Illness & Dying in the United States
Facing Terminal Illness
I think that it is true that in spite of what we undeniably know none of us believe we are going to die, which is what Morrie tells his former student Mitch in the book Tuesdays with Morrie. I also believe that none of us believe we are going to grow old. No wonder we are uncomfortable about facing terminal illness. We have to deal with observing the worst thing that can happen while not admitting to ourselves that death could happen to us but knowing that it will. In the book Morrie and Mitch find a way to deal with Morrie’s dying in a positive way by having Morrie give Mitch his lessons for living and Mitch give Morrie a kind of immortality by writing a book. When Morrie says, “The truth is…once you learn how to die, you learn how to live,” he is telling Mitch that it is important for all of us to accept the idea of our own death so we can realize all the gifts we have just by the fact of being alive. We must take advantage of these available gifts and value them so that we will not have a lot of regrets when it is our time to die.
For Beth, whose husband was dying of cancer, the way she helped him, herself, and her family face his dying was by displaying his paintings in order to celebrate his life as an artist. She also displayed photographs of his family to show him and everyone helping him or visiting him that he had had a fulfilled life. This was her way of helping him die, valuing all that had been important in his life so that he would not have regrets.
Isolation
Unlike Morrie in Tuesdays with Morrie and Beth’s real life husband, who both are able to die at home, many elderly people die in hospitals or nursing homes. For those who do not have family members to visit, the experience must be incredibly isolating. According to an intervention study called Quality of life in nursing-home residents, “The prevalence of depression among residents of nursing homes is 30-75%. In spite of good care, residents may feel like inmates and function as isolated individuals.” Now that people are living so much longer, it makes sense that more and more of them will end up in nursing homes because they will not be able to take care of themselves or have family members be able to keep taking care of them. According to an article in the Washington Post called The New Retirement: Getting Old Ain’t What it Used to Be by Douglas J. Besharov and Keith W. Smilt (august 1, 1999), after age 80, many people have trouble performing the ADLs (activities of daily living), which are “eating, bathing, dressing, toileting and getting out of bed.” About 50% of people need help with ADLs after age 85. Also, nearly 20% of people over 85 have problems of dementia, brain damage, or mental retardation.
For people who are ill or dying, they can be made to feel isolated by the rejection of younger and healthier people, who are not comfortable with them. In his work Stigma, the sociologist Erving Goffman talks about all types of people who feel stigmatized by “normals,” and these can include cripples and other handicapped or disfigured people, and members of ethnic and every kind of minority group. He says that interactions between “normals” and the stigmatized are “usually accompanied by one or more of the familiar discomforts and stickiness: the guarded references, the common everyday words suddenly made taboo, the fixed stare elsewhere, the artificial levity, the compulsive loquaciousness, the awkward solemnity.” All of these reactions are ones that are common to have when visiting a dying person: avoiding talking about the future or even next month plans (“the guarded references”), avoiding saying the words death or dying (“the common everyday words suddenly made taboo), not being able to look the dying person in the eye for long (“the fixed stare elsewhere”), having mouths fixed in smiles or laughing in an embarrassed way (the artificial levity), talking on and on just to keep conversation going (the compulsive loquaciousness); acting stiff and serious (the awkward solemnity). In other words the unnatural behavior of others toward sick or dying or elderly people can make them feel extremely isolated.
Paying for Medical Care
According to Sick by Jonathan Cohn, the first insurance company in the U.S. was started by Benjamin Franklin to protect Philadelphia momes from being destroyed by fire. Health insurance to help protect people from the risk of illness did not start until the 20th century. In the 1920s and 1930s many Americans could not afford the cost of health care because doctors expected to be paid a lot for their expensive training and equipment. Hospitals exanded the the 1920s during the boom economy, but then in the 30s when there was the depression there were not enough patients who could pay. In other industrial countries the goverments supported health care, which was becoming “a right, rather than a privilege.” In the U.S. corporations and doctors were against the government handling health care, corporations becaues they wanted a private economy they could control and doctors because they thought the government would pay them less and try to control them. Non-profit health insurance organizations started out collecting contributions from groups of people like employees and then give them hospital care when they needed it. The first one helped Baylor Hospital in Dallas, Texas in 1929 by getting teachers to contribute for hospital care. Then companies started offering health insurance instead of raised during World War II, and they were given tax breads so the whole U.S. system became based on businesses and employers providing health insurance. Unemployed people and elderly people were left out of the system.
