Jana Blumenthal Michael Dillon Kacy Negethon Abby Law.

Jana BlumenthalMichael Dillon

Kacy NegethonAbby Law

Jana BlumenthalMichael Dillon

Kacy NegethonAbby Law

Infections and Inequalities

Infections and Inequalities

THE MODERN PLAGUESTHE MODERN PLAGUES

written bywritten by paul farmerpaul farmerwritten bywritten by

paul farmerpaul farmer

IntroductionIntroductionIntroductionIntroduction

We know most things about it, but TB still kills more people than any other pathogen, far more than

alcoholisms, AIDS, malaria, tropical diseases and Ebola combined, and nobody seems to care….Where is the shame?

Where is the outrage?Lee Reichman, 1997Lee Reichman, 1997

We know most things about it, but TB still kills more people than any other pathogen, far more than

alcoholisms, AIDS, malaria, tropical diseases and Ebola combined, and nobody seems to care….Where is the shame?

Where is the outrage?Lee Reichman, 1997Lee Reichman, 1997

IntroductionIntroductionIntroductionIntroduction

Farmer discusses social inequalities Farmer discusses social inequalities that contribute to the spread of that contribute to the spread of Aids, tuberculosis, and other Aids, tuberculosis, and other

diseases among the poor and hinder diseases among the poor and hinder their treatment. Farmer has battled their treatment. Farmer has battled

AIDS in rural Haiti and deadly AIDS in rural Haiti and deadly strains of drug-resistant strains of drug-resistant

tuberculosis in Peru. In his tuberculosis in Peru. In his stories of sickness and suffering. stories of sickness and suffering. Farmer challenges the accepted Farmer challenges the accepted

methodologies of epidemiology and methodologies of epidemiology and international health. international health.

Farmer discusses social inequalities Farmer discusses social inequalities that contribute to the spread of that contribute to the spread of Aids, tuberculosis, and other Aids, tuberculosis, and other

diseases among the poor and hinder diseases among the poor and hinder their treatment. Farmer has battled their treatment. Farmer has battled

AIDS in rural Haiti and deadly AIDS in rural Haiti and deadly strains of drug-resistant strains of drug-resistant

tuberculosis in Peru. In his tuberculosis in Peru. In his stories of sickness and suffering. stories of sickness and suffering. Farmer challenges the accepted Farmer challenges the accepted

methodologies of epidemiology and methodologies of epidemiology and international health. international health.

Farmer shows that society has put a net worth on human life. Diseases That are treatable in the United States but not in Haiti or Peru, unfortunately poverty has devalued Human life. “Peru’s government has deemed MDRTB not cost effective, but $350 million for a dozen fighter jet’s a terrific deal.” With better access to information, the poverty stricken now know that MDRTB can be treated with second-line drugs. But with a six month supply of TB drugs many times costing a Haitian more than a years salary. No one wants to treat the most Susceptible to risk, the poor.

Farmer shows that society has put a net worth on human life. Diseases That are treatable in the United States but not in Haiti or Peru, unfortunately poverty has devalued Human life. “Peru’s government has deemed MDRTB not cost effective, but $350 million for a dozen fighter jet’s a terrific deal.” With better access to information, the poverty stricken now know that MDRTB can be treated with second-line drugs. But with a six month supply of TB drugs many times costing a Haitian more than a years salary. No one wants to treat the most Susceptible to risk, the poor.

Societal conditions Societal conditions determine biological determine biological

realities for poor and realities for poor and powerless people by powerless people by

simultaneously putting simultaneously putting them at risk for disease them at risk for disease and denying them access and denying them access

to care.to care.

Emerging Infectious Disease

Emerging Infectious Disease

• Social Inequalities– “We live in a world where infections pass easily across borders--social and geographic-- while resources, including scientific knowledge, are blocked at customs.” (54)

• Transnational Perspective– Inequality in developing countries may cause medical emergencies in developed countries when borders are crossed

• Critical Epistemology– Rhetoric and perceived human value perpetuate disease in oppressed groups

• Social Inequalities– “We live in a world where infections pass easily across borders--social and geographic-- while resources, including scientific knowledge, are blocked at customs.” (54)

• Transnational Perspective– Inequality in developing countries may cause medical emergencies in developed countries when borders are crossed

• Critical Epistemology– Rhetoric and perceived human value perpetuate disease in oppressed groups

What is Tuberculosis (TB) ?

What is Tuberculosis (TB) ?

• Bacterial disease that is spread through the air

• Usually attacks lungs, but can affect any part of the body

• TB is curable with treatment

• TB can lead to death if untreated

• Bacterial disease that is spread through the air

• Usually attacks lungs, but can affect any part of the body

• TB is curable with treatment

• TB can lead to death if untreated

Multi Drug Resistant TB (MDR-TB)

Multi Drug Resistant TB (MDR-TB)

• Lack of access fuels drug resistance

• Most TB patients do not complete their full 6-9 month regimen. The TB bacillus becomes resistant due to incomplete, erratic or inadequate treatment.

• MDR-TB could be growing as rapidly as 400,000 cases each year

• Lack of access fuels drug resistance

• Most TB patients do not complete their full 6-9 month regimen. The TB bacillus becomes resistant due to incomplete, erratic or inadequate treatment.

