Homework #25: Response to Sicko

Précis

            The American health care system does more harm than good. Money is the main incentive of the health insurers, ultimately corrupting the American health care system. Insurers refuse to reimburse people because of preexisting conditions or failure to fit the standards for reimbursement. Those who do not have health insurance are constantly denied care because of their preexisting conditions or unhealthy bodies. The United States has a lot to learn from countries like Canada, Britain, France, and Cuba. Social health care provides free or significantly less expensive health services for its citizens. Treatments are free and no one is denied them. The only place on American soil that benefits from socialized health care is Guantanamo Bay, where inmates are kept.

Evidence

1. People who have health insurance still suffer and have to pay massive amounts of medical bills.

     

i.               Larry and Dona Smith both had well paid jobs and insurance, but once Larry began to suffer from heart attacks and Dona got cancer, they could no longer pay their medical bills, despite their insurance. This forced them to move in with their daughter, no longer able to afford their home.

- This demonstrates that despite having health insurance, these people were not able to afford their health care. The system did not help them, but instead led them to bankruptcy and extreme measures.

b.  The United States would do better to adopt a socialized medical system that provides free health care to help support a longer life expectancy.

           

                        i.             In France, Cuba, Britain, and Canada health care is free because of socialized medicine. People in these countries have a longer life expectancy and a lower child mortality rate.

- By showing the positive aspects of socialized medicine, Moore was able to attack the American health care system and demonstrate its ineffectiveness.

d. I investigated the claim made by Michael Moore that Cubans have a higher life expectancy rate. The article refutes this by saying that the expectancy rate is equal to that of the United States. Google Public Data states that the life expectancy of a Cuban in 2008 was 78.7 years old and in the United States 78.4 years. This is obviously not a significant difference, k therefore we can conclude that the life expectancy of both countries is generally the same. The way Moore presents his argument gives the impression that there is a much larger difference, while this one is marginal at best.

Response

            Moore attempted to discuss an interesting topic concerning health care and insurance. While his argument was at times a little shaky, he did pose some interesting ideas. A biased piece nonetheless, we were able to see one side of the debate in depth. There were stories of people with health insurance who still had to pay medical fees, leading them to bankruptcy. More tragic stories followed where people had to choose which ailment or body part was more important to fix. It is upsetting to see that our health care system exploits our needs for profit. While unnerving, it is hard to not consider all of the people that health insurance does help – where does this line exist? Medical care is obviously all about the profit, not necessarily about the welfare of the patient. It is not that they do not want to help, we are simply a capitalist country – it is in our nature. The movie made illnesses seem more like a pest, something that people in the United States would rather brush off and ignore. Our country apparently does not care quite as much as we believe, but of course this is only one side of the argument. After reading those sources provided refuting Moore’s arguments, I can only wonder who really argues the best point. It seems that the consensus is that our society needs to change health care, but not necessarily to create a socialized system like that of France. The United States would most likely not function well on such a system because it does not hold enough of the values of the people who would initiate the change. A shift such as that one would probably be devastating; instead we need to find micro solutions that can eventually lead to a macro change. 

Homework #24: Illness and Dying Book Part Three

Précis

            Paul Farmer is an anthropologist/doctor whose work revolves around infectious disease. Growing up in poverty in the United States, Farmer and his family struggled at times to make ends meet. Despite this, Farmer was educated at Harvard Medical School and devotes his time battling infectious disease in third world countries. During his time at Harvard Medical, Farmer flew back and forth to Haiti, treating patients and constructing Zanmi Lasante, his treatment center in Cange, Haiti, offering free services. He then created Partners in Health, an organization that strives to raise money and fund the battle against disease for those who cannot afford it. Jim Kim and Ophelia Dahl become his partners in heading the organization, Kim eventually opening up a branch in Peru. Because of his success in both Haiti and Peru, Farmer is then asked to extend his treatment to those contained in Russian prisons. Known for his compassion and empathy, Farmer continuously forms a strong impression on the medical community. Lowering the price of drugs, correcting flawed medical systems, and working with his patients on a personal basis, Farmer attempts to move the world’s medical structure forward.

