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ANTC68-The consumption of the poor by Paul E. Farmer (2000)

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University of Toronto Scarborough
Erin Bryce

Week 9: The consumption of the poor by Paul E. Farmer (2000) Abstract • Explore the life experiences of TB individuals at social context through ethnography 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 (30%) • Case fatality rates were high among all those with 'galloping consumption" • 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 wealthy 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 remedies • He lost weight over the course of several months and cough up blood. Then, they believed that it was caused by pwatrine (TB) • 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 • High unemployment and political violence often struck the city • In 1989, Corina began coughing and attempted to treat herself with herbal remedies • She might have contracted TB during the long bus ride back and forth to work • When her cough worsened, she finally went to the public health post nearby and standard anti-TB therapy began after TB was diagnosed with her sputum • In August 1990, the urban poor underwent fujishock --> inflation in public services and healthcare, and economic recession • The poor have continued to bear the brunt of the reform in Peruvian economy, poor increased from 7 to 12 million 1 year after fujishock implemented • Health post has long wait and inconvenient hours, Corina began to received treatment at a private clinic • She was not able to complete the treatment as she could only afford to buy 2 of the 4 drugs prescribed • She did not respond to standard therapy after her condition worsened (drug-resistant developed) • Corina refused to seek treatment in the health center because the physicians were mean and impolite and Corina was labelled as non- compliant for not completing the treatment. Her son, Jamie was also refused to go to the hospital for the same reason. • They learned that other drugs were available but that the public health system could not provide them free of charge. Ciprofloxacin and ethionamide with an estimated cost of 500 soles a month (8 times her husband's income). Her son died. • Through the efforts of local community-based organization, Corina eventually received therapy with a multidrug regimen designed for resistant TB disease for free, but adverse reaction developed soon after, and she has to stop taking the medication From Harlem to Vietnam and back: Calvin Loach • Calvin was drafted in into the US army when he was 19. • He began to use heroin to treat chronic pain in Vietnam when his right foot injury became infected • He drank and smoke heavily sometimes • In 1991,
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