Mountains Beyond Mountains, by Tracy Kidder
Random House, New York, 2003
Mountains Beyond Mountains is the story of Dr. Paul Farmer, a famous infectious disease specialist and an even more famous defender of the poor. While he is still in medical school, he builds up a medical clinic in Cange, a treeless and godforsaken part of central Haiti and raises money so that patients with drug-resistant TB can have the expensive drug treatment that can cure them. He also becomes involved with curing poor TB patients in Peru and with TB sufferers in jail in Russia. Later he focuses on fighting HIV and AIDS.He is a workaholic doctor and fund raiser who hates being away from his patients and thinks it is a privilege to take care of them. He does not think it is a privilege to be a hotshot doctor who speaks at the U.N. the World Health Organization conferences, and with wealthy donors like Bill Gates. Doing these things and using his charm helps him get the money and the policies to make life a little fairer for poor people.
Paul Farmer hates the idea that resources are scarce but only when it comes to the poor. The idea that the rich deserve great medical care and living conditions and the poor don’t because they are responsible for their bad luck makes him fume especially because it is the exploitation of their land and resources by the rich and powerful that has made the poor people poor.
Quotes
The problem is, if I don't work this hard, someone will die who doesn't have to. That sounds megalomaniacal. I wouldn't have said that to you before I'd taken you to Haiti and you had seen that it was manifestly true (191).
Farmer is explaining to Tracy Kidder, who has to try to keep up with him, why he gets hardly any sleep, works an insane amount of hours (100 hours a week, and will work in Cuba and go back to Haiti the same day with no rest. He does spend his time saving lives in places where there aren’t a lot of other doctors or sometimes any doctors. For him losing patients is so painful that he would do anything to save them.
It’s a parallel universe. There really is no relation between the massive accumulation of wealth in one part of the world and abject misery in another (218).
Farmer is talking about how so many wealthy people, corporations, and governments take no responsibility for the poverty of other people.
My suspicion is that [bankers] are not getting a lot of sex, because they spend a lot of time screwing the poor (253).
Farmer is angry at a banker who thinks that if Haitians could control “their sexual appetites,” AIDS would not be a problem. He hates the ignorance of wealthy people who convince themselves that it is their own fault that poor people are poor and don’t admit that it is bad governments and greedy rich people who have taken the resources where the poor people live so that there are no jobs.
I think, sometimes, that I'm going nuts, and that perhaps there is something good about blocking clean water for those who have none, making sure that illiterate children remain so, and preventing the resuscitation of the public health sector in the country most in need of it. Lunacy is what it is (258).
Farmer is talking about what happened in Haiti when the U.S. stopped giving funding to Haiti because it did not want to support President Aristide, probably because he was not a dictator it felt it could control. Farmer cannot see how punishing poor people for being poor is a sane thing to do. It is definitely an inhumane thing to do.
That's when I feel most alive, when I'm helping people (295).
This quote gives another idea about why Farmer works so incredibly hard. He almost says that he is selfishly helping poor people. Since Farmer lives for his mission of having a democratic world in the sense that everyone would be treated equally, he is most alive when he is looking after someone who needs his help.
In the last part of Mountains Beyond Mountains, when Farmer is trying to control the spread of AIDS, he had to fight people who thought that in poor parts of the world it was only possible to try to prevent AIDS not to treat it. Using antiretroviral drugs would be too complicated and expensive. Just as was the case with drug-resistant TB, Farmer had to argue that sick and dying people have a right to whatever the new technology was producing whether they are rich or poor. Wealthy people act as though dying is just something that poor people do because they can’t afford treatment and even if they get it for a while because someone is generous, they won’t be able to “sustain it,” meaning keep paying for it. Farmer greatly admires Cuba for using its poor resources well enough to have excellent health care and fight the spread of AIDS. There is success at the end of the book when the Gates Foundation gives Farmer’s organization $45 million to wipe out drug-resistant TB in Peru, and Farmer helps George Soros with his $13 million grant to fight TB in Russian prisons after the fall of the Soviet Union. The original plan was just to give the prisoners the first-line drugs, and if the drugs did not help the prisoners could go to a hospice to die. Farmer is inspiring because he acts on what he believes, which is that dying people are all part of humanity and they are even more helpless if they are poor. He takes responsibility to try to save them and he thinks they are all of our responsibility (commas).
Wednesday, December 22, 2010
Tuesday, December 21, 2010
HW # 25 - Response to Sicko
HW 25 Michael Moore film, Sicko
1. Michael Moore’s opinion of health care in the U.S.:
The U.S.health care system is a disaster because it operates to make a
profit instead of to save lives. The 50 million people who don’t have
health care are screwed but so are the people who have it because
insurance companies charge them a fortune and find ways
not to pay for their health care. This country is the only western
democracy without universal health care. Doctors in England live well
without making a fortune like U.S. doctors, and their drugs are 500% cheaper.
Insurance, drug, and health care companies make billions here, but Americans
Are dying from lack of care including 9/11 heroes, while terrorists get
great treatment at the U.S. naval base in Guantanamo, Cuba.
2. Evidence
a. First example - Michael Moore has as insurance employee tell him that his job is to process claims of insured people not to pay for their health care but to find loopholes so the company can refuse to pay.
Second example - When Moore goes to a Canadian hospital and asks people where they pay, they just laugh at him, and he finds out that hospital cashier only pays out money to people who need it for their transportation home.
b. The first example supports his argument that having for profit insurance companies decide whether or not to pay for people’s health care and have the power to make them go broke paying for their surgery when they have paid for their insurance is a disastrous health care system. The second example shows a caring health care system where people can
go to a hospital to try to get well without having to worry if they can
afford their operation.
c. Here is what an insurance company representative has to say about insurance companies finding ways not to pay in Sicko:
IGNAGNI: In every doctor's office, in every hospital, in every health plan, yes, it's true, in all of those situations. No margin, no mission. If you're not in the black, then you can't do your job. The individuals that we cover, 250 million of them, expect to have their health care coverage. We saw eight to 10 stories featured in the film, and, in fact, there was no attempt to get the other side of the story. And I know for a fact, because many of these cases are eight to 10 to 15 years old, there is another side of the story. In many of these cases featured in the film, it was simply a case where the health plan was interpreting, was this coverage purchased by the employer? Now, we can have a debate about whether employers purchase enough coverage. Not only is this insurance person not denying that there are people whose job it is to find ways not to pay claims, this person is also saying that the problem is that employers need to buy more insurance. I think that this shows Moore is right about saying that insurance companies should not have anything to do with health care. They are only in it for the money.