Quotes

“It was as if in seeking out suffering in some of the world’s most desperate locales, he made himself immune to the self-consuming varieties of psychic pain,” (p. 189).

Farmer no longer suffered because it was inferior to the suffering that he found around him.

“One can guess a lot abut the economic condition of a country by inspecting the baggage people carry there from the United States, the shopping mall for the poor countries of the world,” (p. 191).

A country can be defined by what people feel they need and can afford.

“Countries with the steepest grades of inequality and the greatest poverty have the biggest AIDS problems...We need to erase social inequalities, and very few countries have done that,” (p. 199).

Social inequality leads to the spread of infectious disease.

“He was like a compass, with one leg swinging around the globe, and the other planted in Haiti,” (p. 260).

Farmer’s home was Haiti, while he addressed the issues around the world.

“He’s still going to make these hikes, he’d insist, because if you say that seven hours is too long to walk for two families of patients, you’re saying that their lives matter less than some others’, and the idea that some lives matter less is the root of all that’s wrong with the world,” (p. 294).

People need to recognize that no life is better than another in order to address the conflicts in the world.

Thoughts

            I feel that in this last third of the book, the stories became a bit repetitive. Farmer obviously made many advances in fundraising for medicine and conducting effective programs, but it was overemphasized. There was an entire section about how people did not believe that they could do what Farmer did, and he agreed. His reply however was that he wanted them to do the same thing, but it did not have to be in the same way that he did it – the one point that people do not seem to understand. Farmer’s way of approaching disease is interesting. No case is left untreated is an admirable way to go about things, one that people need to address. So many times it seems in our current medical structure people are turned down health insurance and care simply because they are already pre-diagnosed; Health insurers seem no reason to support someone already sick. Farmer does not try to defy the dominant methods instead he embraces them. The difference between him and the rest of the medical community is that money is no longer involved and every life has value, no matter the case. Maybe if we learned to see the world through the eyes of Farmer, we could begin to redefine the medical world. 

Homework #23: Illness and Dying Book Part 2

Précis

Through his organization Partners in Health, Paul Farmer has been able to address MDR Tuberculosis in third world countries.

Quotes

“Never underestimate the ability of a small group of committed individuals to change the world...indeed, they are the only ones who ever have,’ (p. 164).

Small groups are immensely powerful and have the ability to enforce change.

“We know that things change all the time. Culture changes all the time. Advertising people force changes in culture all the time. Why can’t we do that? People in international health sit back and say, ‘Will things change for the better?’” (p.175).

Everything changes, so why can’t the medical world too?

“’Resources are always limited.’ In international health, this saying had great force. It lay behind most cost-effectiveness analyses. It often meant, ‘be realistic.’ But it was usually uttered, Kim and Farmer felt, without any recognition of how, in a given place, resources had come to be limited, as if God had imposed poverty on places like Haiti,” (p. 175).

We claim that resources are limited, but neglect to understand why.

“’It bothers me even to look at it...It can’t support eight million people, and there they are. There they are, kidnapped from West Africa,” (p. 188).

Haiti has more people than it can support, creating these dire situations.

“I was looking around in my mind for a consoling way to view the roadside sights and also, frankly, for something likely to impress Farmer...I said, ‘If you’ve done it unto the least of them, you’ve done it unto me,” (p. 185).

We all are interconnected: we suffer and enjoy together.