In 1965 President Lynden Johnson started Medicare to help the elderly which as paid for out of taxes during the time they worked. He also started Medicaid to help poor people. Medicaid is paid for by the Federal and State governments. Without these programs many people would have become ill and died and still would become ill and die. In 1985 the Consolidated Omnibus Budget Reconciliation Act (COBRA) was enacted so that people who lost their jobs or retired people could keep their health insurance. In 1997 the State Children’sHealth Insurance Program (SCHIP) was enacted for children “at or below 200% of the Fenderal poverty line. Then in 2010 President Obama enacted the Patient Protection and Affordable Care Act to reform U.S. health care by making insurance companies unable to drop people with pre-existing conditions or find other excuses not to pay, and also to have insurance companies charge standard amounts at three different levels so that people can have choices they can afford. There would also be subsidies so that poor people could afford insurance.
In the move Sicko, Michael Moore states that the U.S. health care system costs nearly $7,000 per person a year and that in Cuba the cost is $251 per person. According to the National Health Expenditure Date in 2005, the cost of health care per person in 2005 was $6,697 and according to the 2006 United Nations Development Report, the annual cost in Cuba was $251 per person so Michael Moore was right. Other industrial countries also pay much less per person for health care than the U.S. with a universal health care system. One scene in the movie that stands out is when Michael Moore is interviewing the National Health Service in England and the people there cannot relate to his questions about cost because they only think about providing health care.
In Mountains Beyond Mountains by Tracy Kidder, Paul Farmer also greatly admires Cuba for using its poor resources well enough to have excellent health care and fight the spread of AIDS successfully. He believes that a for profit health system is an unjust system. He says, “ 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.” Republicans think that the government cannot run the health care system well because it does not run anything as well as private companies can and it wastes money. Since it is many of the private insurance companies that have been cheating and charging the government millions of dollars illegally for Medicare services, and since the government has run many national programs well like Medicare, Social Security, Clean Water and Clean Air Programs ("The Forgotten Achievements of Governments," by Douglass J. Amy, Professor of Politics at Mount Holyoke College), the Republicans don’t know what they are talking about.
The Process of Dying
Near Death is a documentary filmed in black and white with no narration about doctors, staff, and patients in the intensive care unit of Beth Israel Hospital. From the clips of the movie shown in class, one segment that was as hard to watch as nails on chalkboard are to hear is when a female nurse tries to explain to her elderly male patient the choices he has about dying. “Your lungs are about as bad as they can get,” she says. When she calmly attempts to explain the dying man’s situation to him, he does not answer her and talks about his family instead in a failed attempt to swerve the conversation away from him. The nurse is incredibly persistent in her questions which rattle the old man and seem to confuse him. At one point she says, “I don’t want to keep you alive unless you like living.” The casualness of many of the doctors was also a little unnerving. In one quick scene a doctor checks the patient’s pulse and mouth and when he detects no sign of life, pronounces the patient dead, announces the exact time of death, and then just walks out of the room.
What is happening in this movie is interesting in the context of what Sharon R Kaufman, a medical anthropologist, writes about in the book A Time To Die. Many patients say that under no circumstances do they want to be placed on life support when they enter the hospital. The problem is that when those patients are in a crisis and life support is the only way to keep them alive, relatives and even the patients if they are capable of knowing what is going on will often be so indecisive that the patients end up on life support. When placed in this situation, are the people involved sustaining life or prolonging dying? I heard a reporter say on the National Public Radio morning news a few weeks ago that there are three ways that all of us can prepare for our death:
- Have a Living Will in which we say wheter we want to go on life support
- Designate a particular person to make decisions for us
- Agree to be an organ donor to help save someone else’s life
It seems to me that doing these three things would avoid a lot of the unnecessary cost and torment regarding life support decisions and that deciding to be an organ donor gives a certain value to the death that it would not otherwise have.
Our guest speaker Beth, I believe, gave the best possible care to her husband once she knew he was dying by keeping him at home so he could have a dignified death without any question of putting him on temporary life support to prolong his dying.
