Tuberculosis in New York City

Mega Macoubray

Anth 215 Final Paper

10/12/2012

Professor Lucero

Tuberculosis in New York City

Tuberculosis is a contagious bacterial infection that is typically in the lungs but can spread to other organs. Tuberculosis is caused by the bacteria: Mycobacterium tuberculosis (M. Tuberculosis). Contracting this disease is very simple by breathing in air droplets from a cough or sneeze of someone who is infected. While this is a curable disease, further evidence of the infection can stay dormant in the body for years. In some cases, reactivation is also an issue. People at high risk for Tuberculosis are the elderly, infants, and people with a previously weakened immune system for example people who have already contracted AIDS, diabetes, or who have gone through chemotherapy. The medical anthropological academic article that I read discusses the Tuberculosis in New York City and the continued fight to end the spread of Tuberculosis. My paper will discuss specific anthropological terms that relate to my article as well as comparing Tuberculosis in the States with tuberculosis in other countries in understanding the how privileged we are in America where we have access to all the necessary treatments.

Tuberculosis in New York City

In the 1960’s New York City had many programs to help stop the spreading of Tuberculosis. In 1989 Hermann Biggs of the New York City Department of Health continued research in the subject and recommended surveillance, isolation, education and free sputum testing in an effort to control the disease. Before the discovery of the specific proper medications needed to control the disease it was the above stated as the only available means of disease control. The most effective way to control the disease was to view the subjects because at this point treatment was not available. At one point there were over 2400 beds set up in hospitals around the New York City area for Tuberculosis patients. With all of the programs and aid, there was a visible decline in the spread of tuberculosis, which also had a negative turn because the programs set up began crumbling, as the disease was no longer seen as an emergency health issue. This left only about 8 clinics by 1998 in comparison to 24 years before.

            The decline in the spread of Tuberculosis has been associated to the Directly Observed Therapy (DOT) where the patients are observed while taking their medication. In 1994, over 1200 patients from different homes, workplaces, street corners, bridges, subway stations, park benches, abandoned buildings were all receiving treatment through the resources from the city with Department of Health and federal and local funding. This was very helpful because one person with tuberculosis on average will infect one person a month and the infection rate can be much higher for those people with an already weakened immune system. People who are most susceptible for infection are the elderly, children, and most specifically people who have HIV/AIDS. With the DOT treatment in New York City, it served as good prevention from either becoming or remaining infectious for people all around the city in varying and differing communities. This was especially helpful as it made people aware of there situation which made these people more cautious in order to not spread their disease to strangers, loved ones, or neighbors.

            Another way New York City aided in the prevention of the spread of tuberculosis was through Infection-Control Measures by screening and isolating people as well as a follow-up for people who underwent treatment. With specificity to New York City, a way in which Infection Control measures was helpful was by reducing exposure in homeless shelters by providing housing for patients with AIDS.  This was a program that was set up by HIV/Aids prevention foundations however it helped dramatically in reducing the spread of Tuberculosis as well. This was dually helpful as it stopped the spread of AIDS and Tuberculosis by fixing the issue of over crowding and making the spread of these diseases less accessible.

With the DOT and infection control, there was also a regimen of four drugs: Isoniazid, Rifampin, Pyrazinamide, and Ethambutol that became active for use in prevention of Tuberculosis in 1991 by the Department of Health and was highly recommended for patients. These drugs were able to help the people with drug-resistant strains that interfered with tuberculosis treatment and also shortened the amount of time that people with tuberculosis would be infectious.  This allowed for the infected people to not be contagious for as long as they would normally be. The article puts much emphasis on the fact that tuberculosis is curable and preventable if the proper steps are taken. To avoid a resurgence of tuberculosis, preventative care must be given to people who are ill and unaware that they are infected as well as maintaining and continuing the DOT treatment.

Medical Anthropology Frame

Considering that medical anthropology examines the way in which culture and society are organized around or influenced by health issues, a medical anthropology perspective would frame this specific article as a continuing problem in New York City which is why it is the New York City Department of Health has been the primary aid for the cities Tuberculosis problem. Since there was also federal funding we can see that the spread of Tuberculosis in New York City is also a problem that the United States as a whole is interested in. While there are many cases of tuberculosis in other countries that are much worsely affected by the disease, we see how New York City’s department of Health’s first mission is to cure the people living within their community. Even though these other countries are definitely suffering more deeply as a whole country in comparison to the affected in New York City, we don’t see any information in this article about New York City trying to assist other countries in their fight against Tuberculosis or vice versa. This article deals strictly with the problem in New York City and what the society in New York City is doing to stop the spread because for the New York City locals, their first concern is to help their city before taking on the global health issues all over the world.