Thoughts

            This third of the book dealt a lot with tuberculosis and its impact on third world countries. At the beginning I thought the book would revolve mostly around Haiti and Farmer’s struggle there. Instead, by the second third, the scene switches to Peru where we shown the battle against drug resistant tuberculosis. Farmer really seems to have everyone’s best interest in mind. At the beginning I was not sure if he was going to be a character I would like, but it turns out he is actually working for the greater good. With the help of his different programs, he was able to lower the cost of many drugs, making them more available for those in third world countries, ultimately helping with disease control. He seems to be less about profit and more about innovation and getting to know the patient. Health has become a luxury in our world but it is clear that he sees it as a vital aspect of life and will do anything to ensure that everyone has it. The book is all about finding alternatives to the system. While he may use generally traditional methods, he also goes beyond the boundaries and explores overlooked areas. Unlike most doctors who work for the money, Farmer seems to really care about his patients and undermines the corrupt structure of the medical world. I am interested to see where his work brings him in the next third of the book. 

Homework # 22: Illness and Dying Book Part One

Précis

Paul Farmer grew up in a less than ideal childhood, ultimately influencing his great compassion for those less fortunate than even he.

Quotes

“Sorcery is, at bottom, the Haitians’ way of explaining suffering, but the allegations themselves can cause suffering,” (p. 27).

Haitians believe not only in traditional medicine but find substance in voodoo methods.

“Is there a more widespread notion than the one that rural people are laconic, and is there a rural place anywhere in the world whose people really are?” (p. 43).

           

People in rural settings enjoy socializing while the majority seems to believe they don’t.

“’Medicine is a social science, and politics is nothing but medicine on a large scale,” (p. 61).

Our society evolves around the science of medicine.

“Patients, it seemed, formed not just a calendar of past events but a large mnemonic structure, in which individuals faces and small quirks – he’d remember, for instance, that a certain patient had a particular kind of stuffed animal in his hospital room – were like an index to the symptoms, the pathophysiology, the remedies for thousands of ailments,” (p. 113).

Farmer approaches medicine in a very personal way, getting to know his patients well.

Thoughts

            So far the book has been quite inspiring in terms of medicine. Paul Farmer, the doctor discussed, addresses the health needs of individuals in Haiti who cannot afford to pay for their medical services. He seems to do it for the patients, not for himself. A lot of doctors tend to shut themselves off from their patients, keep everything impersonal. Instead, Farmer gets to know his patients and understands their needs. Living in Haiti means he has to deal with a different political climate and cultural beliefs. Farmer takes these into account when he tries to go about healing the personal, and I think this seems to really make an impact not only on their health but also on their lives. The only thing is, that I believe he is generally a traditional doctor. In this book the accustomed medical procedures are used but in this case they seem quite effective. Holistic methods might not appear as reliable to the Haitians, they might see it as a thing that contradict their ideas of voodoo. Up till this point Farmer has appeared as a saint, somebody who is really dedicated to the health of others. 

Homework #21b: Comments

For Ben: I liked that you made a lot of connections in your post, but maybe you could've elaborated a little more. For instance, did it seem to help your mother's friend feel more positive when you avoided the subject of death? Or maybe, why was it so spectacular to you that Beth had her 13 year old son help her? I can imagine why, but it would be interesting to hear about it too. Otherwise I thought your post was really interesting considering the fact that you seemed to be able to understand Beth's motives through your own personal experience.

For Devin: "Good relationships create harmony in the world, and I am certain that for Beth the atmosphere of harmony that she created with the people at the hospital made life more pleasant for everyone and took away some of the stress of a very stressful time. " I thought this was nicely written as you make it a general statement that is not only applicable in Beth's case. I think a lot of people tend to overlook the importance of relationships that they might not consider significant. 
The last paragraph I also found really interesting. I never knew that people had these types of hallucinations, but I think they're almost comforting, like you said as people have an "awareness of their own death." Also the idea of "some new part of the world not yet visited" as if death is simply a parallel universe.
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From Devin:
I was really impressed with the connection you made from your own experience with your dad to Beth's treatment of all those who were helping her husband in the hospital. Without judging your father (we all have our impatient moments), the fact that you felt so badly for the waitress and could imagine I think that if he had suddenly started choking she might not have performed the Heimlich Maneuver with much gusto. Hospital workers are paid to help patients but they are obviously going to perform their jobs with more good will when they are treated with respect, and even more than respect with friendship. Your mother's story about the poor man who died alone was really interesting because of your point that maybe it is easier to die if you don't have anyone to live for. It's true that a dying person would naturally feel terrible about leaving people who are dependent on them. On the other hand I think for many people death is scary because whether you have people or not to share your life death is still scary because it is unknown. Obviously you’re an excellent writer and this is an excellent blog post. I would like to emphasize the magnitude of your last line “When does death stop being the enemy…and become the natural idea.” Death has been my greatest enemy for as long as I can remember, and I think it will take an awful lot for me to picture it as “the most natural idea,” but I hope I can. In fact, ideally I hope I can think of it as a great adventure when my time comes (but I wouldn’t put any money on it.)