This fact check from Sicko shows how insurance companies try to cheat with false claims:
Blue Cross/Blue Shield: "Sixty-seven Blue Cross/Blue Shield companies across the nation have paid the United States a total of $117 million to settle government claims that Medicare made primary payments for health care services that should have been paid by the Blue Cross/Blue Shield private insurance companies, the Department of Justice announced today." "Blue Cross/Blue Shield Companies Settle Medicare Claims, Pay United States $117 Million, Agree To Share Information," Department of Justice News Release, October 25, 1995. http://www.usdoj.gov/opa/pr/Pre_96/October95/551.txt.html
Example of direct confrontation – Moore talking to Blitzer (CNN)
Moore: You said that Germany was the only one that was better than us in terms of wait times. The Commonwealth Fund last year showed of the top six countries, we were second to last, next to Canada. It showed that Britain, for instance, 71 percent of the British public, when they call to see a doctor, get to see the doctor that day or the next day. It's 69 percent in Germany. It's 66% in Australia. And you're the ones who are fudging the facts. You fudged the facts to the American people now for I don't know how long about this issue, about the war.
d.Fact check:
L.A Times: March 28, 2006
Former Members Sue Blue Cross
The state's largest health insurer systematically -- and illegally -- cancels coverage retroactively for people who need expensive care, 10 former Blue Cross members claimed in lawsuits filed Monday.
Read more: http://newsbusters.org/node/13866#ixzz18ndVVeLd
I think Sicko was an important movie to make. People talk all the time
about what a terrible health care system we have, and I have seen the bad
side of it myself. Right now my family’s health insurance is temporarily
not available because a doctor my brother saw after a sports injury overcharged
our insurance company by $15. I found this out when I went to play in a
soccer tournament, and we had to have insurance. The doctor has to pay it
back for us to have insurance coverage even though we pay $1,000 a month for health
insurance. I think the dramatic trip to the U.S. navy base at Guantonomo in Cuba with the three guys who had helped on 9/11 and couldn’t get health insurance was great. Not only does Michael Moore get to show that the suspected terrorists involved in 9/11 can get health care paid by the U.S. and the people who risked their lives to save World Trade Center people could not, but he also gets to show that a universal care system like the one in Cuba will help everyone. Once when I was in France, I had a bad fever. A doctor drove three hours on a Sunday night to see me. He had a pharmacy open up just for my medicine, and he did not charge anything for his visit. Michael Moore is right about not having health care and education be for profit services. Especially in a democratic country everyone should have the right to free health care and education. People should not mind paying taxes so that everyone can have these rights.
1. Michael Moore’s opinion of health care in the U.S.:
The U.S.health care system is a disaster because it operates to make a
profit instead of to save lives. The 50 million people who don’t have
health care are screwed but so are the people who have it because
insurance companies charge them a fortune and find ways
not to pay for their health care. This country is the only western
democracy without universal health care. Doctors in England live well
without making a fortune like U.S. doctors, and their drugs are 500% cheaper.
Insurance, drug, and health care companies make billions here, but Americans
Are dying from lack of care including 9/11 heroes, while terrorists get
great treatment at the U.S. naval base in Guantanamo, Cuba.
2. Evidence
a. First example - Michael Moore has as insurance employee tell him that his job is to process claims of insured people not to pay for their health care but to find loopholes so the company can refuse to pay.
Second example - When Moore goes to a Canadian hospital and asks people where they pay, they just laugh at him, and he finds out that hospital cashier only pays out money to people who need it for their transportation home.
b. The first example supports his argument that having for profit insurance companies decide whether or not to pay for people’s health care and have the power to make them go broke paying for their surgery when they have paid for their insurance is a disastrous health care system. The second example shows a caring health care system where people can
go to a hospital to try to get well without having to worry if they can
afford their operation.
c. Here is what an insurance company representative has to say about insurance companies finding ways not to pay in Sicko:
IGNAGNI: In every doctor's office, in every hospital, in every health plan, yes, it's true, in all of those situations. No margin, no mission. If you're not in the black, then you can't do your job. The individuals that we cover, 250 million of them, expect to have their health care coverage. We saw eight to 10 stories featured in the film, and, in fact, there was no attempt to get the other side of the story. And I know for a fact, because many of these cases are eight to 10 to 15 years old, there is another side of the story. In many of these cases featured in the film, it was simply a case where the health plan was interpreting, was this coverage purchased by the employer? Now, we can have a debate about whether employers purchase enough coverage. Not only is this insurance person not denying that there are people whose job it is to find ways not to pay claims, this person is also saying that the problem is that employers need to buy more insurance. I think that this shows Moore is right about saying that insurance companies should not have anything to do with health care. They are only in it for the money.
This fact check from Sicko shows how insurance companies try to cheat with false claims:
Blue Cross/Blue Shield: "Sixty-seven Blue Cross/Blue Shield companies across the nation have paid the United States a total of $117 million to settle government claims that Medicare made primary payments for health care services that should have been paid by the Blue Cross/Blue Shield private insurance companies, the Department of Justice announced today." "Blue Cross/Blue Shield Companies Settle Medicare Claims, Pay United States $117 Million, Agree To Share Information," Department of Justice News Release, October 25, 1995. http://www.usdoj.gov/opa/pr/Pre_96/October95/551.txt.html
Example of direct confrontation – Moore talking to Blitzer (CNN)
Moore: You said that Germany was the only one that was better than us in terms of wait times. The Commonwealth Fund last year showed of the top six countries, we were second to last, next to Canada. It showed that Britain, for instance, 71 percent of the British public, when they call to see a doctor, get to see the doctor that day or the next day. It's 69 percent in Germany. It's 66% in Australia. And you're the ones who are fudging the facts. You fudged the facts to the American people now for I don't know how long about this issue, about the war.
d.Fact check:
L.A Times: March 28, 2006
Former Members Sue Blue Cross
The state's largest health insurer systematically -- and illegally -- cancels coverage retroactively for people who need expensive care, 10 former Blue Cross members claimed in lawsuits filed Monday.