Being Sick
Being sick in this country is too tied to health insurance. Last year my brother was in a college basketball game, and an opponent’s elbow came down hard on the top of his gead. There was a big gash, and he was taken to a Boston hospital for stitches. He called my parents for out health insurance information, which he said was needed before he could get any attention even though he was covered in blood. Later my parents received a bill, Since they pay $1,000 a month for health insurance and any emergency that is taken care of in 24 hours issupposed to be covered, they questioned the bil. Then they received a call from the insurance company asking how the injury happened. They explained that their son was hurt in a college basketball game. “And why was he playing basketball? they asked. This situation contrasts with the time when I was in France playing sports and became sick. A doctor drove to come see me in my room late on a Sunday night, gave me a shot, made a call to open up the nearest pharmacy, gave me medicine to keep taking, and charged me nothing.
Another time my soccer team was practicing on the grounds of a monestary on Long Island near the water. We noticed a body floating face down near the shore. One parent who was a foot doctor and my dad pulled him out, pushed the water out of him, and gave him mouth to mouth resusitation. All of us called 911 on our cell phones. When the ambulance came, the medical people said that he had had a massive heart attack and was barely alive. We found out that he was a visiting monk from the Ukraine. The foot doctor parent called the hospital in Hicksville the next morning to find out how the man was doing. He was told that the hospital released him because he had no insurance. The monestary put him on a plane to go home, and he died a week later. This experience made our whole team feel outrage about our health care system. If this poor man had had a heart attack in any other industrialized country, he would have been treated for free.
Saturday, January 8, 2011
Sunday, January 2, 2011
HW # 28 - Comments 2
For Ben’s Blog
From your description of visiting your friend who was dying from ALS, I have a picture of your parents with nonstop smiles on their faces, of your friend the patient smiling quite a lot, and of you with a slightly smaller smile wondering why everyone seems to have exaggerated smiles on their faces at such an unsmiley time. Later you explain that keeping a positive attitude results in a patient’s more positive attitude, but I think your observation of the irony of acting almost too happy at such an unhappy time is a great insight. In a way visiting a dying person does require a good acting job because visitors cannot show their depression and make the dying person feel even worse. Smiles are infectious, and smiling at someone almost forces that person to smile back. Smiles can also be a nervous reaction and there is probably some of that going on too. I liked the description of the dying friend describing all the nurses who were taking care of him. They make up his world, and it is great that he could praise some and be critical of others and give you a picture of what was going on in his life especially when it was so hard to talk. It probably took a lot of effort trying to understand your friend speak. I was just curious about what his room was like and whether he had tubes and medical equipment attached to him. I also wondered how old his daughter was. You made me want to know more about him.
For Natalie’s Blog
I really liked the honest way you expressed your feelings about visiting your grandmother in the nursing home. The fact that she wasn’t there because she had scheduled an appointment at the same time as your visit says a lot about how the old are just not living
in the same world, and that this fact makes dealing with them take a lot of effort. It was interesting hearing about what a complicated maze the place is considering it is housing people whose minds aren’t at their peak and about your father’s comments on the pill box being complicated too. Both were good insights on how we don’t seem to design things for the elderly with them in mind. I also liked your line about your grandmother having a boyfriend and there not being any pictures of him among all the pictures of her family. I think the idea was that she would not have thought that it would have been proper to have his picture there. It was also funny that you only found three pictures of yourself, and I think it is just human nature to look for pictures of ourselves in that situation. The best part I thought was your description of how you just wanted to get out of the atmosphere of age and illness and thoughts of dying, even saying that you did not want to touch anything there. I understand completely. You just didn’t want any of that atmosphere to infect you or even rub off on you in any way. Your comments on sitting with her when she was opening her presents were insightful too. But why was she so ignorant when she said she was surprised things weren’t made in China when most things are now? Maybe the presents were expensive ones, and her comments were insulting. Anyway the line about her being left with people “who smirk after her comments and dread going to visit her” made me hope that this is not what is in store for all of us as we get up there in age. It probably is though. Great job.
