In 2010 there was a terrible earthquake in Haiti that caused unprecedented destruction. Thousands of people died, homes were destroyed, and what infrastructure existed was decimated.
Shortly after the earthquake, the country experienced a devastating cholera outbreak. There had never been a case of cholera on the island before.
Cholera is a nasty disease that can kill a healthy adult in as little as three hours. It is easy to treat, but thousands of people in Haiti died before health workers were able to control the epidemic.
How can this be?
Yes, Haiti is poor and the infrastructure was in disarray. But surely the people who planned the response knew that cholera was a possibility?
It bears repeating that although infectious disease is spread from bacteria and viruses, there is always, always a social component to disease. As Charles and Clara Briggs wrote in their excellent ethnography about a cholera outbreak in Venezuela, Stories in the Time of Cholera: Racial Profiling During a Medical Nightmare:
Epidemics are ‘mirrors held up to society,’ revealing differences of ideology and power as well as the special terrors that haunt different populations[…]
Cholera created a charged, high-stakes debate about the lives of the people it infected, and competing stories bore quite different policy implications.
So what stories were being told about the cholera outbreak?
At first, the international aid community including the UN tried to blame poor infrastructure. Health workers stepped up education campaigns about clean water use (which is kind of a joke in a country that was completely ravaged by the earthquake). The response tended to emphasize existing problems with the water delivery system, poverty, poor hygiene, and living conditions that were ripe for this type of epidemic. The UN launched a major cholera aid package that some say was just repackaging an aid effort that already existed.
But in the end, they had to own up. It turns out that UN aid workers brought it with them. Not on purpose. But still. They were actually the vectors.
It’s fitting, I suppose, that this is the conclusion. After all, the history of Haiti is an endless story of outsiders bring poverty, violence, disease, devastation.
So how do you create an epidemic? Act first, think later. Don’t ask for advice. Don’t consult an anthropologist. Hope for the best. Rely on old worn-out narratives. Emphasize feeling and emotion. Charge in to save the day.
Cholera was the most vivid example of the latest tragedy visited on Haiti, but surely there were more. What about the American aid workers who went to save the day, like this guy, but came back feeling disappointed when people on the street just wouldn’t stop begging for money:
It’s very frustrating because, again, it’s this strange combination of being dependent, but also expecting it. And that can be very disheartening because the reality is no aid project is going to work if you don’t have people that you’re trying to help bought into it in wanting to help themselves.
Or the foreign aid that often benefits companies from the US while at the same time undermining local economies. Or that fact that medical aid organizations can sometime swoop in without trying to integrate themselves into the existing medical system, with the unintended consequence of leaving the local healthcare system in worse shape than they found it.
Haiti is trying to sue the UN for damages. Here’s hoping that they win.
Don’t you hate these kind of motivational posters? I do. They are corny and cheesy, but sometimes these types of insufferable cliches resonate.
I’ve been in a funk lately, a creative rut. I work at home, I spend lots of time with a three year old, and as a freelance, I am responsible for getting my own business. It feels like there are never enough hours in the day, and sometimes I’m like a hamster in a wheel, going around and around and not getting anywhere, coming up with the same unworkable solutions again and again.
So I love to hear about t innovations or radically different ways of thinking, examples of ahem, turning lemons into lemonade. This article in yesterday’s NYT provides an excellent example of this approach in action.
Remember how we have this messy, mean, non-existent, non-cohesive healthcare system in this country that refuses to provide federally funded healthcare for all?
The folks that run community health centers interface with this impossible reality every day, and they’ve come up with one way of making a dollar out of fifteen cents: using brownfields — or really polluted land — on which to build health clinics.
It’s not as crazy as it seems. The federal government allocates EPA money to clean up these sites, so it’s a creative way of getting extra government funding to build clinics. Lemonade out of lemons. You get the picture.
According to the New York Times:
[This is] a nationwide trend to replace contaminated tracts in distressed neighborhoods with health centers, in essence taking a potential source of health problems for a community and turning it into a place for health care.
And why is this extra important?
By 2015, the number of Americans who rely on community health centers for care is expected to double to 40 million from the 20 million who relied on the centers in 2010, according to the National Association of Community Health Centers.
It’s just this kind of thinking that’s needed to come up with creative, innovative solutions to the gigantic healthcare coverage in this country.