Read more: http://newsbusters.org/node/13866#ixzz18ndVVeLd
I think Sicko was an important movie to make. People talk all the time
about what a terrible health care system we have, and I have seen the bad
side of it myself. Right now my family’s health insurance is temporarily
not available because a doctor my brother saw after a sports injury overcharged
our insurance company by $15. I found this out when I went to play in a
soccer tournament, and we had to have insurance. The doctor has to pay it
back for us to have insurance coverage even though we pay $1,000 a month for health
insurance. I think the dramatic trip to the U.S. navy base at Guantonomo in Cuba with the three guys who had helped on 9/11 and couldn’t get health insurance was great. Not only does Michael Moore get to show that the suspected terrorists involved in 9/11 can get health care paid by the U.S. and the people who risked their lives to save World Trade Center people could not, but he also gets to show that a universal care system like the one in Cuba will help everyone. Once when I was in France, I had a bad fever. A doctor drove three hours on a Sunday night to see me. He had a pharmacy open up just for my medicine, and he did not charge anything for his visit. Michael Moore is right about not having health care and education be for profit services. Especially in a democratic country everyone should have the right to free health care and education. People should not mind paying taxes so that everyone can have these rights.
Sunday, December 19, 2010
HW # 23 - Illness & Dying Book, Part 2
Mountains Beyond Mountains by Tracy Kidder
Published by Random House, 2003
Précis
In the second third of Mountains Beyond Mountains by Tracy KidderPaul Farmers second in command at Partners in Health, Jim Kim, became interested in trying to bring better health car to Carabayllo, a slum section of Lima, Peru. Paul took an interest there too especially after his old friend Father Jack, who had a church there, died of TB. It turned out he had multi-drug resistant TB (MDR). At the time Peru had a model TB program sponsored by the World Health Organization. TB patients received inexpensive “first-line” drugs, the drugs that had just about wiped out TB in the developed countries. By the end of the 20th century, TB was still killing more people than any other infectious disease but only in poor countries. Many people, some say one-third of the world population, have latent TB bacilli in them, but malnutrition and other diseases make them active. Paul was a world expert on TB, and he had treated many MDR cases in Haiti by raising money to give patients the extremely expensive second-line drugs. In Haiti, the MDR victims developed it because they missed treatments with first-line” drugs or there was a problem with drug quality. In Peru the model program made certain that patients received their standeard quality drugs everyday. It was a mystery how Father Jack developed MDR. Farmer figured out that giving first-line drugs that didn’t work again and again to patients made them resistant to more drugs was the cause of their getting MDR. The Peruvian health authorities did not want to hear about MDR from Paul and Jim. They had only been able to get the program due to demonstrations by poor people, nuns, and priests. These officials were not about to give them more money for expensive drugs and asking for it could risk the whole program of giving first-line drugs. They wanted to act as though MDR did not exist. Farmer started speaking out at conferences
about how badly resources were needed to treat MDR. Then one Peruvian doctor whose
daughter was dying of MDR wanted Farmer to treat her without anyone knowing because
he was afraid he would lose his job. Although Farmer wanted to say something like, “What is wrong with you people?” he said publicly that he was not sure why the little girl wasn’t getting better. The Peruvian doctors put him on the second-line drugs Farmer recommended, and she recovered. Inspired by Farmer, Jim then went after the drug companies to make them lower their prices. With the help of a Dutch non-profit organization that specialized in reducing the cost of necessary drugs and with money from Doctors Without Borders, Jim was able to start buying second-line MDR drugs for
Peru.
Quotes
Page 106
Some experts even hypothesized that the disease had originated in Haiti, where, it was said by soe , Voodoo houngans ripped the heads off chickens and guzzled their blood, then had sex with little boys… In his thesis he’d (Farmer) marshal a host of epidemiological data to show that AIDS had almost certainly come from North America to Haiti, and might well have been carried there by American and Canadian and Haitian American sex tourists, who could buy assignations for pittances in a Port-su-Prince slyum called Carrefour.
In this quote Farmer is talking about the need for people to find a scapegoat for bad things that happen and the terrible injustice that was done by blaming Haiti for starting and spreading AIDS.
Page 113
To classmates, later to his students, Farmer’s medical memory seemed encyclopedic and daunting, but it was not inexplicable. “I date everything to patients,”…Patients, it seemed, formed not just a calendar of past events buy a large mnemonic structure, in which individual faces and small quirks…were like an index to the symptoms, the patho-physiology, the remedies for thousands of ailments. The problem of course was that he remembered some patients all too well. In later years he didn’t like to talk about Chouchou. He told me, “I take active precautions not to think about him.”
This quote shows what the motivation is for Farmer’s challenging and sometimes dangerous work. Deaths and murders are not statistics for him. They are all individual people, and he makes a highly emotional connection to them. He had to make special efforts not to think about Chouchou, a young man who had been brutally tortured for criticizing the sorry state of a road in Haiti when the junta was in power. Farmer had been unable to save him, but he did write about what had happened to him, and the Boston Globe published the story.
Page 147
“Thank you, Paul, for that provocative talk,” said the moderator, a TB specialist from the U.S. Centers for Disease Control, a friend of Farmer’s named Ken Castro.
Farmer was on his way offstage. He turned back. “Excuse me, Ken, but why do you qualify my talk as provocative? I just said we should treat sick people, if we have the technology.”
In his talk Farmer had been challenging the World Health Organization for saying that MDR-TB should not be treated in poor countries because it is too expensive. This quote shows how Farmer would not let anyone, even his friend, get away with not considering healing sick poor people just because they are poor.
Page 162
I remember signing the oath to assist the patient and do him no harm. I don’t really remember signing that I would do it in a cost-effective way.”
In this quote Jim shows how close his thinking is to his mentor Paul Farmer. In the same way that doctors swear to help patients no matter who they are they should also not let cost keep them from helping patients.
Page 164
Jim said, “And let me just conclude this…by paraphrasing someone of our tribe, of Paul’s tribe and my tribe of anthropologists. Margaret Mead once said, Never underestimate the ability of a small group of committed individuals to change the world.” He paused. “Indeed, they are the only ones who ever have.”
In this quote Jim could be talking about how Paul Farmer and he convinced the world that MDR-TB could be treated successfully and that two million poor people a year did not have to die. He was actually inspiring his audience to join people who make change for the good happen instead of people who resist change for economic or self-serving reasons.
