities, or specific ethnic groups" social sufferings, lack of shelter, food and water shortages, pollution, destruction of infrastructures, emergence of infectious diseases, mental illness, and suicide, displacement of fracturing of social units
Proportion of Dwellings in Need of Major Repars
First Nations on reservations was the highest by far at 45% (increased from 1996-2006) Non-Aboriginal was below 10% (decreased from 1996-2006) First nation on reserves, metis, and inuit were all around 20% until 2006 Inuit went up
Adult HIV Prevalence Rate by Region, 2013
Global - 0.8% Sub-Saharan Africa - 4.7% Caribbean - 1.1% Eastern Europe/Central Asia - 0.6% Latin America - 0.4% North America/Central Europe - 0.3% Asia/Pacific - 0.2% Middle East/North Africa - 0.1%
The Invisible people - Greg Behrman
How the US has slept through the global aIDS Pandemic, the greatest Humanitarian Catastrophe of our time Difficult morality of not attending to HIV in Africa
Australis (Indig vs. Nonindig)
Indigenous people die much younger than non-indigenous people
A salvage ethnography of the Guinea Worm
Jimmy Carter's eradication campaign in Ghana in the late 1980s What did it take so long to eradicate the guinea one? - Local fit Blend of cultural and structural competency Humans drink water and ingest fleas with larva in them Jimmy Carter went to West Africa to teach people how to drink water from a straw This is what Amy Moran's article was about Invent straw that filters water so that people could drink water without dramatically changing the landscape Vertical project that focuses on the straw
The "Right to Know" or "Know Your Rights"? Human Rights and a People-centered approach to health policy
Joseph J Amon Know your HIV status "right to know" movement began as a strategy of testing at-risk groups "mandating testing.. may seem like an effective public health approach, but it fails to address the barriers and real risks that people... face" what happens to people one they "know"... do they receive medicines or other forms of support? do they face stigma or shunning? can they even tell loved ones? loss of family, housing, or property "know your rights" movement... focuses on the right to health as a human right and access to medicines and legal protections
Vita: Life in a Zone of Social Abandonment
João Biehl Zones of social abandonment are emerging everywhere in Brazil's big cities—places like Vita, where the unwanted, the mentally ill, the sick, and the homeless are left to die.
community based suffering and coping
LeBron James was saying he has a relationship to this kind of death Political claim related to justice, equality, violence "I can't breathe" "strong" - togetherness, community ex. Boston Strong Orlando night club - togetherness
The Suffering Stranger: Medical Anthropology and International Morality
Leslie Butt goal of much anthropological scholarship is to "enhance descriptions of suffering" people who are undergoing affliction and struggling are transformed into "suffering strangers" with the goal of eliciting "sympathy from afar" rather than presenting interesting or sentimental stories, scholarship should advocate for concrete actions in the areas of social justice and policy
"After Life" - Joan Didion
Life changes fast. Life changes in the instant. You sit down to dinner and life as you know it ends. The question of self-pity. Her husband died in the NY, had a heart attach at dinner This is my attempt to make sense of the period that followed, weeks and then months that cut loose any fixed idea I had ever had about death, about illness, about probability and luck, about good fortune and bad, about marriage and children and memory, about grief, about the ways in which people do and do not deal with the fact that life ends, about the shallowness of sanity, about life itself.