• MDR-TB could be growing as rapidly as 400,000 cases each year

Poverty and TBPoverty and TB

•Treatment requires taking several medications regularly for at least six months

•Small living spaces expose and re-expose infectious bacteria

•Family members, homeless shelters, prisons

•Unable to take time off of work, hindering recovery and exposing co-workers

•Treatment requires taking several medications regularly for at least six months

•Small living spaces expose and re-expose infectious bacteria

•Family members, homeless shelters, prisons

•Unable to take time off of work, hindering recovery and exposing co-workers

Intersection of Two Global Intersection of Two Global EpidemicsEpidemics

Intersection of Two Global Intersection of Two Global EpidemicsEpidemics

• Approximately 2 billion people (one-third of the world's population) are infected with Mycobacterium tuberculosis, the cause of TB.

• TB is the cause of death for one out of every three people with AIDS worldwide.

• The spread of the HIV epidemic has significantly impacted the TB epidemic - one-third of the increase in TB cases over the last five years can be attributed to the HIV epidemic

• Approximately 2 billion people (one-third of the world's population) are infected with Mycobacterium tuberculosis, the cause of TB.

• TB is the cause of death for one out of every three people with AIDS worldwide.

• The spread of the HIV epidemic has significantly impacted the TB epidemic - one-third of the increase in TB cases over the last five years can be attributed to the HIV epidemic

What are HIV and AIDS?What are HIV and AIDS?

•HIV is a virus that kills CD4 cells(T-cells) which help body fight off disease

•Transmitted through blood, semen, vaginal secretions, and breast milk

•AIDS is the most advanced stage of HIV

•HIV is a virus that kills CD4 cells(T-cells) which help body fight off disease

•Transmitted through blood, semen, vaginal secretions, and breast milk

•AIDS is the most advanced stage of HIV

Poverty and HIV/AIDSPoverty and HIV/AIDS

•Treatment requires:Treatment requires:– a personalized selection of a personalized selection of medications for remainder of lifemedications for remainder of life

– constant tests of viral levels and constant tests of viral levels and T-countsT-counts

•Infected person must be Infected person must be adaptable to sudden needed adaptable to sudden needed rest, unexpected illness, etc.rest, unexpected illness, etc.

•Treatment requires:Treatment requires:– a personalized selection of a personalized selection of medications for remainder of lifemedications for remainder of life

– constant tests of viral levels and constant tests of viral levels and T-countsT-counts

•Infected person must be Infected person must be adaptable to sudden needed adaptable to sudden needed rest, unexpected illness, etc.rest, unexpected illness, etc.

RealityReality

• Annual per person cost of TB treatment medication:- min $500

• Per capita income in Peru-$5000

• Annual per person cost of HIV treatment medication:– $4000

• Per capita income in Haiti– $400

• Annual per person cost of TB treatment medication:- min $500

• Per capita income in Peru-$5000

• Annual per person cost of HIV treatment medication:– $4000

• Per capita income in Haiti– $400

AID’S came from Africa then traveled to United States

and Europe, subsequently was introduced into Haiti by

either tourist or returning Haitians, 33% of all AID’S

patients live in suburb’s of Port Au Prince.

Complications to HIV infections in rural and

suburban Haiti are leading cause of death

AID’S came from Africa then traveled to United States

and Europe, subsequently was introduced into Haiti by

either tourist or returning Haitians, 33% of all AID’S

patients live in suburb’s of Port Au Prince.

Complications to HIV infections in rural and

suburban Haiti are leading cause of death

Factors of AIDS in Haiti

Factors of AIDS in Haiti

• 70 % unemployment rate• Transnational homosexual contact• Pursuit of trade and tourism• Crowded demographics, population pressures

• Economic pressure• Patterns of sexual unions• Gender inequality• Concurrent disease• POVERTY

• 70 % unemployment rate• Transnational homosexual contact• Pursuit of trade and tourism• Crowded demographics, population pressures

• Economic pressure• Patterns of sexual unions• Gender inequality• Concurrent disease• POVERTY

Voodoo, Sorcery Voodoo, Sorcery and and

SuperstitionsSuperstitions

• Haitian voodoo priest routinely conduct rituals where blood of animals is consumed

• Many Haitian voodoo priest are homosexual men

• Many Haitians believe infections are caused by sorcery

• Many Haitians believe AIDS is a U.S. experiment gone wrong

• Infections can be sent by someone who willfully inflicts death upon the afflicted.

• Haitian voodoo priest routinely conduct rituals where blood of animals is consumed

• Many Haitian voodoo priest are homosexual men

• Many Haitians believe infections are caused by sorcery

• Many Haitians believe AIDS is a U.S. experiment gone wrong

• Infections can be sent by someone who willfully inflicts death upon the afflicted.

•Three decades after the surgeon general claimed that “its time to close the book on infectious diseases,” these pathogens, most of them treatable, remain the world’s number one killers.

•TB will be the 4th leading cause of death overall in the developing countries by the year 2020

•Three decades after the surgeon general claimed that “its time to close the book on infectious diseases,” these pathogens, most of them treatable, remain the world’s number one killers.

•TB will be the 4th leading cause of death overall in the developing countries by the year 2020

Good AspectsGood Aspects

• Passionate and engaging anecdotes

• Extensive, well-documented research

• Tangible language; easy read

• Copious information

• Room for finger painting at end of book

• Passionate and engaging anecdotes

• Extensive, well-documented research

• Tangible language; easy read

• Copious information

• Room for finger painting at end of book

•Redundant at times, unfortunately same story, ex. patient gets TB, then die’s

•Farmer assumes the reader is familiar with all terminology associated with infections and diseases

•No real clear solution to fix the problem

•Idealistic way of looking at the world thru pragmatism

Bad PointsBad Points