From Ben:  I love the depth of thought that you put into this homework. For instance, when you said  "Without relationships, maybe you would treat death as an old friend, ready to finally take  you away. We seem to only fear death because of fear of what we’ll miss." That statement  really got me thinking, and was more insightful than anything I could have thought of.  I also really liked the way that you represented many of your ideas. You asked the reader  a lot of questions, a technique that for me, adds more meaning to what you're saying and  certainly captures my attention more than just ordinary statements. Great Job!

Homework #21: Expert Number One

• Beth wanted her husband to be treated as a person, not simply as a patient. Thus his room was strewn with pictures of his family and his own artwork, to show the life behind the dying man.
• Everyone was a human being in Beth’s mind; she asked about their personal lives, made sure they knew that they were just as significant to the healing of her husband, no matter the size of the task the person performed.
• Instead of receiving the assistance of hospice care, she took care of her husband herself. Why should people who barely know him manage some of the most intimate moments of his life?
• Her husband experience hallucinations and raised his arms, almost as if he were protecting himself from death itself.
• At the time of his passing there was an indescribable stillness.
• The only way death is bearable is when relationships are present in one’s life.
• Some wisdom comes from the process: one gains the sense of reality that we are not immortal.

                “Everyone was a human being in her mind; she asked about their personal lives, made sure they knew that they were just as significant to the healing of her husband, no matter the size of the task the person performed.” When hearing this, I remember thinking back to one day up in the Finger Lakes with my parents, we had gone out to dinner. We walked into the completely empty restaurant and my father chose a table for us. The waitress kindly came up to us and expressed that this was not the appropriate place to sit – this room was only used between certain hours. She noted that she would be happy to bring us outdoors where we could eat on the terrace. My father, aggravated, yelled at the waitress, describing the inconvenience of the situation. I stood there embarrassed, urging my father to stop. In no way was one of us ill, or dying, but there I stood with a father, treating another human being as if she had no worth. I thought of myself in the hospital, him becoming impatient with the nurse, and I therefore would not receive the same respect in the hospital. It was a scene I wished to never see played out in real life. I realized myself that these people do not need to help us, under no obligation do they have to take our blood, x-ray our bodies, or prop up our pillows, but they do. They help us so much but in return we dehumanize them. Why do we see them as so insignificant? Is it the way they walk, or dress? Or simply that they probably did not go through as much training to attain that position as the head doctor? Weird that we act superior to them, when they probably have the most important tasks of all. They save lives – a doctor may analyze our situation, but these people provide the evidence to help maintain our very existence.