Magic Johnson
Living with AIDS - science is offering new hope for others
SCYAYFD - idendity of family
Mom has an attachment to place and landscape - crucial to understand their relationship with doctors powerful sense of cultural identity egalitarian farming society - in mountains lack of assimilation in China, Laos, and the US (ultimately the result of the vietnam war)
Tyranny of the Gift: Sacrificial Violence of Living Donor Transplants
Nancy Scheper-Hughes - anthropologist and founding director of Organs Watch social construction of the organ as a "gift" masks the physical manifestations of wounds and the concrete risks of condition gender issues and inequalities... women are seen as more of the donator globally but there are contexts in which donation is associated with manhood and masculine honor
Mental Illness and Katrina
People experienced mental illness Was related to how long they were displaced - loss of home, items, maybe even family/friends
Kidney World Order
Recipient countries = USA, Canada, Australia, a few smaller ones Donor countries = south american ones, china, lots of the middle east, south africa Typical Recipient: Age 48 Male, income=53,000 Typical Donor: Age 29 Male, income=480
GI Bill 1944
Returning soldiers get funding for housing and college went to get money from the government
TAC - Treatment Action Campaign
Right to life is inshrined in our constitution, proud resources for health to activists Transformed positive results as being something to be proud of social suffering
Dove advertisement
Soap is political - Racially insensitive ad by Dove Certain racialized bodies have been associated with cleanliness Clean... whiteness
Racism against Japanese
Social suffering can lead to identification with social trauma, race, stigma Western Defense Command and 4th army wartime civil control administration - instructions for japs not welcome in many places "Japs keep moving this is a white man's neighborhood
"doctors don't know anything" Seth Holmes
South America/Central America vegetable pickers - Always wearing bandanas and long sleeves = sun, heat stroke Lack of documentation - don't have access to social services, education for kids, health care Labor camp - migrant workers would live, no roof, traps heat, no windows, rodents
structural competency
The trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases also represent the downstream implications of a number of upstream decisions about such matters as health care and food delivery systems, zoning laws, and urban and rural infrastructures
Moran-Thomas on Jimmy Carter
This project takes so long because there are not infrastructural changes Took decades Cultural interpretation that the worms were placed in body at birth Why did international agencies come with drinking straws to try to cure a disease that doesn't really kill anyone or cause pain? Instead of helping a larger disease like HIV???
Delmar Divide
Top: Home value: 78,000 Income: 22,000 5% went to college 99% AA Bottom: Home value: 310,000 Income: 47,000 67% went to college 70% white
Technologies of Self - Poverty and Health in an Urban Setting
Veena Das - study of health and poverty in Delhi - study of medical pluralism in a vast field of sources and resources - navigation of public and private clinics, healing traditions, and lay and expert models as individuals cope with multiple afflictions - subjectivity composed not as a direct response to crisis, but in the flow of relationships and in relation to institutions and others - critique of illness narratives - "conception of subjectivity forged in the workshop of everyday life"
Life expectancy at birth, by race and sex 1970-2009 USA
White female - 76->81 AA Female - 68->76 White Male - 68->75 AA Male - 60->71
Educational attainment in STL 1960-2010
Whites - 17% --> 70% AAs - 9% --> 50%
Infant Death rate in St. Louis 1950s-2000s
Whites - 22/1,000 --> 5/1,000 AAs - 41/1,000 --> 15/1,000
Unemployment rates in STL 1970-2010
Whites 4% - 8% AAs 9% - 22% (took a dip in the 2000s but is back up)
societal-level suffering
as a result of major historical processes and events Processes that are social in nature and effect population ex. WW1 - 25% of Oxford's men died "Lost generation" ex. WW2 Poland lost 17% of population... SU lost 14.2 % - 25 million people
Arthur Kleinman's "conjoint approach"
bring traditional healers and family members into the process as active collaborators and remake biomedicine to incorporate stories, subjectivities, and complicated historical and social realities
Book - Social Suffering
by Arthur Kleinman, Veena Das and Margaret Lock
characteristics of structural violence
different than "direct violence" often invisible and difficult to pin down a locus of agency--making it perhaps seem unreal or unchangable -normlaized, routined, taken for granted -policies and structures cause "bio-inequalities" (inequality in schooling as biological effects)
Hmong perspective
doctors do not listen, belittle the patient, use the patients as bodies fro experiments, ask prying and sensitive questions, take blood sample, issue dangerous medicines "yes" = listening but no comprehension (micro dynamic - a lot of info is not getting conveyed
Mill Creek Valley
early 1950s 20,000 inhabitants (95%) black, 800 businesses 1954 Federal Housing Act - in conjunction with local capital, led to "urban renewal"
interpersonal suffering
face-to-face, intimate, familial La Pieta - Michelangelo 1499 Mother is taking on the suffering of son (Christ) - Faces have this magnetism - We can understand in our interpersonal relationships... we hold hands, talk to them, be there for them -> Neither person is alone, alienated
Lia post hospital
for 2 years Lia was kept alive by modern medicine in a "persistent vegetative state" after leaving hospital in a near-fatal state, she recovered... doctors said it was due to natural processes and reduced swelling, Lia's parents to herbal remedies Lia's case is common: avoidance of care due to lack of cultural sensitivity or any adequate means of addressing issues of culture and history among clinicians Lia Lee died of pneumonia - outlived life expectancy by 25 years
% of people 15 and 49 with HIV in Haiti
huge increase from 1990 to 1994 slow decrease until 2009
Deaths due to HIV all Ages Haiti
increase from 1990 to 2002, slow decrease until 2009 (8000)
Deaths from HIV/AIDS in the US, 1987-2008
increased until 1995 and then huge decrease! Huge decrease in HIV - Shifted the textures of fear associated for HIV HIV --> condoms have life saving power Is condom still compulsory even though HIV isn't lethal?