And personally, I’m inspired to think about my own goals in a new way, and to think about how to make liabilities into possibilities.
What do you think?
Back when I was young and idealistic, there was nothing I loved more than a good protest.
I vividly remember the first time I attended a demonstration — it was on Parliament Hill in Ottawa, Canada and were were protesting the incarceration of Nelson Mandela. After that, I was hooked.
I’ve marched against police violence in Seattle, white supremacy in Montreal, and sexual assault in Iowa City. I’ve taken back the night more times than I can count, and I’ve faced off against loggers (one of whom was wearing this T-shirt) in British Columbia’s Clayquot Sound as part of a protest against clearcutting.
I once demonstrated against impending restrictive abortion regulations in Seattle, and carried this sign:
On my way home, a young boy stopped me and asked me to explain what the sign meant. Awkward.
I used to get goosebumps and a thrill at the first sound of a good chant. I loved rousing speeches promising social justice, peace and equality. During the Bush
reign of terror administration, I took a bus from Iowa to Washington,DC to protest the invasion of Iraq. The experience was thoroughly exhilarating at the same time that it was extremely depressing. Enormous demonstrations were held all over the world, but we all know what happened in the end.
It was this lifelong interest in social justice that propelled me to seek employment in the non-profit women’s health field. When I finally got a full-time job writing for a major reproductive health and HIV organization, I was beyond excited.
But instead of rousing speeches and radical movement toward social justice, I found career climbers and male dominated board rooms. Public health initiatives seemed top-heavy and destined to fail, success was measured in tiny percentage points. People talked about “stakeholders” and “gender champions” and said things like “scale-up” and “roll-out” and “capacity building.”
The employees at this non-profit didn’t protest, in fact, they found protestors to be quite threatening. I was enlisted to help write a paper about the travesties committed by ACT-UP. And yes, dear readers, I did it.
This morning, there was an article in the L.A. Times about a group of young people disrobing in front of John Baynor’s office in protest of cuts to domestic AIDS funding. I found myself thinking about the importance of this type of dramatic, confrontational action. There’s no worry about funders disapproval or concern that you might be burning bridges with potential allies. This kind of action reminded me that there are still plenty of people who are able to concoct creative ways to engage with the political process, to express rage at inequality, and yes, even to demand social justice.
I’m not much of a sign-holder anymore, perhaps those kinds of actions are best left to the young and idealistic. But while I might not be one of the people who strips naked on Capitol Hill, I’ll always be sitting on the sidelines, silently cheering them on.
What do you think? Do you go to demonstrations? Do you think that protests like these are good tools for political change, particularly when it comes to health policy?
Yep, it’s inevitable. Another week has come to an end. In health news this week:
- Saturday is World Prematurity Day, which is very close to my heart since my son was born 12 weeks too soon. The US isn’t doing a great job in preventing prematurity, we’re currently 113th in the world in numbers of preterm births (?!). According to the World Health Organization, 15 million babies are born too soon every year. That’s more than one in 10 births — and more than one million of these babies die shortly after they are born. The WHO and the March of Dimes estimate that three-quarters of preterm babies who die could survive without expensive care if a few proven and inexpensive treatments and preventions were available worldwide.
- Turns out that doctors with less than ten years experience spent an average of 13% more than more experienced physicians. I like this study because it looks at how physicians — instead of patients — are responsible for escalating healthcare costs. This isn’t something that you hear very often. =
- Drug makers called “compounders” are to blame for the recent meningitis outbreak caused by fungal contamination in a steroid prescribed to people with back pain. These companies (like Ameridose, the company responsible for the tainted steroid in question) are essentially unregulated by the FDA. They have been supported by many in congress because their products are often an affordable alternative to huge drug manufacturers. One argument about regulation was that states should be left to do it themselves. This confirms my theory that whenever a government official makes a states’ rights argument, it is cause for concern.
- A study of pregnant Medicaid recipients in 14 southern states found that African-American women were more likely than to have longer hospital stays and pregnancy complications. The study estimated that eliminating disparities in adverse pregnancy events could save between $114 and $214 million annually in Medicaid costs in the 14 states studied.
- Access to contraception is a human right. Even the United Nations says so.
Have a great weekend! Meet you back here next week, when I’ll be posting about healthcare in-sourcing, premature birth, and sharing an interview with a wonderful doula and author!