This section of the book made me think about hearing someone say recently that AIDS in Africa was a “natural form of population control for countries that couldn’t deal with so many poor people.” Poor people are just statistics to someone like this person and not individual faces the way they are to Paul Farmer. You know that if someone close to him developed AIDS, he would not think it was “natural.” He would try to blame someone and probably Haitians and Africans! Even for people who would not say something this heartless most of us don’t think too much about dying people especially dying poor people, because we don’t have an emotional connection to them and because the only way to help if we going stay in our comfortable lives is to give money for which we have a thousand other uses. It is tempting to yell at someone who says something stupid like this. When Farmer was not allowed to treat a man in Peru for MDR-TB and had to watch him die, he wrote an angry letter to TB health officials that did no good. He knew the only way they to change bad policies is taking constructive action. Farmer believes that well-off people should share their wealth with poor people who are just like us only poorer. We don’t have to be geniuses and saints like him to know he is right.
Published by Random House, 2003
Précis
In the second third of Mountains Beyond Mountains by Tracy KidderPaul Farmers second in command at Partners in Health, Jim Kim, became interested in trying to bring better health car to Carabayllo, a slum section of Lima, Peru. Paul took an interest there too especially after his old friend Father Jack, who had a church there, died of TB. It turned out he had multi-drug resistant TB (MDR). At the time Peru had a model TB program sponsored by the World Health Organization. TB patients received inexpensive “first-line” drugs, the drugs that had just about wiped out TB in the developed countries. By the end of the 20th century, TB was still killing more people than any other infectious disease but only in poor countries. Many people, some say one-third of the world population, have latent TB bacilli in them, but malnutrition and other diseases make them active. Paul was a world expert on TB, and he had treated many MDR cases in Haiti by raising money to give patients the extremely expensive second-line drugs. In Haiti, the MDR victims developed it because they missed treatments with first-line” drugs or there was a problem with drug quality. In Peru the model program made certain that patients received their standeard quality drugs everyday. It was a mystery how Father Jack developed MDR. Farmer figured out that giving first-line drugs that didn’t work again and again to patients made them resistant to more drugs was the cause of their getting MDR. The Peruvian health authorities did not want to hear about MDR from Paul and Jim. They had only been able to get the program due to demonstrations by poor people, nuns, and priests. These officials were not about to give them more money for expensive drugs and asking for it could risk the whole program of giving first-line drugs. They wanted to act as though MDR did not exist. Farmer started speaking out at conferences
about how badly resources were needed to treat MDR. Then one Peruvian doctor whose
daughter was dying of MDR wanted Farmer to treat her without anyone knowing because
he was afraid he would lose his job. Although Farmer wanted to say something like, “What is wrong with you people?” he said publicly that he was not sure why the little girl wasn’t getting better. The Peruvian doctors put him on the second-line drugs Farmer recommended, and she recovered. Inspired by Farmer, Jim then went after the drug companies to make them lower their prices. With the help of a Dutch non-profit organization that specialized in reducing the cost of necessary drugs and with money from Doctors Without Borders, Jim was able to start buying second-line MDR drugs for
Peru.
Quotes
Page 106
Some experts even hypothesized that the disease had originated in Haiti, where, it was said by soe , Voodoo houngans ripped the heads off chickens and guzzled their blood, then had sex with little boys… In his thesis he’d (Farmer) marshal a host of epidemiological data to show that AIDS had almost certainly come from North America to Haiti, and might well have been carried there by American and Canadian and Haitian American sex tourists, who could buy assignations for pittances in a Port-su-Prince slyum called Carrefour.
In this quote Farmer is talking about the need for people to find a scapegoat for bad things that happen and the terrible injustice that was done by blaming Haiti for starting and spreading AIDS.
Page 113
To classmates, later to his students, Farmer’s medical memory seemed encyclopedic and daunting, but it was not inexplicable. “I date everything to patients,”…Patients, it seemed, formed not just a calendar of past events buy a large mnemonic structure, in which individual faces and small quirks…were like an index to the symptoms, the patho-physiology, the remedies for thousands of ailments. The problem of course was that he remembered some patients all too well. In later years he didn’t like to talk about Chouchou. He told me, “I take active precautions not to think about him.”
This quote shows what the motivation is for Farmer’s challenging and sometimes dangerous work. Deaths and murders are not statistics for him. They are all individual people, and he makes a highly emotional connection to them. He had to make special efforts not to think about Chouchou, a young man who had been brutally tortured for criticizing the sorry state of a road in Haiti when the junta was in power. Farmer had been unable to save him, but he did write about what had happened to him, and the Boston Globe published the story.
Page 147
“Thank you, Paul, for that provocative talk,” said the moderator, a TB specialist from the U.S. Centers for Disease Control, a friend of Farmer’s named Ken Castro.
Farmer was on his way offstage. He turned back. “Excuse me, Ken, but why do you qualify my talk as provocative? I just said we should treat sick people, if we have the technology.”
In his talk Farmer had been challenging the World Health Organization for saying that MDR-TB should not be treated in poor countries because it is too expensive. This quote shows how Farmer would not let anyone, even his friend, get away with not considering healing sick poor people just because they are poor.
Page 162
I remember signing the oath to assist the patient and do him no harm. I don’t really remember signing that I would do it in a cost-effective way.”
In this quote Jim shows how close his thinking is to his mentor Paul Farmer. In the same way that doctors swear to help patients no matter who they are they should also not let cost keep them from helping patients.
Page 164
Jim said, “And let me just conclude this…by paraphrasing someone of our tribe, of Paul’s tribe and my tribe of anthropologists. Margaret Mead once said, Never underestimate the ability of a small group of committed individuals to change the world.” He paused. “Indeed, they are the only ones who ever have.”
In this quote Jim could be talking about how Paul Farmer and he convinced the world that MDR-TB could be treated successfully and that two million poor people a year did not have to die. He was actually inspiring his audience to join people who make change for the good happen instead of people who resist change for economic or self-serving reasons.
This section of the book made me think about hearing someone say recently that AIDS in Africa was a “natural form of population control for countries that couldn’t deal with so many poor people.” Poor people are just statistics to someone like this person and not individual faces the way they are to Paul Farmer. You know that if someone close to him developed AIDS, he would not think it was “natural.” He would try to blame someone and probably Haitians and Africans! Even for people who would not say something this heartless most of us don’t think too much about dying people especially dying poor people, because we don’t have an emotional connection to them and because the only way to help if we going stay in our comfortable lives is to give money for which we have a thousand other uses. It is tempting to yell at someone who says something stupid like this. When Farmer was not allowed to treat a man in Peru for MDR-TB and had to watch him die, he wrote an angry letter to TB health officials that did no good. He knew the only way they to change bad policies is taking constructive action. Farmer believes that well-off people should share their wealth with poor people who are just like us only poorer. We don’t have to be geniuses and saints like him to know he is right.