Kazuo Ishiguro
is Awarded the Nobel Prize in Literature wrote never let me go
Structural violence...
is one way of describing social arrangements that put individuals and populations in harm's way.. the arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people" - PIH co-foudner Paul Farmer (Pathologies of Power)
Pruitt-Igoe
joint urban housing projects first occupied in 1954 in the U.S. city of St. Louis, Missouri By the late 1960s, the complex had become internationally infamous for its poverty, crime, and racial segregation the 1950s and 1960s, the Army performed chemical tests by spraying radioactive chemicals on and around the building. All 33 buildings were demolished with explosives in the mid-1970s, and the project has become an icon of failure of urban renewal and of public-policy planning.
Merced
large Hmong refugee population since 1970s - economic, cultural, language barriers in healthcare and history of marginalization, violence, and hardship that influences interactions with institutions and authorities
No saben nada
migrant farmworkers miss appointments, do not follow-up, and demonstrate avoidance of the healthcare system Language barriers, lack of transporation ,no medical records, undocumented status, fear of deportation "don't know anything" = signal a lack of structural awareness in this context, "cultural competency" ought to be reframed as "structural competency" effective healthcare delivery would need to attend o structural issues and problems
Pneumocytis Pneumonia - LA
oct 1981-may1981 5 young men, all active homosexuals, were treated for biopsy-confirmed Pneumocytis carinii pneumonia at 3 diff hospitals. 2 died. All 5 had CMV infection and candid mucosal infection
"After Life" - Joan Didion - textures
ordinariness of death-event speed, quickness, a blur confusion, lack of preparation technical terms used by the paramedics and health professionals at the scene of the heart-attack and the hospital are confusing and alienating temporality of loss and grief loss is loss of familiarity - assuming his presence silence and space - apartment feels empty, lonely, useless things - death certificate, books, clothes
US AIDS related complications
reached an all-time high 1995, same year that ARVs were initiated and then approved as standard treatment by the FDA in 1996
Ryan White HIV/AIDS Program
ryan white care act 1990 largest HIV/AIDS program in US provided services and treatments for people living with AIDS in low-income and marginal populations 2006 reauthorization expanded the program to cover people living with HIV
For Use By White People
sign on bathroom in south Africa - Apartheid Regime - White people are so much richer than everyone else - social arrangement
problems for Lia in the healthcare system
stereotyping of Hmong as transplanted "from Stone Age to Space Age" counseling and social work leave parents more confused parents disagree with how much medicine Lia is getting and the use of a spinal tap... then they are labeled as "non-compliant" doctors violated a core cultural taboo by communicating to Lia's parents that she will die if they do not comply-taken as a threat parents believed that the medicine was making her more sick, which led the doctors to believe that her parents wanted her to die
"In Bed" 1968 The White Album - Job Didion
talks about migraines and what its like to live with a disease that comes and goes doctors say they cant really help thought of as "imaginary" no real, concrete problems for doctors to tackle captures subjectivity
Ryan White
the boy who battled with AIDS (through a drug transfusion) When Ryan White tried to return to school, he fought AIDS-related discrimination in his Indiana community. Along with his mother Jeanne White Ginder, Ryan White rallied for his right to attend school - gaining national attention - and became the face of public education about his disease. Surprising his doctors, Ryan White lived five years longer than predicted. He died in April 1990, one month before his high school graduation and only months before Congress passed the legislation bearing his name in August 1990 - the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.
subjectivity
the quality of being based on or influenced by personal feelings, tastes, or opinions (real def)
Social Suffering
very popular in the 2000s
Infant mortality rate (Indigvs. Nonindig)
was double for aboriginal population in Australis 6.2 vs 3.7 (is about 4 or 5 in US)
Government wide spending on HIV/AIDS
went from 44 million to almost 10 billion from 83-99