Have you heard about this case in Ireland where a woman was denied an abortion and died as a result?
Savita Halappanavar, a 31 year old dentist, was 17 weeks pregnant with her first child. She began having severe back pain and was told that she was miscarrying. She then requested that her doctors medically terminate the pregnancy, but was denied because abortion is against the law in Ireland. She died of blood poisoning a couple of days later.
There has been worldwide media attention on the case, since it’s a situation where an abortion actually would have saved the life of the mother.
Ireland’s constitution officially bans abortion, but in 1992, the Supreme Court ruled that it should be legal when a woman’s life is at risk.The government never passed a law to this effect, which means that Irish physicians are very reluctant to perform abortions, regardless of the circumstances.
In 2010, three women sued the Irish government in the European Court of Human Rights for denying them access abortions. The women each had extenuating circumstances: an alcoholic with four children, two of which were disabled; a woman undergoing chemotherapy, and a woman who had taken emergency contraception that had failed to work. The court found they had no right to abortions under the constitution, and their complaints were dismissed. However, the court also found that Ireland’s ban on abortion even in the case of life-threatening pregnancies was in violation of European Union law.
Halappanavar’s death coincided with the release of a long-awaited expert report that recommends possible changes to Irish abortion law. The report was commissioned by the Irish government after the 2010 European Court of Human Rights ruling.
Currently, about 4,200 women travel outside of Ireland every year to terminate pregnancies.
I’m as pro-choice as they come, but you’ve got to give it to the Irish. They are so adamantly against abortion that they sought a travel injunction against a 14 year old who was raped by a neighbor and whose parents were trying to get her to England to have an abortion.
They refuse abortion in all cases. No matter what. No exceptions for rape, no exceptions for life-threatening conditions, no exceptions for the threat of fetal-alcohol syndrome, or neglect, or deformity caused by chemotherapy.
It ain’t pretty, but if you are against abortion, then own it.
They acknowledge that sometime women die when they don’t have access to safe, legal abortion. They have no problem with the fact that outlawing abortion means that women and girls are forced to carry pregnancies to term and then parent children that are the product of rape when they are denied access to safe and legal abortion.
That’s the reality, and at least the Irish government is willing to take the fall out.
What do you think?
Angela Wall, PhD. is the communications director at Breast Cancer Action, the San Francisco-based advocacy group that calls itself themselves “the bad girls of breast cancer.” She’s a cultural critic, rabble rouser, mama, organizer, communications expert and feminist who’s doing important work for women’s health.
This week we had a great conversation about health activism, the use of humanities degrees, and opportunities for women working in the health non-profit sector.
What is your job? What do you do on a day-to-day basis?
I’m the Communications Director at Breast Cancer Action. We’re a feminist health organization that advocates to stop cancer where it starts. We’re different from other breast cancer organizations because we’re very political. We also question the dominant primarily pink paradigm of breast cancer activism through our Think Before You Pink campaign.
A big part of my job is thought leadership which includes writing, editing, and motivating. I’m always conveying the urgency of why protecting women’s health is an important issue.
BCAction has a unique brand and a powerful, fiery, passionate voice. I’m the gatekeeper of that voice, and it’s my job to make sure that all publications that go out reflect this. I talk to the press, do media outreach, set up interviews, work on the strategic aspect of campaigns and help program staff to publicize and organize their materials. I’m the go-to publicity person.
You took a bit of a winding path to get to this position, and I’d love to hear you ended up doing this work. You have a PhD – what was your experience in academia?
I have PhD in Feminist Cultural Theory (Cultural Studies), so my first inclination was to be an academic. My dissertation was on reproductive technologies and reproductive health: the whole mess of what it meant to be a woman in a world of new reproductive devices and technologies at the end of the 20th century.
After I finished my degree, I taught at Georgia Tech in the Literature, Communication and Culture program. It was a heavily male dominated environment, and I while I loved teaching and the students, I got burnt out. Being in academia wasn’t what I felt passionate about.
So after you left academia, what did you do?
Eventually, my partner and I moved to San Francisco, California where he got a job, and I worked for a small tech start-up, doing focus groups, consumer research and general marketing. At no point in my life would I ever have thought that I would end up in that role. Advertising was the belly of the beast! I worked for three years for a great company, but at the end of the day I hated the idea of working for the corporate sector, so after I had my daughter, I quit.