Sunday, December 12, 2010
HW # 22 - Illness & Dying Book Part 1
Mountains Beyond Mountains by Tracy Kidder
Published by Random House, 2003
In the first third of Mountains Beyond Mountains, the two sections that stay in my mind are first the time when Tracy Kidder asks Paul Farmer what he gets out of sacrificing so much of his life for a job with so many hardships and second when they both witness the mango truck overturned and the dead “mango lady” lying on a bed of fallen mangos next to it. In the first passage Farmer talks about feeling “ambivalent” about “selling my services in a world where some can’t buy them.” For desperately poor people who are sick and dying he thinks he should feel ambivalent about making his living out of their dying. In fact we know that he thinks all doctors should feel this way and everyone who isn’t upset about the unfair distribution of money for medicine in this world. We know this because he uses his special word, “comma” after these opinions, which Tracy Kidder
says comes before the unsaid word, “asshole,” meaning what all of us are who are comfortable with the world as it is and its great injustice. In the passage about the tipped over mango truck, Farmer is silent for a long time after seeing the dead body of the “mango lady.” We know from the opinions he’s expressed earlier that his is thinking about all that is wrong with the world that would have made that “accident” happen including the terrible dirt roads that are just tracks with huge bumps, the wreck of a truck that is completely unsafe to drive, the deforestation that makes the heat burn much more, and the fact that the poor woman had to go so far to sell her mangos to help her hungry family. There are many more reasons why the poor “mango lady” died than just having been hit by a turned over truck, and they should not have been allowed to happen. After reading these sections in just the first third of the book, I think the loud message is that we all have responsibility for the poorest people of the world and that not thinking about the fact that most are sick and dying or what we can do about it is not acceptable.
Quotes
Page 25
A sixteen-year-old boy too weak to walk, who weighs only sixty pounds. Farmer diagnoses an ulcer. “His body’s gotten used to starvation. We’re gonna buff him up.” Farmer hefts a can of the dietary supplement Ensure. “This is good stuff. WE’ll give him three cans a day. So we’ll give him a couple hundred dollars of Ensure, and I’ll take great pleasure in violating the principle of cost-efficacy.”
Farmer shows here that he will do whatever he can to save this boy. If that means giving him enough Ensure to get his weight back up, he will do it no matter whether someone far away in the international health community thinks that spending that much to save one person is cost-effective. If you can save a life, do it. What would be the point in half-saving people, meaning not giving the amount they need to survive just to save money.
Page 31
Then he (Farmer) walks back up the hill, to the TB hospital…Most of the patients have gathered in one room and are sitting on the beds watching a soccer game on a wavy, snowy TV screen. “Look at you bourgeois people watching TV!” Farmer says.
The patients laugh. One of the young men looks up at him. “No, Dokte Paul, not bourgeois. If we were bourgeois, we would have an antenna.”
.This is a great paragraph because it shows how close Farmer is to his TB patients that he can joke around with them and they with him.. It also shows how much understanding Hatians have of their place in the economic hierarchy.
Page 32
In a bed by the door of the hospital lies a moaning thirteen-year-old girl, just arrived y donkey ambulance… “I’m very good at spinal taps”…The veins stand out on Farmer’s thin neck as he eases the needle in. Wild cries erupt from the child: “Li fe-m mal, mwen grangou!’ Farmer looks up, and for a moment he’s narrating Haiti again. “She’s crying, “It hurts, I’m hungry.” Can you believe it? Only in Haiti would a child cry out that she’s hungry during a spinal tap.”
Farmer shows his incredible sympathy for the girl and also the fact that he can still be surprised by the pain of hunger being so extreme that it can even overpower the pain of a
spinal tap. He is also probably making it clear to Tracy Kidder who is there to write about him about the crime of hunger in the sense that it should not be allowed for anyone to be that hungry.
Page 36
Just recently, a TB patient from a village called Morne Michel hadn’t shown up for his monthly doctor’s appointment. So – this was one of the rules – someone had to go and find him. The annals of international health contain many stories of adequately financed projects that failed because “non-compliant” patients didn’t take all their medicines. Farmer said, “The only noncompliant people are physicians. If the patient doesn’t get better, it’s your own fault. Fix it.”
Farmer shows how he understands the reasons behind the reasons. When poor Haitians don’t take all their medicine, it is the fault of non-compliant physicans who aren’t taking the responsibility they have to heal their patients. Farmer knows that there can be many reasons why desperately poor and starving people might not be taking all their medicine.
He conducted a test and found that when patients were given a little cash for food, transportation and child care they did get and take their medicine.
Page 42
“And if it takes five-hour treks or giving patients milk or nail clippers or raisins, radios, watches, then do it. We can spend sixty-eight thousand dollars per TB patient in New York City, but if you start giving watches or radios to patients her, suddenly the international health community jumps on you for creating nonsustainable projects. If a patient says, I really need a Bible or nail clippers, well, for God;s sake!”
Farmer shows what a maverick he is. He is not going to stick to economic rules made by people in the international health community thousands of miles away that come down hard on small items needed by impoverished TB patients in Haiti when thousands of dollars can be spent on TB patients in wealthy areas.
After reading these sections in just the first third of the book, I think the loud message is that we all have responsibility for the poorest people of the world and that not thinking about the fact that most are sick and dying and what we can do about it is not acceptable.
Reading this book is what made my brother decide to major in public health at Tufts University. It inspired him to apply for a fellowship to work for a summer with the street children of Nairobi. I remember his saying that the poorest children receive a tiny amount of milk in a paper bag that has not been refrigerated in the morning and can’t get any more that day. They all look ill and hunt for food on the garbage heaps. I have seen how Paul Farmer could inspire someone (my brother)to take action to prevent the dying of the world’s poorest people, and maybe this book will influence what I decide to do in college too.
