Tagged: public health

How to Start an Epidemic

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A cholera epidemic was just one of the unnintended consequences of UN health workers

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.

Ten Great Books About Women’s Health

I'm committed. So don't spoilt the ending.

I’m committed. So don’t spoil the ending.

I don’t read too much non-fiction these days. Right now I’m speed reading  Gone Girl . It’s kinda sorta okay but makes me feel like my brain is melting. I don’t really like Gone Girl, but I can’t stop reading it. It’s kind of like my sugar addiction.

On my shelf waiting to be read I have Swamplandia and The Time Traveller’s Wife. This month my reading list fits  my demographic profile way too neatly. Amazon could peg me perfectly.

To my credit, the last time I went to the library, I checked out Far From the Tree, Buddhism for Mothers and  In the House of the Interpreter. But I haven’t read them yet. This summer I read everything Jamaica Kincaid ever wrote (except this one) . She is so perfect. But I also read The Happiness Project.  Please don’t let me read Jodi Picoult. If I read Jodi Picoult, it’s all over.

Anyhoo, back when I was a full-time smarty pants, I spent countless hours reading nonfiction, I read about health. Particularly women’s health. There is so much out there, and I feel lucky to have been introduced to it. So in case you’re looking for something to read that’s not a white lady novel, here  we go.

Ten great books about  women’s health:

1. Killing the Black Body: Race, Reproduction and the Meaning of Liberty. Dorothy Roberts is a great writer. This book will help you understand the racist undertones of much of American political discourse about reproductive health and entitlement programs.

2. How the Pro-Choice Movement Saved America: Freedom, Politics and the War on Sex. Cristina Page. Best title ever

3. Cunt. Speaking of titles… okay, it’s a little crass and the language is tiny bit outdated, but Inga Muscio’s take menstruation, reproductive health and sexual freedom is still empowering

4. A Darker Ribbon. One of the most well-researched critiques of the breast cancer movement that is not preach or overly academic.

5. Reproductive Rights and Wrongs: The Global Politics of Population Control. This should be required reading for anyone working for — or wanting to work for —  an international development organization.

6. The Spirit Catches You and You Fall Down : A Hmong Child, Her American Doctors and a Collision of Two Cultures. A can’t-put-it-down kind of read written by a journalist.

7. Testing Women, Testing the Fetus: The Social Impact of Amniocentesis on America.  An ethnography of genetic counseling. A little bit on the jargony side, but still a good read.

8.   Pathologies of Power: Health, Human Rights, and the New War on the Poor.Paul Farmer will make you want to try and save the world.

9. Safe Food: The Politics of Food Safety. You are what you eat. Marion Nestle.

10. How to Have Theory in an Epidemic: Cultural Chronicles of AIDS. Would get the award for best title if I hadn’t already given it to Cristina Page. Paula Treichler is one of my favorite smarty-pants writers.

And one bonus book…

11. Birth as an American Rite of Passage. Robbie Davis-Floyd. A classic. Read it.

What about you? What are your favorite women’s health books? What did I forget?  And hey, what are you reading? I’ll forgive you if it’s Jodi Picoult.

Five Radically Different Approaches to Women’s Health

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So often, public health interventions are boring — recommend more education, evaluate an existing program, come up with a list of resources….yawn.

But although they don’t always make headlines, there are lots of fantastically innovative people working to improve women’s health. I’m always excited to see these types of projects which have the potential to do so much good.

Here are five truly different approaches to improving women’s health:

  1. Naturopathic Oncology. Seems like a contradiction, right? Wrong. I’ve been intrigued by efforts to initiate more natural approaches to cancer treatment ever since I researched breast cancer activism in graduate school and met the woman who started this  great project. But apparently, naturopathic oncology has started to take hold in the more mainstream medical field, and the Seattle Cancer Treatment and Wellness Center actually has naturopaths on staff.
  2. Cultivating and caring for “mad gifts”. The Icarus Project has a completely unique approach to mental health. Rather than calling it “mental illness” they “envision a new culture and language that resonates with our actual experiences of ‘mental illness’ rather than trying to fit our lives into a conventional framework.” So important, and so rare.
  3. Midwifery and fertility services for the rest of us. Not surprisingly, most prenatal care is very straight-oriented. But Maia Midwifery takes a different approach, prioritizing the needs of queer families. I love that the approach is so radically different from some of the overly granola earth-mama stuff that is part and parcel of most midwifery practices. Also in California is ReCLAIM Midwifery, which focuses on transgender health. This is true innovation, but it will probably be a very long time before this approach is incorporated into mainstream prenatal services.
  4. Real sex education. Rather than the lip service paid to sex education that happens in schools, Scarleteen is a resource for teenagers that provides a wide range of resources. Created in response to 1998 abstinence only policies, the site uses message boards, tweets, Tumblr feed, SMS (and Facebook and even Pinterest)  to connect with its audience, and has zillions of real life questions and answers. I hope it’s still around when my four year old is a teenager.
  5. Telling and talking. Speaking of four year-olds, after a completely useless preschool lesson on Martin Luther King Jr. (my son learned that King “changed our world” but had absolutely no idea why or how) he told the teacher that  he would like to learn about where babies come from. Awkward. We took a trip to the library afterwards, and I satisfied his curiosity with a picture book called It’s so  Amazing. But this isn’t the end of these types of questions, so  I’m excited about  this series of books developed specifically for families with children conceived with donor assistance.

