India!

As I write these words, I’m sitting on a bus in southern India, surrounded by 24 other students from the University of Minnesota. We’re on the last leg of our journey from Minneapolis to Mysore, just a short 4 hour bus ride from the Bangalore airport to our hostel. According to my watch, which is still on Minnesota time, we’ve spent a total of 31 hours in transit.

We are here as the guests of the Swami Vivekananda Youth Movement (SVYM), a development organization that operates in Mysore. The trip is a UMN global seminar- a winter break class on global health, from an Indian perspective. This program has been in the works since my freshman year of college, so I am thrilled that as a senior, I finally get to go.

My objective for this trip is to learn as much as I can about what works in development. My questions so far fall into three categories: practice, theory, and context. I want to understand the working model of SVYM, from its financial sustainability to its model of health care delivery. Perhaps equally important, I want to learn about the theoretical framework under which SVYM operates: what is their definition of “development,” for example? And finally, as a total outsider, I hope to gain a better understanding of the context in which SVYM operates, from the economic and political environment to the cultural dynamics of the communities they serve.

So much of my global health education has revolved around criticism- the great value of MSID, for me, was that it smashed my naïve ideas of “progress,” “development,” “globalization,” and “global health,” all of which I had previously viewed as almost exclusively positive. I am extremely grateful for this, because to paraphrase Carl Sagan, to me it is far better to see “development” for what it really is, than to persist in delusion, no matter how satisfying. But as a result of this focus, so far I’ve failed to come into personal contact with any models of development that I can actually believe in. Perhaps I never will. But in that hope, here I am in India.

A quick Farmer soundbite

It’s almost as if he predicted Occupy Wall Street, and its subsequent criticism as being “aimless” (or, even, my personal reservations about the movement, namely that it’s hard for me to imagine concrete and effective changes into which to channel the political will that’s being stirred up*):

[Solutions] are within our grasp if we have sufficient vision and will to demand something better for the poor, wherever they live. In constructing an alternate vision, we will all be acting unreasonably–that is, without the certainty of success. “Nonetheless,” notes Wallerstein, “we are condemned to act.” He continues: “Therefore, we must first be clear about what is deficient in our modern world-system, about what it is that has made so large a percentage of the world’s population angry, or at least ambivalent about its social merits. It seems quite clear to me that the major complaint has been the great inequalities of the system, which means the absence of democracy.”

Infections and Inequalities p. 36 (I’m currently reading this book for my medical anthropology class, so there will be more where this came from.)

*This is really just my difficulty in imagining a “different social order.” But what I take Farmer to mean here is that it’s okay to demand change, even if we don’t have concrete solutions in mind; in fact, we are morally compelled to do so. But even that’s misleading: we do have concrete solutions at hand. Partners in Health is a particularly prominent one.

Music Monday: “Just” by Radiohead

I’ve posted this song on facebook way too many times, but it still gives me the shivers. Both the song and the video are windows into my brain.

The most impulsive thing I’ve ever done

Because it totally fits with my education and “interests.”
Because it’s not like I won’t be traveling enough this year for medical school interviews.*
Because I have been so involved with STAND in the past.

I present to you: the most impulsive thing I have ever done. On Friday, I will fly to Washington, DC to attend a conference on genocide prevention, complete with lobbying and a march on the Capitol. What?

Since this has been a largely irrational decision, it’s difficult to articulate my reasons for going. However, I think they mostly boil down to the following:

The main reason genocide prevention doesn’t “fit my interests” is because I feel so powerless to do anything about it. I don’t understand the issues and causes involved, and I don’t know anything about effective anti-genocide policy. But beyond that, I feel powerless, politically. I don’t know how to be a political activist on any issue, not even one as urgent as genocide.

And that’s exactly why I want to go to this conference. If I have learned anything from Farmer, Orbinski, et al, it is that advocacy** is a critical component of socially just health care. Being a good physician implies that you assume a certain degree of humanitarianism; you have chosen to actively intervene in people’s lives in the hopes of helping them get better. To me, it then logically follows that this ethic of humanitarianism should apply to wider populations than the handful of patients that show up at the doctor’s office, and with a broader scope than that offered by clinical medicine. The physician-activist must diagnose and address pathologies of the social order as well as of the flesh.

