Thursday, August 28, 2014
EBOLA, AIDS, AND INEQUALITY IN GLOBAL HEALTH CARE
Somewhere along the line a friend gave me the book Infections and Inequalities by Paul Farmer...and then I forgot to read it. A little while back I picked it up and started my way though it. Well, it is more than ten years old and discusses times even earlier on then that, but I can tell you now it is an amazing book. I haven't finished it yet, but I am already so impressed that I ordered two more books of his. My interest is, of course, multi faceted. I have a background of working in a free health clinic which included the early and mid years of the AIDS epidemic, and then continuing work in the field of community health at a large inner city community health center. I also worked on the streets with persons involved with drug use, homeless, runaways, and others. I also have some sort of strange long term interest in epidemiology and the like, in viruses and bacteria, in infectious diseases and plagues. Call me odd. Then, of course, I have been forever involved in the fight for social justice, against white supremacy, against inequality, etc. Put all that together and how could I not like Farmer's book.
With that in mind, you can imagine that I am following closely the outbreak of Ebola in Western Africa. Sure, I am trying to figure out what is going on with the virus itself. It seems to me to have mutated, obviously, and become maybe more virulent. More significantly is the individual human misery this disease causes, and the fear it spreads.
I have already written (see here) on the all too obvious racism which those in power, and the media have exhibited when it comes to this and earlier outbreaks. I noted that it wasn't until the media discovered that, low and behold, white people, Americans, Europeans had actually contracted the virus that their interest and efforts ramped up some. Few had cared when it was only Africans dying. We have I believe, so far dodged a bullet in not seeing more of an international spread of Ebola. I can't help but notice that with that fact, once more, the media has dialed back on its coverage.
In that same piece from Scission, linked to above, I talked also about the way Big Pharmacy and global capital are involved, are partners, are accomplices with the virus itself.
Today, I am turning to Paul Farmer to help explain all of this and most especially the effects of ever growing inequality in global health care which this outbreak makes once again (just as it did with AIDS) obvious. Without addressing inequality we can never really address disease. To me, of course, that means dealing with global capital itself, but there is more (and less) then that to do also. We have to deal with the myths and stigmas propagated, with the blame the victim mentality which creeps (actually more than creeps) into research, into health policy, into efforts to fight the epidemic, into all aspects of what is happening today in Western Africa, and which happens everyday throughout the world in other settings with other diseases and health issues. Need I recall again AIDS. Need I recall the early days, that many of you do not know, where the myths of a Haitian vector, of voodoo rites, of "dark practices in the night," stigmatized a nation and a people. Need I remind you of the way we blamed prostitutes and drug users and those people with "multiple sex partners." How black women were deemed a "risk." I know I don't have to remind you of the homophobia associated with this disease. We talked of risk groups and risk factors, and we never talked of poverty, of inequality, of what my wife, a nurse, now refers to as the Pathology of Poverty as THE risk factor...as the common denominator. I argued my head off with people and agencies that belatedly come to the scene about this during my years working with HIV disease. No one really wanted to listen. I actually grew tired of the arguing and began to feel like I was allowing myself to be used as some sort of token voice allowing others to feel okay with themselves. You see there was what I called the AIDS Industry, and that industry thrived on educating people who were already educated, on case managing the lives of people who were grown ups, of deciding who got bus passes, and what you had to do to get food, of on one hand saying only certain people (gays, drug users, hookers, Haitians) were at risk, but then scaring up money by saying everyone was at equal risk. It was an industry that existed, it sometimes seemed to me, more for the grant money, for the government funding, for itself (all the wonderful non profits or not for profits who in fact profited) then for the people it supposedly was created to help. Don't get me wrong, I met many wonderful people involved in the fight against HIV, and I met even more wonderful people with HIV itself. I remember the early days of the epidemic in a mixed way. I remember the anger that no one cared then when there was no money. I remember the bigotry of many. I remember the days when we had nothing to offer someone, at all, who had contracted the virus. I remember the days when I really thought that by now there would be no more gay men left. You know though what I remember the most from those early days of the plague years. I remember the absolutely incredible, remarkable response by some, mostly gay men, mostly the gay community who took it upon themselves to fight the disease and to support and help those affected by it. I remember the day at the small free health clinic where I worked when a wonderful gay man, a nurse, said to me, "Randy, we have to do something." I remember proudly that we did. With no money, with no concern about bureaucracy, of regulations our little clinic suddenly was flooded with gay men wanting, demanding to do something. Do something they did. It is a period of my life that I will never forget - before the AIDS Industry itself existed - when it was just gay men and a few other good men and women banding together in some form of solidarity and caring, unconcerned about individual agendas or personal ideology...coming together. I have never really experienced anything like it before or since.
And that brings us back to ebola. Think of all the times you have heard about "burial rituals," about eating bush meat, about people not following guidelines, of distrust of healthcare workers. Think of all the scary myths and all the fear. Think of how seldom you have heard that the common factor again is poverty, and, as always white supremacy and racism. Think of how seldom you have heard not about how poor Africa is, but of why that is so. Think of how seldom you have seen this or that government contribute anything to the actual fight against poverty, as opposed to merely contributing to the creation and maintenance of that poverty. Think about why polio is still here and growing, about TB, malaria, and cholera. Think even of the last time you heard a "left" organization, or party talk about plagues and their relationship to colonialism, Empire, and Capitalism...and then actually make that relationship a real part of their work.
Anyway, here to talk about all that and more is Dr. Paul farmer, taken from Truthout.
As the death toll the West African Ebola outbreak nears 1,400, two American missionaries who received experimental drugs and top-notch healthcare have been released from the hospital. We spend the hour with Partners in Health co-founder Dr. Paul Farmer discussing what can be done to stop the epidemic and the need to build local healthcare capacity, not just an emergency response. "The Ebola outbreak, which is the largest in history that we know about, is merely a reflection of the public health crisis in Africa, and it’s about the lack of staff, stuff and systems that could protect populations, particularly those living in poverty, from outbreaks like this or other public health threats," says Farmer, who has devoted his life to improving the health of the world’s poorest and most vulnerable people. He is a professor at Harvard Medical School and currently serves as the special adviser to the United Nations on community-based medicine. He has written several books including, "Infections and Inequalities: The Modern Plagues."