What about you? Have you heard of exciting, cutting edge programs or innovations in women’s health?

Turning those lemons into lemonade

Lemonade

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?

 

Silence still equals death

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Did you know that Saturday was World AIDS Day?

I wasn’t paying attention. Like so many Americans, I have the luxury of acting as if the virus doesn’t exist.

But AIDS is still a major problem in the US. I live in the South, the region of the country that experiences the highest rate of the disease. But most of the time (or even all the time) it’s completely off my radar. There are lots of reasons for this, one of which is the fact that people living with HIV/AIDS are largely invisible. For all I know, my neighbor could be HIV positive, but I would have no idea. Unlike breast cancer or even depression, HIV is so stigmatized that people with the disease remain completely hidden.

Remember that old mantra, silence= death? It still does.

When was the last time you saw a “I’m HIV positive” bumper sticker? Or even a red ribbon?

HIV continues to be a disease that highlights social inequality. According to a new report:

  • Black women account for 64% of all new HIV diagnoses in the country
  • Nine of ten of the states with the highest death rate of HIV are in the South
  • Approximately 1 in 16 Black men will be diagnosed with HIV in their lifetime

If these numbers make you shudder, they should.  I know 16 Black men, many of whom are family. Statistically, one of them could have HIV, but if they do, I wouldn’t know it. We don’t talk about it.

One innovative  strategy for addressing this issue developed by the NAACP in partnership with Gilead Sciences is to engage Black churches as partners in preventing the onslaught of this disease. They’ve  developed a training manual for pastors in Black churches, guiding them on how to address HIV/AIDS in their communities and emphasizing that it is a social justice issues.

Highlighting the interconnectedness of social inequality to health disparities is one of the most crucial ways to improve public health. The training manual encourages pastors to be inclusive to gay and lesbian congregants, and to exercise compassion as part of a mission to save lives.

It’s an unlikely partnership in some ways, but one that is meaningful and that will hopefully prove to be effective.

What do you think? Has HIV/AIDS affected you at all? Have you heard of other unlikely partnerships aimed at preventing other diseases?

 

 

 

 

Getting a mammogram won’t save your life

Actually, no it doesn’t. And just FYI, this campaign is sponsored by the American College of Radiology.

For almost two decades, breast cancer has been a very visible public health issue. Women over the age of 40 (or sometimes 50) are pressured by doctors, health advocacy organizations, friends, family and pop culture to submit to a yearly mammogram. It could save your life, we’ve been told.

We’re told not to worry about the discomfort or pain, the strangeness of having your boob squished like a pancake in a giant X-ray machine, the possibility of false positives. We’ve been reassured that the level of radiation to which we are exposed is minimal.

This insistence on yearly screening has seemed problematic to me for many years, in part because of my  own observations working in the healthcare industry.

For a year, I had a job at the Family Medicine clinic at the University of Washington. My job was to check in patients, call in referrals, file their paperwork and be the friendly face they saw at the front desk.

One of the things I noticed was the number of scans that women were being asked to undertake. Full body bone density scans. Mammograms. Abdominal x-rays. Pap tests. The doctors offered (and sometimes directed) women toward an onslaught of screening tests.  On the other hand, male patients were rarely sent for routine screening exams.

It doesn’t take a genius to guess that this might be an issue. After all, we have no reason to think that researchers or clinicians take women’s health more seriously than men’s health. Yet there is a history of putting women’s bodies under the microscope, of seeing them as breeding grounds for disease, of poking and prodding and monitoring.

This annoyance and irritation at the way female patients were treated by the medical field t propelled me into graduate school. Why was there such an interest in promoting mammography? What were women really getting out of it? What did the pink ribbon really mean?Do mammograms really save lives?

Turns out, the answer is no.

A new observational study published in the New England Journal of Medicine oncluded that mammograms don’t work. In his beautifully argued op-ed in the NYT yesterday, David Newman points out that although observational studies are not the gold standard, in this case the approach was strategic. The study confirms the conclusions drawn from a series of clinical trials: Mammograms might increase diagnoses and may increase treatment, but they don’t save lives. You’re just as likely to die from a breast cancer detected from a mammogram as you are from breast cancer you detect yourself.

So why do doctors and health advocates persist in pushing women to get the test?

Newman puts in this way:

[T]he trial results threatened a mammogram economy, a marketplace sustained by invasive therapies to vanquish microscopic clumps of questionable threat, and by an endless parade of procedures and pictures to investigate the falsely positive results that more than half of women endure. And inexplicably, since the publication of these trial results challenging the value of screening mammograms, hundreds of millions of public dollars have been dedicated to ensuring mammogram access, and the test has become a war cry for cancer advocacy. Why? Because experience deludes: radiologists diagnose, surgeons cut, pathologists examine, oncologists treat, and women survive.

While Newman doesn’t bring in a feminist or gendered analysis of this issue, it’s sitting right there, the pink elephant in the room. Just like the continued marketing of hormone replacement therapy, or the lack of non-invasive methods to detect cervical cancer, mammography has been accepted practice for so long because culturally,  it’s perfectly fine to expect women to submit themselves to poking and prodding and examination.

What do you think? Have you had a mammogram? Will you get one (or stop getting one) after hearing about this study?

 

Getting naked for social justice

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?