We also see some instances of Bio power in this article because as the spread of tuberculosis became less relevant, people stopped focusing as much on solving the issue and many programs were shut down or closed. The government and the politics through local and federal donations have the option to choose how much they are willing to help. With power in general having such a big impact in anthropology it is through the power of the programs and the aid of the government as well as the funds towards research that gave the people with tuberculosis in New York City all the benefits they did receive. In America, since we have the resources and opportunities it is important that our people are helped especially in terms of health. As tuberculosis was on the rise in the 1990’s, we saw more programs and more funding being given to assist.

WHO Results

Not only in New York City has there been control of Tuberculosis, but according to the WHO records, “The TB mortality rate has decreased 41% since 1990 and the world is on track to achieve the global target of a 50% reduction by 2015”(WHO 2012). The WHO reports also discuss the many countries who are unable to provide enough to help their people, “the African and European regions are not on track to halve 1990 levels of mortality by 2015”(WHO 2012). Continually with the prevention of Tuberculosis, WHO discusses the eleven new vaccines that are being developed which will also be very helpful for the drug-resistant TB patients. Geographically, it is Africa and Asia who account for the highest rates of TB. With global health and anthropology in terms of ethnography, we are working towards a tuberculosis free world. The continuing research and fight will be very beneficial to other countries. The fact that America has the resources to continue research and developing new vaccines will help the world globally especially through the anthropological concepts that will aid with community understanding to properly help varying communities around the world who are in dire need of tuberculosis vaccines.

Redefine the Problem with Medical Anthropology Concepts

With ethnography as the close range and extended participation and observation of a society by an anthropologist in order to gain general insights by a thorough acquaintance of the particular, people are able to learn about different communities and from that help those communities. This article being based in the US and in a very well known city made the research that much easier. By being able to understand the community and work with the community, the needs and assistance was met quite easily. One good thing about this article was that it showed how there is constant help going towards the people in New York City who are infected with Tuberculosis. The people who were infected were able to get treatment and prevent spreading the infection. Luckily for these Americans, we didn’t hear about all the troubles that it took for them to get treatment or how they could not afford the treatment. This also relates to biopower because the American government made it easier for their people to receive treatment and escape death while the fatality rates are much higher for people in other countries.

Personal Understanding in Relation to Medical Anthropology Concepts

My perspective based on my knowledge of medical anthropology concepts makes me realize how lucky I am to be from the United States where I have access to the highest levels of education and the highest levels of health care if I am willing to pay for it. What shed light on this problem are the perceptions of the people. Since there is a problem of the spreading of the disease in America, that gives a negative perception of our country for which nobody wants. People do not want to live in a country that is constantly infected with diseases. For this reason the perception of the American people and the perceived perception of others looking onto the American country made the prevention of the spread of tuberculosis in American a greater deal. For this reason with much research the four medicine treatments were granted to the people in need in order for those people to be healthy. Also, the eleven new medical treatments are currently being tested and trialed.

Furthermore with social representation in terms of dealing with unfamiliar ideas, Tuberculosis had already been around in the US so there was already much information that had been documented in order to quickly solve the problem. Also with tuberculosis being found in people from varying communities throughout New York City, it was a problem that affected many and a treatment that helped many. It became an issue for many individuals who together formed a group based on their similar situations where they would normally feel unfamiliar; they were brought together based on a common desire to cure tuberculosis.

Conclusion

Tuberculosis is a deadly disease that is killing hundreds of thousands people all around the world yearly.  With anthropology, and global health, we can become aware of the areas in the world that need help the most. Through ethnography, perceptions, and an understanding of culture, anthropologists can understand how to best use their resources to help people all around the world. Biopower is important to understand because, politics and money, are used to gain power and power is a big determinant in decisions based on who to help, why to help them, and how to help. As our world becomes more connected, global health will be more achievable. Anthropology through ethnography and research are constantly helping to make the world a smaller and more accessible place.

            It is awesome that in New York City, people from all different communities including the homeless and the drug addicts are given necessary treatments for their tuberculosis conditions. Living in America can provide those resources because our country is a super power. By helping our people and determining which treatments work best, this will help other cases around the world because the research will be more advanced. There will always be constant interest and care towards global health.