Published by Random House, 2003
In the first third of Mountains Beyond Mountains, the two sections that stay in my mind are first the time when Tracy Kidder asks Paul Farmer what he gets out of sacrificing so much of his life for a job with so many hardships and second when they both witness the mango truck overturned and the dead “mango lady” lying on a bed of fallen mangos next to it. In the first passage Farmer talks about feeling “ambivalent” about “selling my services in a world where some can’t buy them.” For desperately poor people who are sick and dying he thinks he should feel ambivalent about making his living out of their dying. In fact we know that he thinks all doctors should feel this way and everyone who isn’t upset about the unfair distribution of money for medicine in this world. We know this because he uses his special word, “comma” after these opinions, which Tracy Kidder
says comes before the unsaid word, “asshole,” meaning what all of us are who are comfortable with the world as it is and its great injustice. In the passage about the tipped over mango truck, Farmer is silent for a long time after seeing the dead body of the “mango lady.” We know from the opinions he’s expressed earlier that his is thinking about all that is wrong with the world that would have made that “accident” happen including the terrible dirt roads that are just tracks with huge bumps, the wreck of a truck that is completely unsafe to drive, the deforestation that makes the heat burn much more, and the fact that the poor woman had to go so far to sell her mangos to help her hungry family. There are many more reasons why the poor “mango lady” died than just having been hit by a turned over truck, and they should not have been allowed to happen. After reading these sections in just the first third of the book, I think the loud message is that we all have responsibility for the poorest people of the world and that not thinking about the fact that most are sick and dying or what we can do about it is not acceptable.
Quotes
Page 25
A sixteen-year-old boy too weak to walk, who weighs only sixty pounds. Farmer diagnoses an ulcer. “His body’s gotten used to starvation. We’re gonna buff him up.” Farmer hefts a can of the dietary supplement Ensure. “This is good stuff. WE’ll give him three cans a day. So we’ll give him a couple hundred dollars of Ensure, and I’ll take great pleasure in violating the principle of cost-efficacy.”
Farmer shows here that he will do whatever he can to save this boy. If that means giving him enough Ensure to get his weight back up, he will do it no matter whether someone far away in the international health community thinks that spending that much to save one person is cost-effective. If you can save a life, do it. What would be the point in half-saving people, meaning not giving the amount they need to survive just to save money.
Page 31
Then he (Farmer) walks back up the hill, to the TB hospital…Most of the patients have gathered in one room and are sitting on the beds watching a soccer game on a wavy, snowy TV screen. “Look at you bourgeois people watching TV!” Farmer says.
The patients laugh. One of the young men looks up at him. “No, Dokte Paul, not bourgeois. If we were bourgeois, we would have an antenna.”
.This is a great paragraph because it shows how close Farmer is to his TB patients that he can joke around with them and they with him.. It also shows how much understanding Hatians have of their place in the economic hierarchy.
Page 32
In a bed by the door of the hospital lies a moaning thirteen-year-old girl, just arrived y donkey ambulance… “I’m very good at spinal taps”…The veins stand out on Farmer’s thin neck as he eases the needle in. Wild cries erupt from the child: “Li fe-m mal, mwen grangou!’ Farmer looks up, and for a moment he’s narrating Haiti again. “She’s crying, “It hurts, I’m hungry.” Can you believe it? Only in Haiti would a child cry out that she’s hungry during a spinal tap.”
Farmer shows his incredible sympathy for the girl and also the fact that he can still be surprised by the pain of hunger being so extreme that it can even overpower the pain of a
spinal tap. He is also probably making it clear to Tracy Kidder who is there to write about him about the crime of hunger in the sense that it should not be allowed for anyone to be that hungry.
Page 36
Just recently, a TB patient from a village called Morne Michel hadn’t shown up for his monthly doctor’s appointment. So – this was one of the rules – someone had to go and find him. The annals of international health contain many stories of adequately financed projects that failed because “non-compliant” patients didn’t take all their medicines. Farmer said, “The only noncompliant people are physicians. If the patient doesn’t get better, it’s your own fault. Fix it.”
Farmer shows how he understands the reasons behind the reasons. When poor Haitians don’t take all their medicine, it is the fault of non-compliant physicans who aren’t taking the responsibility they have to heal their patients. Farmer knows that there can be many reasons why desperately poor and starving people might not be taking all their medicine.
He conducted a test and found that when patients were given a little cash for food, transportation and child care they did get and take their medicine.
Page 42
“And if it takes five-hour treks or giving patients milk or nail clippers or raisins, radios, watches, then do it. We can spend sixty-eight thousand dollars per TB patient in New York City, but if you start giving watches or radios to patients her, suddenly the international health community jumps on you for creating nonsustainable projects. If a patient says, I really need a Bible or nail clippers, well, for God;s sake!”
Farmer shows what a maverick he is. He is not going to stick to economic rules made by people in the international health community thousands of miles away that come down hard on small items needed by impoverished TB patients in Haiti when thousands of dollars can be spent on TB patients in wealthy areas.
After reading these sections in just the first third of the book, I think the loud message is that we all have responsibility for the poorest people of the world and that not thinking about the fact that most are sick and dying and what we can do about it is not acceptable.
Reading this book is what made my brother decide to major in public health at Tufts University. It inspired him to apply for a fellowship to work for a summer with the street children of Nairobi. I remember his saying that the poorest children receive a tiny amount of milk in a paper bag that has not been refrigerated in the morning and can’t get any more that day. They all look ill and hunt for food on the garbage heaps. I have seen how Paul Farmer could inspire someone (my brother)to take action to prevent the dying of the world’s poorest people, and maybe this book will influence what I decide to do in college too.
Friday, December 10, 2010
HW # 21 - Comments
BEN
I liked your first connection about visiting your good friend's mother with ALS in the hospital and how you would chat about the Patriots (cannot believe you're a Patriot fan) in order to keep the conversation upbeat. I know that ALS is a terrible disease and it would be interesting to hear how seeing someone with it firsthand affected you. I myself have never been with anyone with a serious disease. I think that having that experience must be powerful and important in the way that it makes death and dying more real, making us aware, as Beth said, of our own mortality. I also liked the connection you made to Beth's taking care of her husband with only the help of her son when you told us that your aunt took care of your sick grandmother all by herself. I think it must be true that many more women take care of sick and dying relatives than men do. It's obviously much nicer for a sick person not to have to be in the hospital but it must have been a huge burden in this case for your aunt.
Natalie
I was really impressed with the connection you made from your own experience with your dad to Beth's treatment of all those who were helping her husband in the hospital. Without judging your father (we all have our impatient moments), the fact that you felt so badly for the waitress and could imagine I think that if he had suddenly started choking she might not have performed the Heimlich Maneuver with much gusto. Hospital workers are paid to help patients but they are obviously going to perform their jobs with more good will when they are treated with respect, and even more than respect with friendship. Your mother's story about the poor man who died alone was really interesting because of your point that maybe it is easier to die if you don't have anyone to live for. It's true that a dying person would naturally feel terrible about leaving people who are dependent on them. On the other hand I think for many people death is scary because whether you have people or not to share your life death is still scary because it is unknown. Obviously you’re an excellent writer and this is an excellent blog post. I would like to emphasize the magnitude of your last line “When does death stop being the enemy…and become the natural idea.” Death has been my greatest enemy for as long as I can remember, and I think it will take an awful lot for me to picture it as “the most natural idea,” but I hope I can. In fact, ideally I hope I can think of it as a great adventure when my time comes (but I wouldn’t put any money on it.)