From Mom
First of all, I am so glad about this assignment because I don’t think Devin would have gone to visit our friend Gloria by himself otherwise. At his age I wouldn’t have wanted to make this visit by myself either. There is nothing appealing about visiting a dying person. I felt proud to read that Devin had touched her hand because I know that must have meant a lot to Gloria and to Maria, and it can be hard to do. I liked the reference he made to what Paul Farmer said about the connection that touching an ill person makes. It’s good that he wasn’t uncomfortable or scared. The best part of his visit was hearing that he took the David Sedaris book I received as a present with him and actually read something from it to Gloria. I have just skimmed through the stories and there really isn’t one that is clean enough to read to Maria yet alone to Gloria. Both are very religious Catholics, who never use bad language. Devin must have looked hard to find the section he read out loud and I am sure that he did some editing. I’m also sure that Gloria heard him and loved the fact that he was reading something funny to her. One last comment I have is about his asking Maria if Gloria would be going to the hospital. He knew that Maria was keeping her at home, but I think when he was there with Gloria that it seemed to him that she should be in a hospital because she looked so ill. This seems like a normal reaction. If someone is very sick and possibly dying, then there should be doctors and nurses to look after this person. The visit to the class from the woman named Beth whose husband died must have made a very positive impression, and I liked the wording Devin used when he said that Maria and Beth were giving “their family member the most dignified dying experience possible.”
From Demetri
This story reminds me of my aunt. I visit her every week in the hospital and i read stories to her. We are now reading the Prophet and im having trouble understanding it but she helps get the meaning of the story. She teaches me things and she tells me story of her wonderful life. And i have a wonderful time visiting her.
From Ben
The part about this post that I enjoyed the most was the way you were able to connect the insights you made from visiting Gloria to the insights you had previously came up with while reading Mountains Beyond Mountains and while listening to Beth. For instance, when you said, "Both of them wanted to give their family member the most dignified dying experience possible. Both also had a lot of pictures in the room to give visitors of sense of the person and also to make the dying person have good memories," you did a great job of connecting to specific things that Beth said when thinking of your own experience in the hospital. I also really liked the way your writing had a very personal touch to it.
From Juggleandhope
I'll be interested to learn how this experience either lives with you or gets buried by your life.
I'll ask you in 3 years.
In the meantime, it sounds like the dance went pretty smoothly - you were helped in the choreography by your mom, by Maria, and by Gloria herself including props (bulbs), key moments (the hand-holding), and task (reading). Lucky! A lot of life feels easier and sweeter when you know the standard steps.
Would you change the general choreography at all when you visit the next ill person?
From Natalie
I enjoyed your post particularly because you did not completely focus on Gloria's current state, but instead reminisced on how she used to be. For example that she was married and how you used to go the store for her. It's apparent that even though she is slowly reaching the end of her life, you are still able to remember that she is a person and lived a fulfilled life. I think a lot of times our society hides the ill and dying and forgets that they too used to carry out a normal, routine life. Overall I really like how you wrote this post, it demonstrated your emotions and internal thoughts throughout the entire experience.
From your description of visiting your friend who was dying from ALS, I have a picture of your parents with nonstop smiles on their faces, of your friend the patient smiling quite a lot, and of you with a slightly smaller smile wondering why everyone seems to have exaggerated smiles on their faces at such an unsmiley time. Later you explain that keeping a positive attitude results in a patient’s more positive attitude, but I think your observation of the irony of acting almost too happy at such an unhappy time is a great insight. In a way visiting a dying person does require a good acting job because visitors cannot show their depression and make the dying person feel even worse. Smiles are infectious, and smiling at someone almost forces that person to smile back. Smiles can also be a nervous reaction and there is probably some of that going on too. I liked the description of the dying friend describing all the nurses who were taking care of him. They make up his world, and it is great that he could praise some and be critical of others and give you a picture of what was going on in his life especially when it was so hard to talk. It probably took a lot of effort trying to understand your friend speak. I was just curious about what his room was like and whether he had tubes and medical equipment attached to him. I also wondered how old his daughter was. You made me want to know more about him.