                         Maintaining relationships not only with the x-ray technician, but also loved ones was a prominent aspect of Beth and Erik’s struggle. Beth states, “The only way death is bearable is when relationships are present in one’s life.” Loved ones are there to keep you strong, to keep you going. Sometimes a little motivation is all we need to overcome something – to succeed. But I wonder what it is like to die without anyone. At the dinner table a couple weeks ago my mother told a story about when she was a social worker and had to hold a funeral for a man who no longer had anyone else to do it for him. The state paid for it and it was an open event for people to go to: few did. It was poorly funded and truly sad to watch. But we do not know, maybe it was easier for the man to accept death. With nothing to hold onto, what is there to keep you from embracing peace? In the process of his death, he had no one there to hold his hand or stroke his hair and tell him everything was going to be okay. So many would see this as treacherous, unfathomably terrible that a person would have to go through something so intense, alone. But this process shed all the lies; nothing was hidden from sight – his life was in his own hands. He was able to let go without fretting for the welfare of his children, or if his wife could manage keeping the house. With no loose ends to tie, he could fall into a deep sleep. I am not saying that I would personally want to go this way; I doubt most people would, but perhaps that Beth’s statement is not entirely true. Relationships while thrilling and at the same time comforting, can begin to hide the truth, make a person hate death for taking them away from the things they love. Without relationships, maybe you would treat death as an old friend, ready to finally take you away. We seem to only fear death because of fear of what we’ll miss.

            Beth’s entire story was really captivating – honestly I almost started crying. If I can cry just because of someone else’s story, someone who told it so strongly, I cannot imagine how I would be going through it myself. It was interesting to see the way Beth decided to portray the process of her husband’s death. At the beginning she sucked her bottom lip, her eyes a little glossy it seemed. But as Andy finished his preface, and she began, it seemed that the woman who had be sitting there before was gone. Beth told the story so confidently, even going so far as to scold her husband for being foolish, while I believe most people would not dare think of the dead in such a fashion. I simply wonder, how? How was it so easy to talk about such a hard topic? I understand that we were the last class, and that years have passed, but the images that came forward must have been heart breaking. Death is a scary thing for most people, but it seemed to have lost its advantage over Beth. She even said herself, “One gains the sense of reality that we are not immortal.” Shrugging her shoulders she threw out there the commonest of statements, “We’re all going to die”, but unlike most, knew what she was talking about. People let those words slide from their mouth, not really understanding what is they are saying, shrugging their shoulders as to say, “so what?” But Beth did not do that, instead she showed acceptance. When though will we all be able to accept this? Or will that time never come? When does death stop being the enemy, the one who stole the person you loved most, and become the most natural idea?

            

Homework #19: Family Perspectives on Illness & Dying

I started off my interview with the question “what is your first reaction when you are sick? Both my parents seemed intent on going to lie down and separating themselves from others in order to get better. It seems that isolation is in the root of our minds; we believe that when we are sick, we need to be alone, just as our society believes that any one who is sick should be sent to the hospital – separated. Eventually we began talking about knowing someone who is or was fatally ill. They both spoke of personal experiences, especially describing the feelings involved in interacting with the person. It seemed that they were all about being honest with the person, that there was no point in acting like they were any different, because it only made the person feel worse. Funny, considering the fact that when my parents are sick they said they try to be alone, isolate themselves, but when someone they love is sick, they do not want them to feel isolated at all.

            My father also mentioned that it seemed unfair that the person had to go through a fatal illness, that sometimes it is not their fault; it is simply in their blood. He also stated that death does not always have to be sad thing; sometimes someone puts up a strong battle and it is admirable. They lived for as long and as well as they could until they were taken over by disease. Society on the other hand tends to focus on the negatives, the fact that not only a life is ceasing to exist, but also classifies the topic as a complete taboo. My grandfather for example has or had prostate cancer; he avoids the subject at all costs, even to the point where we can only assume his treatment has been successful. I myself have never really had any experience with someone who is fatally ill; I cannot exactly say what I would do. I hope though, that I would be able to be honest with the person and make them feel as comfortable as possible.

