This past week we have learned that
Medical Anth and Global Health in particular are big issues, with pig problems
that involve many people, who are often at odds with one another, even when, in
theory they should be on the same team. There are a lot of players, and a lot
of power, almost exclusively running on a north to south axis. One of these
players that was mentioned in Dr. Ceron's lecture was a man named Paul Farmer,
a physician, medical anthropologist, and one of the founders of Partners in
Health and all around amazing human being. This photo is pretty famous now, of Farmer treating one of his patients in Haiti. He works tirelessly and he is an on the ground, in the thick of it kind of guy. He doesn't just sit around at meetings and make recommendations, he works for his patients.
I must begin by disclosing that Farmer
is one of my personal heroes and one of the people who inspired me to study
medical anthropology. He tackles big problems with seemingly big solutions,
but he goes about it in a from-the- bottom -up kind of way, a very
anthropological kind of way. Working with those who actually need the help
to see what solutions they think would work best.
A good way to get to know Farmer and
his work and philosophy is to read Tracy Kidder's ( a male Tracy) semi-
biographical work, Mountains Beyond Mountains. In this book, Kidder covers
Farmer's non-traditional upbringing, his
time in medical school and the time he spends working in Haiti, where he
meets the author, Roald Dahl's daughter, Ophelia Dahl as well as Jim Yong
Kim, current president of the World Bank.
I was reminded of Farmer’s work with
TB when I saw this chart of statistics in the WHO report, along with this
statement: “In 2010, there were an estimated 8.8 million new cases –
approximately 13% of which occurred in people living with HIV. In 2010, an
estimated 1.1 million HIV-negative people died from tuberculosis, while an
additional 0.35 million died from HIV-associated tuberculosis.”
TB is often thought of in the in the
US as something that doesn’t even exist, at least to the average lay person.
After all people don’t get “consumption” anymore, right?
The fact remains that TB is a huge
problem on a global scale and multi-drug-resistant (MDR) TB is becoming an even
greater problem, but MDR or not TB is a huge problem for people with
co-morbidities such as HIV/AIDS, as can be seen upon close inspection of the
WHO statistics.
Farmer uses his knowledge as an
anthropologist as well as his expertise as a physician and his resources at the
US university hospital he works at to solve problems from the ground up. He
works directly with the Haitians, and amongst them in order to find out what
works best to truly cure patients. For example, people are more likely to take
the full course of their medication and be disease free, if they have enough
food, having enough food means having money for food and if they can get to
their appointments at the treatment center, this means transport. These
examples clearly show us that Farmer’s work is based on the idea of
comprehensive care. In the 25 years that Farmer has been working in Haiti, he
has seen many changes but he has also seen much growth in the way of his
partnership with the Haitian people, following are some figures from the PIH
website,
PIH/ZL's work in
Haiti by the numbers (FY 2011):
13,784 children received educational
assistance
6,268 HIV-positive patients on treatment
98,735 pregnant women seen in
antenatal clinics
53 houses constructed or repaired
482 TB patients treated
75,000 cholera patients treated
(http://www.pih.org/pages/Haiti)
All of this goes to show change is
possible, even with the big problems and the many voices, the myriad of actors
and large organizations on the word stage.
Kidder, Tracy (2003-09-09). Mountains Beyond Mountains. Random House, Inc.. Kindle Edition.
WHO, World Health Statistics 2012 Report.pdf
www.pih.org
Sorry about the missing charts, some glitch with Blogger.
ReplyDeleteI would like to comment on the statement that talks about the success of Farmer’s comprehensive care treatment for Haitian TB patients, specifically the blogger’s explanation that “people are more likely to take the full course of their medication and be disease free, if they have enough food..money..transport.” I believe supplying the needs to get treated is a critical aspect to treatment that is often under looked in regards to global health. As stated there are many actors in the role of global health with different views and ideas. However, very few of these ideas actually make an impact on combating disease.
ReplyDeleteI wholeheartedly agree with the comment included about Farmer’s work being a more hands on solution compared to other global health approaches. Farmer’s solution as described really connects the treatment with the patient. He understands that treating a patient for TB in Haiti extends far more than telling them there is a clinic with the medication needed. He understood that the TB positive patients were living in poverty. Medication for treatment, follow ups and checkups become secondary to them, with their major focus on accumulating enough funds to take care of their family. If their basic life essential needs aren’t being satisfied they are nearly impossible to treat/ recover from disease. I did get a chance to read a summary of the book Mountains Beyond Mountains by Tracy Kidder, and was really blown away by the quality of the work and time he spent trying to tackle the TB epidemic. I too as well believe that Farmer does embody what it means to be a Medical Anthropologist. He did not centralize his focus on the medication dosages rather the people. For example, his work showed patients who cannot afford food or are eating poorly responding negatively to the treatment. He understood that without the means of transportation and money, patients could not afford to get treated. I believe that understanding the living arrangement, lifestyle and culture of the patients and designing a treatment plan that realistically molds for the patients is a great approach. This is an example of why medicine and anthropology go hand in hand with each other. If we understand both concepts patients will receive the care they need at full extent. As the World Health Organization reports TB is a much larger problem in that region compared to other areas in the world like the U.S. Regions don’t just vary by geographical location. They vary economically, politically and culturally. With that being said what works for a country in South America obviously wouldn’t work for a country in Africa. When a disease disproportionally affects certain areas of the world more than others makes me believe that if we connected anthropological research we could generate a medical plan to tackle it. Although there are many other factors to consider, I believe Farmer’s hands on approach proves this correct. Farmer did not have nearly as much money as other researchers however; he was still successful in treating patients at a high rate. That shows that incorporating medical anthropological elements into treatment plans could/will be far more effective than focusing on any particular drug treatment.