I liked your first connection about visiting your good friend's mother with ALS in the hospital and how you would chat about the Patriots (cannot believe you're a Patriot fan) in order to keep the conversation upbeat. I know that ALS is a terrible disease and it would be interesting to hear how seeing someone with it firsthand affected you. I myself have never been with anyone with a serious disease. I think that having that experience must be powerful and important in the way that it makes death and dying more real, making us aware, as Beth said, of our own mortality. I also liked the connection you made to Beth's taking care of her husband with only the help of her son when you told us that your aunt took care of your sick grandmother all by herself. I think it must be true that many more women take care of sick and dying relatives than men do. It's obviously much nicer for a sick person not to have to be in the hospital but it must have been a huge burden in this case for your aunt.
Natalie
I was really impressed with the connection you made from your own experience with your dad to Beth's treatment of all those who were helping her husband in the hospital. Without judging your father (we all have our impatient moments), the fact that you felt so badly for the waitress and could imagine I think that if he had suddenly started choking she might not have performed the Heimlich Maneuver with much gusto. Hospital workers are paid to help patients but they are obviously going to perform their jobs with more good will when they are treated with respect, and even more than respect with friendship. Your mother's story about the poor man who died alone was really interesting because of your point that maybe it is easier to die if you don't have anyone to live for. It's true that a dying person would naturally feel terrible about leaving people who are dependent on them. On the other hand I think for many people death is scary because whether you have people or not to share your life death is still scary because it is unknown. Obviously you’re an excellent writer and this is an excellent blog post. I would like to emphasize the magnitude of your last line “When does death stop being the enemy…and become the natural idea.” Death has been my greatest enemy for as long as I can remember, and I think it will take an awful lot for me to picture it as “the most natural idea,” but I hope I can. In fact, ideally I hope I can think of it as a great adventure when my time comes (but I wouldn’t put any money on it.)
Wednesday, December 8, 2010
HW # 21 - Expert # 1
- Beth treated everyone who worked at the hospital with an equal amount of respect no matter the task s/he performed in treating her husband.
- Beth also made the effort to get to know the people who were caring for her husband, asking about their own lives and families in order to build stronger relationships.
- Beth questioned everytihg the doctors had to say about her husband's terrible illness.
- Beth displayed her husband's artwork and pictures of him and the family in an attempt to make people aware of the individual man that he was -- an artist.
- Beth rejected the option of having hospice care for her husband and chose to look after him herself with the help of her younger son Evan.
- Because she knew what a close relationship her older son had with his dad, Beth shielded him from her husband's deterioration in the last two weeks of his life.
- Beth said that there was "an indescribable stillness" at the moment of her husband's death. It was almost as if time stood still.
- Beth did not cry right away and mentioned that she had the realization that we would all die.
I can relate Beth's experience of time standing still when situations of monumental importance occur. When my soccer team went to France to play in the Nation's Cup, we played against the Ukraine in our second game of the tournament. In front of 30,000people I nutmegged one player en route to delivering a through-ball to my forward, who scored easily. Immediately after seeing the ball hit the back of the net, I did a front flip, and time seemed to be suspended while I was in the air. I remember wondering when I was going to come down. I believe that the silence Beth experienced was a way of acknowledging and honoring the moment of her husband's death that would have been quite different if she had been hysterical or crying profusely.
I can certainly relate to Beth's experience in getting to know all the people who were caring for her husband so that she could be confident that he would be treated well. On a much less of an important scale, when my mom and I shop at Dean & Deluca, which is near her office, we have made it a point to build great relationships with the people who work there, always asking about their lives and keeping them up to date with the most interesting stories we have to offer. As a result,we receive numerous amounts of free food. Others stores that I have built similar relationships with include Jamba Juice, City Bakery, and the Adidas store near the Broadway/Lafayette subway. This is not to say that I think it is a good thing to form good relationships with people only to get something from them. Having good realtionships with the people around you is good in and of itself. Good relationships create harmony in the world, and I am certain that for Beth the atmosphere of harmony that she created with the people at the hospital made life more pleasant for everyone and took away some of the stress of a very stressful time.
Further Thoughts
When she first began her talk I wondered whether she had any feelings of regret about speaking to our class about such a painful experience. I was thinking that in her place I wouldn't have wanted to be so open about such a personal time with a room full of strangers. By the end of her talk though, I think I had some insight into why she wanted to share what had happened with us. None of us want to think about death, so most of the time when it comes, we aren't prepared for it. She was actually giving us some preparation in a positive way by making death real for us and telling us how she was able to make this time as bearable as possible for her husband, her family, and herself. I could picture all the photos and his artwork in her husband's room. Not only did they show the person that her husband was and make the room warm and homey, but they also must have been good conversation openers for anyone coming in the room.
I was also interested in the hallucinations that her husband had and her thought that he might have been trying to fight off death. My grandmother's sister died having her first child. She seemed to be unconscious and then suddenly sat up, threw her arms out, and said, "How beautiful! This is gong to be such an exciting adventure." I like the idea of people having some kind of awareness of their own death and being brave enough to fight it or brave enough to want to accept it and go to it like some new part of the world not yet visited.
- Beth also made the effort to get to know the people who were caring for her husband, asking about their own lives and families in order to build stronger relationships.
- Beth questioned everytihg the doctors had to say about her husband's terrible illness.
- Beth displayed her husband's artwork and pictures of him and the family in an attempt to make people aware of the individual man that he was -- an artist.
- Beth rejected the option of having hospice care for her husband and chose to look after him herself with the help of her younger son Evan.
- Because she knew what a close relationship her older son had with his dad, Beth shielded him from her husband's deterioration in the last two weeks of his life.
- Beth said that there was "an indescribable stillness" at the moment of her husband's death. It was almost as if time stood still.
- Beth did not cry right away and mentioned that she had the realization that we would all die.