It’s easy to make these grand statements about advocacy and social justice, but what do they actually mean in practice? At this point, I still have no idea. So I’m attending this conference, in the hope that it might just shed some light on what it means to be an activist.

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*I have two interviews in the two-week period following this conference. During that time, I will be spending more time away from Minneapolis than actually at school. Yikes.

**My favorite example of this principle is Dr. Orbinski’s Nobel Prize acceptance speech.

On lies and our moral responsibility to find truth

This was a recent facebook status of mine:

Facebook: Probably not the best place to vent Bachmann-induced rage?

The link I included was to this article in the Star Tribune, in which University of Minnesota medical school professor Steven Miles (go check out that link and see why he’s my hero) offers $1000 for substantiation of Michele Bachmann’s claim that the HPV vaccine gave her supporter’s daughter “mental retardation”. I could probably write a short book on the repugnancy of Republican politics regarding this particular vaccine, but instead I want to address an issue I’ve been wrestling with recently.

In the heat of the moment, I referred to “Bachmann’s lies.” This may be somewhat uncharitable to Rep. Bachmann, as her anecdote may in fact be true: it’s plausible that one of her supporters did indeed come up to her and claim that the HPV vaccine caused her daughter’s condition. It also may not be entirely fair to say that the supporter was lying; like many parents of autistic children who campaign against vaccines, she likely believes wholeheartedly that the HPV vaccine caused her daughter’s neurological disorder. In terms of the medical evidence of a vaccine-neurological disorders (autism tends to be the disorder of choice) causal link, her claim is wrong (and demonstrably so, though I’ll get to that in a second), but it’s unlikely that she’s being intentionally deceitful.

Is there any difference, however, in terms of the moral judgment we can make? If someone is actively promoting a falsehood that they believe is true, can we hold them just as responsible as someone who is deliberately lying?

My answer, based on the consequences of the falsehood in question, is yes. The claim that vaccines cause autism is a particularly dangerous one. Briefly, since not everyone can be vaccinated, and diseases requiring multiple vaccinations leave open crucial windows of vulnerability before immunity is fully conferred, a successful immunization campaign relies on herd immunity. Anti-vaccination fear-mongering, led by the medical fraud Andrew Wakefield and the swarms of ridiculous quacks peddling their “natural” remedies for autism (like Joe Mercola), undermines this herd immunity, resulting in thousands of vaccine preventable illnesses, not to mention children dying from whooping cough, clear examples of “stupid deaths” (especially given the fact that with the resources we have in the United States to spend on immunization campaigns, these illnesses are easily preventable). And with influential news outlets like The Huffington Post (I refuse to link to that unethical organization, so instead you get the most excellent Orac!) giving a mouthpiece to anti-science propaganda, the situation is not likely to improve.

Not only is anti-vax propaganda dangerous, but it’s intellectually irresponsible, and this is the focal point of my criticism. The claim that vaccines cause autism is not only physiologically ludicrous, but it is also possibly the most exhaustively debunked claim in the history of modern medicine. Therefore, someone who campaigns against immunizations has arrived at their position irresponsibly, and is thus culpable of promoting falsehood through negligence.

On a more fundamental level, however, this is a question of epistemology, and people who promote “alternative medicine” and campaign against vaccines simply don’t understand how science works. Anecdotal evidence and appeals to emotion (which are really the only support that has ever been offered for the vaccine-autism link– even the original “scientific” paper by Wakefield was based on just 10 [!] cases) are seen as compelling; there is no call for rigorous statistical analysis, null hypotheses, or even a plausible biochemical mechanism.

This is why skepticism, as a personal epistemological framework as well as a cultural movement, is important. Understanding how we know what we know is not only existentially fulfilling, but essential for ethical reasons as well, as the danger to public health posed by the anti-vax movement clearly shows.

The question, “How do you know that?” is possibly the most important political question of all.

Building a different social order, part 1

“The poor are a by-product of the system in which we live and for which we are responsible. They are marginalized by our social and cultural world. They are the oppressed, exploited, proletariat, robbed of the fruit of their labor and despoiled of their humanity. Hence, the poverty of the poor is not a call to generous relief action, but a demand that we go and build a different social order.”

-Gustavo Gutierrez, The Power of the Poor in History

Gustavo Gutierrez, Peruvian liberation theologian and scholar

This is the first of a two-part series of posts on the above quotation. Part two is coming soon.