For Natalie’s Blog
I really liked the honest way you expressed your feelings about visiting your grandmother in the nursing home. The fact that she wasn’t there because she had scheduled an appointment at the same time as your visit says a lot about how the old are just not living
in the same world, and that this fact makes dealing with them take a lot of effort. It was interesting hearing about what a complicated maze the place is considering it is housing people whose minds aren’t at their peak and about your father’s comments on the pill box being complicated too. Both were good insights on how we don’t seem to design things for the elderly with them in mind. I also liked your line about your grandmother having a boyfriend and there not being any pictures of him among all the pictures of her family. I think the idea was that she would not have thought that it would have been proper to have his picture there. It was also funny that you only found three pictures of yourself, and I think it is just human nature to look for pictures of ourselves in that situation. The best part I thought was your description of how you just wanted to get out of the atmosphere of age and illness and thoughts of dying, even saying that you did not want to touch anything there. I understand completely. You just didn’t want any of that atmosphere to infect you or even rub off on you in any way. Your comments on sitting with her when she was opening her presents were insightful too. But why was she so ignorant when she said she was surprised things weren’t made in China when most things are now? Maybe the presents were expensive ones, and her comments were insulting. Anyway the line about her being left with people “who smirk after her comments and dread going to visit her” made me hope that this is not what is in store for all of us as we get up there in age. It probably is though. Great job.
From Mom
First of all, I am so glad about this assignment because I don’t think Devin would have gone to visit our friend Gloria by himself otherwise. At his age I wouldn’t have wanted to make this visit by myself either. There is nothing appealing about visiting a dying person. I felt proud to read that Devin had touched her hand because I know that must have meant a lot to Gloria and to Maria, and it can be hard to do. I liked the reference he made to what Paul Farmer said about the connection that touching an ill person makes. It’s good that he wasn’t uncomfortable or scared. The best part of his visit was hearing that he took the David Sedaris book I received as a present with him and actually read something from it to Gloria. I have just skimmed through the stories and there really isn’t one that is clean enough to read to Maria yet alone to Gloria. Both are very religious Catholics, who never use bad language. Devin must have looked hard to find the section he read out loud and I am sure that he did some editing. I’m also sure that Gloria heard him and loved the fact that he was reading something funny to her. One last comment I have is about his asking Maria if Gloria would be going to the hospital. He knew that Maria was keeping her at home, but I think when he was there with Gloria that it seemed to him that she should be in a hospital because she looked so ill. This seems like a normal reaction. If someone is very sick and possibly dying, then there should be doctors and nurses to look after this person. The visit to the class from the woman named Beth whose husband died must have made a very positive impression, and I liked the wording Devin used when he said that Maria and Beth were giving “their family member the most dignified dying experience possible.”
From Demetri
This story reminds me of my aunt. I visit her every week in the hospital and i read stories to her. We are now reading the Prophet and im having trouble understanding it but she helps get the meaning of the story. She teaches me things and she tells me story of her wonderful life. And i have a wonderful time visiting her.
From Ben
The part about this post that I enjoyed the most was the way you were able to connect the insights you made from visiting Gloria to the insights you had previously came up with while reading Mountains Beyond Mountains and while listening to Beth. For instance, when you said, "Both of them wanted to give their family member the most dignified dying experience possible. Both also had a lot of pictures in the room to give visitors of sense of the person and also to make the dying person have good memories," you did a great job of connecting to specific things that Beth said when thinking of your own experience in the hospital. I also really liked the way your writing had a very personal touch to it.
From Juggleandhope
I'll be interested to learn how this experience either lives with you or gets buried by your life.
I'll ask you in 3 years.
In the meantime, it sounds like the dance went pretty smoothly - you were helped in the choreography by your mom, by Maria, and by Gloria herself including props (bulbs), key moments (the hand-holding), and task (reading). Lucky! A lot of life feels easier and sweeter when you know the standard steps.
Would you change the general choreography at all when you visit the next ill person?
From Natalie
I enjoyed your post particularly because you did not completely focus on Gloria's current state, but instead reminisced on how she used to be. For example that she was married and how you used to go the store for her. It's apparent that even though she is slowly reaching the end of her life, you are still able to remember that she is a person and lived a fulfilled life. I think a lot of times our society hides the ill and dying and forgets that they too used to carry out a normal, routine life. Overall I really like how you wrote this post, it demonstrated your emotions and internal thoughts throughout the entire experience.