How did you connect with Breast Cancer Action?
Unlike many women, I didn’t get involved because of a personal experience; it was more out of a political impetus. When my daughter started preschool, I began volunteering in the BCAction office a couple days a week. I wanted a place to re-enter the working world, and a feminist non-profit that focused on women’s health seemed like a great place to do that.
A friend and I did had done a pro bono project for BCAction whilst I’d been working, using our marketing experience to perform focus groups to look into what prompted women to take action in breast cancer. We explored how women understood the word activism. This research helped shape the organization’s strategic plan. When the director of communications quit several years later, the then Executive Director asked if I would step in while they hired for the position. I began as a consultant and eventually extended to a permanent hire. I’ve been working at BCAction now for almost four years.
Did you have any training or background in health issues before you started doing this work?
As a graduate student, I was really involved in ACT UP, reproductive rights, and abortion clinic defense. As I mentioned, I also wrote a dissertation on reproductive rights. I don’t have any medical training though.
I had considered getting an MPH, but there are very few times when I actually need that medical background. I think that not being a scientist actually ends up being an asset, since part of my job is to translate science and medical language for the lay woman. So much of the work of BCAction connects the dots between all that’s said and written about breast cancer and its actionable impact on women’s lives.
Much of my educational background worked on challenging the whole construct of what counts as factual objectivity in science and pulling to the forefront the reality that science is grounded in a cultural network of language which is subject to a whole host of conventions, traditions, and biases. The idea that writings about science are somehow more objective and less biased than other kinds of writing is a false dichotomy. Scientists carry their own cultural experiences and biases into their work even if they think they don’t.
Research is persuasive because so often so much is at stake: there are funders, stakeholders, future grant dollars etc., tied up in research results. We have to put it in context and peel back layers to understand the full story and connect the dots.
This is particularly true when it comes to drug trials. So many of them are funded by pharmaceutical companies and they are not unbiased: they are not in the business of putting patients first or advocating for improved women’s health, they’re in the business making money and are held accountable to shareholders.
What are some of the things you like about your job?
One thing I really appreciate is that my day-to-day job requires that I use the critical thinking skills I acquired through my humanities education. I have to ask questions like: why is coverage of this issue in the New York Times wonky, what’s being left out and why? What’s in need of critique? Where are the gaps in the presidential debates? What’s not being said? I have to use my critical thinking skills to draw out the ways in which women are not put first when it comes to the health agenda.
There are days when I feel like I was specifically trained to do this job.
What advice would you give to women who are interested in working for a health advocacy organization?
I love being able to tell women who are trained in the humanities that there are alternative career paths out there! Teaching is not your only option. Nor do you have to go into the corporate world. You have very specific skills that a whole variety of organizations can use.
The best way to get your feet wet is to do an internship or do some volunteering. Many non-profits require self-driven, motivated people. The pace is fast and there are not a lot of resources for training, learning and professional development. Identify organizations that you are really interested in, whose work and writing lights a fire under you, follow their campaigns, blogs, Facebook, and mailings.
Ask yourself, does that sounds like something that interests you enough to do eight hours a day? You need passion to do a non-profit job—your reward does not come with your paycheck.
My experience has been that women are generous about opening doors for other women looking to follow this career path.
Thanks Angela! I’m so glad to have made this connection, and look forward to some great future collaborations.
Would you like to be profiled as part of this series or do you know someone who you think I should talk to? Drop me a line at jcmoffett at gmail dot com.
Hey girl, Mittens has your back.
Need a job?
In the economy I’m going to bring to play, we’re going to have employers that are going to be so anxious to get good workers they’re going to be anxious to hire women.
Man, this economy is going to be so poppin’ that employers will be falling all over themselves to hire ladies. We’re a damn good deal and I’m sure Mittens will keep it that way.
Need some birth control?
I don’t believe that bureaucrats in Washington should tell someone whether they can use contraceptives or not. And I don’t believe employers should tell someone whether they could have contraceptive care of not. Every woman in America should have access to contraceptives.
That’s right. Nobody can tell no one nothing. Yes, you can’t not have no access to your pills!
But best of all, Mittens has a big pension.
It’s really really big. Obama even admitted it:
I don’t look at my pension. It’s not as big as yours so it doesn’t take as long.
I think I’ve finally decided who I’m voting for. What about you?