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For this post, I want to focus on the first part of this quote. According to Gutierrez, the poor are “marginalized… oppressed, exploited… robbed of the fruit of their labor and despoiled of their humanity.” But how, exactly? What is it about simply being poor that is so excluding and dehumanizing? One word at a time:

Marginalized. To be poor means to be less valuable in the eyes of society. One of the most important concepts I learned from Ecuadorian professors was that of the margin-center dynamic. We learned to use it in relation to colonialism; in the colonies, everything related to or originating from Europe was held up as the most important aspects of society, while all mention of indigenous culture was stigmatized and diminished. This relationship can be conceptualized graphically, with “European culture” represented as a circle dominating the center of the page, and “indigenous culture” relegated to the margins. In addition to culture, economic (salaries and hiring practices), political (suppression of voice/lack of political education), and even geographical (urban vs. rural) systems are all ways in which people can be marginalized, not to mention sexual and racial inequality.

Oppressed. Political oppression is a fact of life for many of the world’s poor. From the Somali peasants who find their communities dominated by ruthless warlords, to the Syrian proletariat receiving the brunt of the government’s violent crackdowns, to even anti-union legislation in the United States, the poor at best experience unequal access to political participation (look at lobbying power, for example, or the amount of say the citizens of poor countries have in U.S. foreign policy), and violent oppression at worst.

Exploited. The rapid integration of the global economy creates many opportunities for introducing new capital to underdeveloped areas, which can be extremely useful in overcoming the misery of extreme poverty. However, it also provides ways for international corporations (largely headquarted in You-Know-Where) to exploit human labor with extreme efficiency. The wealth of the United States is increased exponentially by the cheapness of foreign labor, which manifests as cheap goods/increased purchasing power. You and I are literally using the world’s poor to get cheaper t-shirts and shoes.

Robbed of the fruit of their labor. This is essentially a repetition of the previous paragraph, with the distinction that only a small percentage of the economic activity of the poor actually benefits their communities. This is strikingly true in the case of tourism, which is the largest revenue-generator for many impoverished corners of the world, including the city in Ecuador where I lived for 5 months. Instead of using the money generated by tourism to invest in public goods (sanitation, education, health, etc.), companies and local government agencies tend to spend it almost exclusively on projects they think will bring in more tourism. And so you get run-down beach towns with more bars than classrooms.

Despoiled of their humanity. Finally, the poor are almost universally objectified, dehumanized, robbed of agency. From being seen as wholly dependent on welfare systems, to the extreme case of being perceived as objects to be rescued (as I argue here), the individuality and humanity of poor persons is almost never emphasized. Poor people have fewer opportunities for personal expression, and fewer people want to listen.

This is the social order of our times, the global system we inhabit and reproduce every single day. And, as I have argued elsewhere (or rather clumsily attempted to reproduce the arguments of Farmer et al), people suffer and die because of it. If we want to make a difference, it is clear that charity, no matter how generous, will only be a partial solution if it ignores the systemic causes and effects of poverty.

…And I’m back

It’s hard to describe the feeling that came over me as I walked into Walter library this morning. There was a bit of pancake-induced euphoria left over from my breakfast at Al’s. There was just a small amount of panic at the prospect of my busiest semester yet. But stronger than everything was the thrill of being in familiar territory, doing what I do best.*

This will be the best semester so far. I have a new and exciting project in lab, two science courses that will likely blow my mind, and medical anthropology. I am altogether too excited about that last one to articulate my feelings here, so just take a look at the reading list:

Infections and Inequalities: The Modern Plagues – Paul Farmer

The Spirit Catches You and You Fall Down – Anne Fadiman

Stories in the Time of Cholera: Racial Profiling During a Medical Nightmare - Charles L. Briggs

Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America – Rayna Rapp

Two of those were already on my reading list (My life goal is to read every single word Farmer has ever written, and I’ve been planning to re-read The Spirit Catches You ever since we read it in 11th grade), but even if they weren’t, it’s medical freakin’ anthropology! I just wish I could take some “real” anthro courses to go with it. Is it too late to change my major?

[Edit] Ack. 13 hours in, and I’m swamped already. Here’s to falling off the (caffeine) wagon.

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*That’s a pretty pathetic thing to say about walking into a library, but hey, everyone’s gotta have talents.