HW # 27 - Visiting an unwell person
The first feeling I had when I entered our friend Gloria’s room was a combination of surprise and sadness that she looked so changed in her hospital bed. Her face was thin and her skin looked bluish and see-through. Her white hair looked flattened down and lifeless compared to the healthy thick way it used to look. Her arms looked thin and bluish too and a little bruised. I held her hand for a second because her daughter Maria asked me to. It felt a little cold. When Gloria tried to speak, her mouth could not open very far. She said she hated to have me see her looking the way she did. I said I was just happy to see her. I showed her a pot of some narcissus bulbs my mother gave me to bring to her, and she said they were her favorite flowers. Then her eyes closed suddenly. I thought something terrible was happening, but her daughter said that she gets tired really easily. I said that I should go, but then Gloria opened her eyes again and said I could sit next to her and read something. I had brought this David Sedaris book someone gave my mom for Christmas because it has short, short stories in it, and some of them are pretty funny. After trying to find one without bad language, I read “The Migrating Warblers,” and I still had to edit out words as I read. I came to a part where one warbler was complaining to the other about how backwards and superstitious birds are in Guatemala, and the other one asked “Why not winter in Florida like everybody else? The other one said that even though there were “language barriers and severed heads,” Central America was “Cheap, cheap, cheap.” Gloria smiled the biggest smile I think she could.
Then I was alone in the room except for Gloria. Gloria’s daughter Maria was in the kitchen getting me a drink. I looked around. There were a lot of photos on two tables on either side of the bed. I guess the idea was for Gloria to see pictures of her family and friends and remember happy times. I had not seen them before. Gloria’s house is at the end of our block. She used to sit outside and say hello to me whenever I walked by. Sometimes I would go to the store to get her something or go to the Farmer’s Market a few blocks away to get fruit and vegetables for her. She always wanted to pay me, but I would not let her. Actually, once she gave me $2, and my mother told me never to let her pay me again. She was always smiley and happy. I saw a picture of her when she was married. She looked really young and beautiful. Maria came back with some juice for me, and I was glad it had ice in it because the room was so hot I felt really sweaty. Gloria seemed to have fallen asleep, and Maria told me that she would sleep more and more until the end. I asked if she would go to the hospital soon. Gloria said that she wanted her mother to die at home and that it would not be very long now. She said her
brother was coming tomorrow and that there would be other family members to be with her at the end. She thanked me a lot for coming.
I thought that Maria was handling her mother’s death in the same way that Beth handled her husband’s death. Both of them wanted to give their family member the most dignified dying experience possible. Both also had a lot of pictures in the room to give visitors of sense of the person and also to make the dying person have good memories. When Maria asked me to hold Gloria’s hand, it made me think about how Paul Farmer always made physical contact with his patients because touching made a closer connection with them. I think that is what Maria wanted for her mother too.
Then I was alone in the room except for Gloria. Gloria’s daughter Maria was in the kitchen getting me a drink. I looked around. There were a lot of photos on two tables on either side of the bed. I guess the idea was for Gloria to see pictures of her family and friends and remember happy times. I had not seen them before. Gloria’s house is at the end of our block. She used to sit outside and say hello to me whenever I walked by. Sometimes I would go to the store to get her something or go to the Farmer’s Market a few blocks away to get fruit and vegetables for her. She always wanted to pay me, but I would not let her. Actually, once she gave me $2, and my mother told me never to let her pay me again. She was always smiley and happy. I saw a picture of her when she was married. She looked really young and beautiful. Maria came back with some juice for me, and I was glad it had ice in it because the room was so hot I felt really sweaty. Gloria seemed to have fallen asleep, and Maria told me that she would sleep more and more until the end. I asked if she would go to the hospital soon. Gloria said that she wanted her mother to die at home and that it would not be very long now. She said her
brother was coming tomorrow and that there would be other family members to be with her at the end. She thanked me a lot for coming.
I thought that Maria was handling her mother’s death in the same way that Beth handled her husband’s death. Both of them wanted to give their family member the most dignified dying experience possible. Both also had a lot of pictures in the room to give visitors of sense of the person and also to make the dying person have good memories. When Maria asked me to hold Gloria’s hand, it made me think about how Paul Farmer always made physical contact with his patients because touching made a closer connection with them. I think that is what Maria wanted for her mother too.
HW # 26 - Looking back & forward in unit
1. “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.”
