ANTC68H3 Lecture Notes - Emerging Infectious Disease, Drug Resistance, Ciprofloxacin

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Published on 19 Apr 2013
Week 9: The consumption of the poor by Paul E. Farmer (2000)
Explore the life experiences of TB individuals at social context through
Back with a vengeance?
WHO: 2 million TB deaths in 1999
TB was the leading cause of young adult deaths in most US cities
TB returned with a vengeance --> "emerging infectious disease"
Estimated 2 billion are currently affected with quiescent but viable
mycobacterium tuberculosis
TB remains the world's leading infectious cause of preventable deaths
in adults
Robert Koch identified tubercle bacillus at the end of 19th century
TB victims during 18th and 19th centuries included members of all
classes, always disproportionately affect the poor
TB also known as consumption
Consumptive cases --> gentlemen (16%), trademen (28%), labourers
Case fatality rates were high among all those with 'galloping
TB incidence declined in industrializing nations with improved sanitary
conditions, food, trade surpluses
In 1900, annual death rates from TB for white Americans approached
200 per 100,000 population, 400 per 100,000 in black Americans
The poor were more likely to become infected and ill, they were also
more likely to receive substandard therapy or no therapy at all
After WWII, those with access to new anti-TB medication could expect
to be cured of their disease
Racial differential risk --> case fatality in whites was almost 7 times
higher among unskilled labourers than among professional persons
"forgotten plague" --> forgotten because TB ceased to bother the
Pwatrine in Central Haiti: Jean Dubuisson
Jean Dubuisson lives in a small village in Haiti's Central Plateau, with
his wife and 3 surviving children
Jean and wife were having a hard time feeding their own children --> 2
children died, left with 3 surviving
There was no clinic or dispensary in his home villages and costly to go
to closest clinic in a nearby town
Jean did not seek medical care, he drank herbal teas as empiric
He lost weight over the course of several months and cough up blood.
Then, they believed that it was caused by pwatrine (TB)
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He went to the clinic closest to his home village, and paid $2 for
multivitamins. He was advised to eat well, drink clean water, sleep in
an open room and away from others and go to a hospital
2 months later, he was admitted to a church-affiliated hospital for 2
weeks before being referred to a sanatorium
Jean was charged $4 a day for his bed and most Haitian hospitals do
not serve food
He discharged himself when the family ran out of money and livestock
(to sell for money)
Jean and his family moved to Bois Joli, a small village served by a
Haitian organization which was sponsoring a comprehensive TB
treatment project, to seek treatment
He got sunken eyes and severe anaemia when he began therapy
His daughter was also treated
Although he is free of active TB now, his left lung was almost
completely destroyed and he gets short of breath with minimal exertion
MDR-TB and Fujishock in urban Peru: Corina Bayona
Corina Bayona and her family emigrated to Carabayllo, the new and
sprawling slum north of Lima, in 1974
Corina worked as a main in a schoolteacher's house and her husband
worked as a night watchman in the industrial area south of Lima
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