I can relate Beth's experience of time standing still when situations of monumental importance occur. When my soccer team went to France to play in the Nation's Cup, we played against the Ukraine in our second game of the tournament. In front of 30,000people I nutmegged one player en route to delivering a through-ball to my forward, who scored easily. Immediately after seeing the ball hit the back of the net, I did a front flip, and time seemed to be suspended while I was in the air. I remember wondering when I was going to come down. I believe that the silence Beth experienced was a way of acknowledging and honoring the moment of her husband's death that would have been quite different if she had been hysterical or crying profusely.
I can certainly relate to Beth's experience in getting to know all the people who were caring for her husband so that she could be confident that he would be treated well. On a much less of an important scale, when my mom and I shop at Dean & Deluca, which is near her office, we have made it a point to build great relationships with the people who work there, always asking about their lives and keeping them up to date with the most interesting stories we have to offer. As a result,we receive numerous amounts of free food. Others stores that I have built similar relationships with include Jamba Juice, City Bakery, and the Adidas store near the Broadway/Lafayette subway. This is not to say that I think it is a good thing to form good relationships with people only to get something from them. Having good realtionships with the people around you is good in and of itself. Good relationships create harmony in the world, and I am certain that for Beth the atmosphere of harmony that she created with the people at the hospital made life more pleasant for everyone and took away some of the stress of a very stressful time.
Further Thoughts
When she first began her talk I wondered whether she had any feelings of regret about speaking to our class about such a painful experience. I was thinking that in her place I wouldn't have wanted to be so open about such a personal time with a room full of strangers. By the end of her talk though, I think I had some insight into why she wanted to share what had happened with us. None of us want to think about death, so most of the time when it comes, we aren't prepared for it. She was actually giving us some preparation in a positive way by making death real for us and telling us how she was able to make this time as bearable as possible for her husband, her family, and herself. I could picture all the photos and his artwork in her husband's room. Not only did they show the person that her husband was and make the room warm and homey, but they also must have been good conversation openers for anyone coming in the room.
I was also interested in the hallucinations that her husband had and her thought that he might have been trying to fight off death. My grandmother's sister died having her first child. She seemed to be unconscious and then suddenly sat up, threw her arms out, and said, "How beautiful! This is gong to be such an exciting adventure." I like the idea of people having some kind of awareness of their own death and being brave enough to fight it or brave enough to want to accept it and go to it like some new part of the world not yet visited.
Sunday, December 5, 2010
HW # 19 - Family Perspectives on Illness & Dying
In our family there has definitely been more dying on my father’s side than on my mother’s side. My father’s mother often leaves a message on our phone saying that someone has died and to call her. I hear my father saying, “Who is it this time, Fatty?” (He calls her Fatty although she has not been fat for twenty years, according to Fatty.) After she responds, I hear my father say “Fatty, I have no idea who that is and have no intention of going to their funeral.” Then he finds out that it was second cousin LeMelle’s adopted daughter who was the actual daughter of distant cousin LeRoy, who had to give her up because he couldn’t handle drugs. My father thinks that everyone should be cremated and that the funeral business is a racket.
Fatty used to like to go from Detroit where she lives to South Carolina for the funerals because they were like family reunions. She would tell my dad whether the relative looked good or terrible in the coffin and whether it seemed like the family had spent a lot on the funeral. My grandmother has a sense of humor so if the person looked good she would say something like, “If only Irma had looked like that when she was alive, she would have been strutting her stuff for another 20 years.” And if the person looked bad, she would blame the family for not spending enough on the funeral. Her family had owned a funeral parlor in the town of Whitmire, South Carolina. When she married my grandfather, they moved to Detroit so that he could work for Chrysler, and their first apartment didn’t even have hot water. No wonder she likes funeral parlors. They made it possible for her to grow up with hot water.
Now that Fatty is almost 90 years old she can’t go to South Carolina anymore. My grandfather is afraid of flying, and he had to have a leg amputated so he can’t drivea car. She has decided that she wants to be cremated now but thinks that she might still want to have “a viewing.” My dad thinks the cremation decision is great but told her that the “viewing” part is one of the dumbest ideas she has ever had. “Let people remember you when you were in your prime and not all gray and wrinkly.” She is still deciding.
My grandmother on my mother’s side definitely wants to be cremated. She says that her parents and the generations before them only thought about being buried because that was the only choice. If there were fewer people in the world, burial would still be okay. Now with billions of people there isn’t enough room to bury everybody. Granny thinks that if you live near a crematorium, you should be cremated. If anyone in the family happened to be going to England after she dies, she would not mind having her ashes sprinkled over the cemetery where her family is buried, but she doesn’t want anyone to go to any trouble. I asked her if she would want the ashes buried in one place with one of those stones that give your name and the years you lived. It would be a place where people could go to think about her. She said that memories are where people thinkof dead people, and hopefully they will be good ones.
Fatty used to like to go from Detroit where she lives to South Carolina for the funerals because they were like family reunions. She would tell my dad whether the relative looked good or terrible in the coffin and whether it seemed like the family had spent a lot on the funeral. My grandmother has a sense of humor so if the person looked good she would say something like, “If only Irma had looked like that when she was alive, she would have been strutting her stuff for another 20 years.” And if the person looked bad, she would blame the family for not spending enough on the funeral. Her family had owned a funeral parlor in the town of Whitmire, South Carolina. When she married my grandfather, they moved to Detroit so that he could work for Chrysler, and their first apartment didn’t even have hot water. No wonder she likes funeral parlors. They made it possible for her to grow up with hot water.
Now that Fatty is almost 90 years old she can’t go to South Carolina anymore. My grandfather is afraid of flying, and he had to have a leg amputated so he can’t drivea car. She has decided that she wants to be cremated now but thinks that she might still want to have “a viewing.” My dad thinks the cremation decision is great but told her that the “viewing” part is one of the dumbest ideas she has ever had. “Let people remember you when you were in your prime and not all gray and wrinkly.” She is still deciding.
My grandmother on my mother’s side definitely wants to be cremated. She says that her parents and the generations before them only thought about being buried because that was the only choice. If there were fewer people in the world, burial would still be okay. Now with billions of people there isn’t enough room to bury everybody. Granny thinks that if you live near a crematorium, you should be cremated. If anyone in the family happened to be going to England after she dies, she would not mind having her ashes sprinkled over the cemetery where her family is buried, but she doesn’t want anyone to go to any trouble. I asked her if she would want the ashes buried in one place with one of those stones that give your name and the years you lived. It would be a place where people could go to think about her. She said that memories are where people thinkof dead people, and hopefully they will be good ones.
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