            As my father said, sometimes battles can be quite admirable, a reason to respect the death of a person. When I asked my mother if she would consider a holistic method, she said yes, definitely. This is partly due to the fact that my mother knows people who have had the type of admirable story that my father was referencing, gained through holistic methods. My aunt, before I was born, was extremely sick with skin cancer. Her doctor said to her that the medicine she could give her would do 20% of the work – of the healing, but that it was up to my aunt to do the rest. The doctor had her going to therapy in order to help her maintain a positive attitude and avoid depression. In addition, my aunt took vitamins everyday and through these tactics ended up defeating the cancer. While she did have prescribed medication, a lot of her healing ended up being through mental counseling. My father on the other hand mentioned my mother’s chiropractor and said, “I just think he’s a wacky guy.” While he did note that he would try a holistic method, he does not seem to weigh in on this idea as heavily as my mother. I feel confident saying that my father takes the more traditional route in relying on the typical white-coated doctor. But then again when I asked him which doctor he trusts the most out of the one’s he has had so far, none came to mind.

            I myself was at my mother’s chiropractor over the summer because I had not been feeling all that great. He pushed into my stomach, had me raise my arm and hold it while he tried to push it down. My arm was easily defeated by his strength, which apparently clued him in to exactly what was wrong with me. I had a physical with my regular doctor the next day as I had just returned from Germany and I asked her opinion of my problem. She laughed when I mentioned that I had been to a chiropractor the day before. The funny thing is, they both ended up giving me the same advice, coming from two completely different perspectives. I ended up taking the supplements that the chiropractor had prescribed and was already feeling better within a day. In terms of medicine I do feel like I identify a bit more with my mother as I do put a little more faith in holistic methods than maybe my father would.

            While my father does not hold quite as much respect for the holistic methods, both he and my mother try to avoid medication at all costs. My mother feels like medication is over prescribed these days, that people are taking medicine for things that could probably heal on their own. In agreement, my father also added that people seemed dependent on the drugs, using them as an excuse to live an unhealthy lifestyle.  I believe a lot of this attitude comes from observations of their parents. Alice, my mother’s mother is suffering from old age – she is forgetting things, does not always feel in best shape. The doctors prescribed her over 10 different medicines, which my mother felt was a little much. She took it upon herself to research the drugs, to at least know what her mother was becoming so dependent on. It turns out, half of the medications were simply duplicates of the others. My mother, infuriated, spoke to the doctors with her findings as evidence and ended up convincing them to take my grandmother off a majority of the drugs. You would imagine that my grandmother would be grateful for it, which I am sure in some way she was, but above all, she trusted the doctors to do what was right for her. The medical world holds a lot of significance to my grandmother; she assumes that what they say is always correct, simply the only way it is to be done. Therefore she finds comfort in the drugs, which probably frightened her when she learned that some would be taken away from her. Her ex-husband, or my grandfather also must take lots of medication as he had open-heart surgery at the age of forty. While my grandmother embraces the drugs thrust upon her, my grandfather has enough pride to counter the doctors as much as possible. But when it comes down to it, he needs to take the medication to survive.

            The final question that I asked was “if you had one year to live, what would you do”. While the answers generated in class were interesting, we are all unwed and without children. The possibilities seem endless to us because we have nothing to tie us down. I myself said travel, which just happened to be the first words out of my mother’s mouth. “A year off of life” as she calls it; she would take my family and I to Europe and explore – just goof off for a year. Her answer came quick and easy, as if it were the simplest question in the world. When I asked my father, I was bombarded with back up questions. “How much money do I have? Am I fatally ill? Or am I just going to get shot at the end of the year?” He took the question a lot more seriously than most do. In the reality of it all, we must come to terms with the actual possibility of us being able to do the things we want – unfortunately there are factors that determine what we can and cannot do. Ultimately he decided that he would tie up all of his affairs, leaving my family and me as much money as possible. He said he wanted my sister and me to be happy that he had finally passed on, and to not remember him physically, but instead have an everlasting impression of him in our minds. Or in other words, he wanted to be remembered for the deeds he performed, the people he helped, and the lessons he taught, rather than how he looked. We would be free to forget his face, but not his ideals. All he could possibly think about was making sure that after he had moved on, we would continue to have great lives, so that if our kids were to ask us this question, we would have a better answer than he did.