(Mountains Beyond Mountains p. 218)
2. Paul Farmer hates the idea that resources are scarce but only when it comes to the poor,
meaning that expensive drugs are available only to those who can pay for them. (Mountains Beyond Mountains)
3. 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.” (Mountains Beyond Mountains)
4. 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." (Sicko)
5. Beth treated all the people who worked at the hospital with an equal amount of respect no matter what task they performed in treating her husband. She made the effort to get to know them asking about their lives and families in order to build stronger relationships with them and have them care more about her husband. (Visit from Beth)
Mountains Beyond Mountains made the strongest impression on me because it shows how the world seems not to care about the illness and dying of the poorest peoples, and it shows what can be done by one man and others influenced by him to make a huge difference in the lives of people who need the most help. Sicko made a big impression on me about what’s wrong with this country’s health system because it tells who is to blame.
Questions to explore in the final two weeks:
Euthanasia – Physician assisted suicide
We can talk about the reasons people are for it and the reasons people are against it. We could have a debate.
Funerals – Burials vs. cremation
To get started we could show the Mike Nichols and Elaine May video, “$65 Funeral”
and the Carol and Robin Williams one called “The Funeral.”
Then we talk about cost, space and environmental issues, but it would be really good to
show the videos.
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 should make everyone really angry not just Paul Farmer because it is the exploitation of their land and resources by the rich and powerful that has made the poor people poor. We should all hate the fact that so many wealthy corporations and governments take no responsibility for the illness and the dying of desperately poor people.
When poor Haitians didn’t take all their medicine, members of the medical establishment said that they were “non-compliant” and used that as a reason not to give them more medicine especially if it was expensive. Farmer explained that there are many reasons why poor people might not be taking medicine. For example, they might not be able to get to the clinic or they might be selling it because their family is starving. He called the physicians “non-compliant” if they weren’t making sure their patients were taking 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 their medicine.
Sicko should make Americans think about what is wrong with a health care system that is for profit. It is crazy that insurance companies try to cheat people out of the coverage
they have paid for when they get sick, but since they are trying to make big profits, it makes sense why they do. Hospitals and doctors charge way too much for their services and so do
drug companies because they are all trying to make a profit. It makes sense that the government should be running health care setting limits on what all the for profit health
care providers can charge.
wealth in one part of the world and abject misery in another.”
(Mountains Beyond Mountains p. 218)
2. Paul Farmer hates the idea that resources are scarce but only when it comes to the poor,
meaning that expensive drugs are available only to those who can pay for them. (Mountains Beyond Mountains)
3. 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.” (Mountains Beyond Mountains)
4. 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." (Sicko)
5. Beth treated all the people who worked at the hospital with an equal amount of respect no matter what task they performed in treating her husband. She made the effort to get to know them asking about their lives and families in order to build stronger relationships with them and have them care more about her husband. (Visit from Beth)
Mountains Beyond Mountains made the strongest impression on me because it shows how the world seems not to care about the illness and dying of the poorest peoples, and it shows what can be done by one man and others influenced by him to make a huge difference in the lives of people who need the most help. Sicko made a big impression on me about what’s wrong with this country’s health system because it tells who is to blame.
Questions to explore in the final two weeks:
Euthanasia – Physician assisted suicide
We can talk about the reasons people are for it and the reasons people are against it. We could have a debate.
Funerals – Burials vs. cremation
To get started we could show the Mike Nichols and Elaine May video, “$65 Funeral”
and the Carol and Robin Williams one called “The Funeral.”
Then we talk about cost, space and environmental issues, but it would be really good to
show the videos.
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 should make everyone really angry not just Paul Farmer because it is the exploitation of their land and resources by the rich and powerful that has made the poor people poor. We should all hate the fact that so many wealthy corporations and governments take no responsibility for the illness and the dying of desperately poor people.
When poor Haitians didn’t take all their medicine, members of the medical establishment said that they were “non-compliant” and used that as a reason not to give them more medicine especially if it was expensive. Farmer explained that there are many reasons why poor people might not be taking medicine. For example, they might not be able to get to the clinic or they might be selling it because their family is starving. He called the physicians “non-compliant” if they weren’t making sure their patients were taking 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 their medicine.
Sicko should make Americans think about what is wrong with a health care system that is for profit. It is crazy that insurance companies try to cheat people out of the coverage
they have paid for when they get sick, but since they are trying to make big profits, it makes sense why they do. Hospitals and doctors charge way too much for their services and so do
drug companies because they are all trying to make a profit. It makes sense that the government should be running health care setting limits on what all the for profit health
care providers can charge.
Wednesday, December 22, 2010
HW # 24 - Illness & Dying Book, Part 3
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).
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).
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.
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