Albuquerque update on health access organizing

it's been my intention to share more of the details of the organizing process happening here, so many rich, beautiful, hopeful details, too many really. i'm just gonna have to share some of the highlights and appreciate the reality that anyone who decides to do this kind of work will find their own beauty in the struggle. :>

ever heard of permaculture? it's a philosophy in the environmental movement that believes that humans can have a profound impact on healing the earth by making subtle shifts at key points in a process and by layering ones efforts so that the same action/effort can impact one's process on many dimensions simultaneously. leverage is a key concept. but not just physical leverage. it's about timing and alignment and nurturing parallel processes which eventually combine to accomplish higher order goals. if you are interested in profound social change, not just violent revolution or academic critcisms, i recommend studying permaculture. look it up.

this has been a part of our style of organzing in albuquerque. the notion is that if you put all your eggs in one basket, it's really easy for the opposition to disrupt that basket and destroy your process. along with adequate interpretation services, one of the goals we have chosen is to deconstruct the 50% up front fee required of all self-pay patients prior to receiving non-emergent medically necessary care. this is the biggest burden for indigent patients who cannot qualify for financial assistance or afford insurance. it was constructed by an unfairly vicious lawyer in association with an unfairly vicious family practice doctor administator with the full support of top level administration with the goal of blcoking care to mostly undocumented immigrants and other "self-payers." so what's the big deal? health care's a privilege right? well, this is a public hospital i'm talking about serving the poorest people in the poorest state with a mission to serve anyone who needs it. if people don't have the 50% up front, they get their health care and they still get a bill which they have to pay over time. ain't that how the social contract goes in a capitalist society?

so after a few years of planting and watering seeds, shifting earth around, digging deep trenches and alot of other earth metaphors, which translates to doing alot of friggin policy and history research, team building, public education, talking with elected officials, forming a legal analysis of the public hospital's lease agreement with the county, working with med students to gather specific data on who is affected, forming relationships with doctors on the ethics committee, working closely with patients directly affected by this policy and engendering profound trust with them so they are willing to speak out, etc, the battle is now engaged publicly.

our team is challenging the sanity, legality and ethics of this policy in open forums with elected officials, the board of the hospital and the medical staff leadership. we already know the CEO, the decision-maker, isn't gonna budge without power equal to his pushing against him.

at today's meeting with the CEO, a county commissioner and a state legislator, we had a room full of young kids and their recenlty pregnant spanish speaking mom's who related horror stories of toxic front desk treatment, huge bills, zero interpretation services. there was also a lawyer, a doctor and a nurse present and an advocate/interpreter. it was a powerful, diverse, fun team with alot of voices represented in unity around the goal of improving health. we've done these meetings without the lawyer, without the doctor, without the advocate, without the community. all of us were needed to share the truth of a fragmented, corrupt system with people in charge who fundamentally do not believe that there is anything wrong with them or their actions or their institution. it's how the mind of power works. any failure is explainable in and of itself, it's not a symptom of a greater dissonance, it's anecdotal and ignorable.

you can see this kind of thinking in the church 1000 years ago as they try to explain how the earth is the center of the universe becaue it suits their purpose of control and power, not the truth. the social revolution will happen when enough of us, a critical mass, decide to gather together our many diverse voices, to trust each other's hidden experiences of violence and share them in public with the pride of warriors not victims. it'll happen when we stop letting the mind of power divide us into individuals with anecdotal stories of pain and joy. it'll happen as enough of us realize that we all contain the mind of power, the capacity to dominate, manipulate and exploit. ain't no good or evil people, just choices.

the weave continues, the relationships build, care for each other and the earth leads the way home.

just another day in paradise.

:>

aziwa

Docs running for Congress take us back to the dark ages


watch out for the gay agenda!

So, Dr. Tom Coburn, MD, an Ob-Gyn doc and former member of the US House of Representatives, is trying to take us back, waaaaaaay back. Some quotes from an article in the Oklahoma Gazette:

One of Coburn’s key concerns (one might say obsessions) is his vow to make abortion illegal, even in cases of rape. So strong are the feelings of this obstetrician-gynecologist that he recently told an AP reporter, “I favor the death penalty for abortionists and other people who take life.”

Executing doctors who perform legal abortions? He later clarified his remark saying, “… I was not referring to current law.”

And Coburn on the "gay agenda" and his crusade against gays:

Last year to the Rogers County Republicans he said, “… The gay community has infiltrated the very centers of power in every area across this country, and they wield extreme power. ... That agenda is the greatest threat to our freedom that we face today. Why do you think we see the rationalization for abortion and multiple sexual partners? That’s a gay agenda.”

But then again, he isn't the only one running an anti-gay crusade -- The Daily Show has a hilarious segment about a guy in Florida running as the "friendly republican" who thinks that lesbians are encroaching on his right to play pool, and the gay agenda has gone way too far. There's a great Samantha Bee interview with him -- it cracked me up, check it out!

Back to the original post -- I'm waiting for some of my progressive young doc friends to start their campaigns and bring some dignity back to physicians running on real issues of social justice in the U.S.

Mad respect for former President Carter

Carter's one of the few ex-presidents still actively doing amazing work in this country and abroad (ok, Clinton's doing cool work too). He was an international observer for the Venezuelan elections, in which Chavez won -- yes, the people want him, after 6 referendums in which he's always been voted in (how much more evidence do we need?) Anyway, Carter's supposedly been an international observer to tens of elections in various countries and has voiced strong opinions on war, foreign policy, and issues at home.

Spreading our "floridation" to Venezuela

Greg Palast has a frightening column on how the Bush Administration is doing business with ChoicePoint, the company that sold voter files to our governemnt (with the erroneous felon lists in Florida). The U.S. paid ChoicePoint $67 billion of our taxpayer money (in another no-bid deal) to buy private voter information for all citizens of several countries around the world(isn't it illegal to sell or buy private voter information on all citizens of another country?). These countries, interestingly, are not the countries we think are harboring terrorists, they're democratic countries that are not ecstatic about Bush's globalization agenda. One of these countries is Venezuela, which is having a recall election TODAY on its president, Hugo Chavez -- a man who Selma James states has "achieved a level of grassroots participation our politicians can only dream of".

Selma James' article has much more on Venezuela's recent reforms, including women's rights, health care, and redistribution of wealth from the oil reserves that Venezuela sits atop. No wonder Chavez is so popular (and also why he's so hated by many). Election results should be coming up shortly...

Innovative touch screen kiosks for contraceptives!

This from the kaiser daily reproductive health report, 8/12/04:

Family Planning Health Services of Wausau, Wis., has developed four touch-screen computer kiosks that will allow women who are eligible for the state's Medicaid program to order contraceptives at no cost, the AP/St. Paul Pioneer Press reports. Women ages 15 to 44 with annual incomes of less than $17,224 are eligible for free contraceptives under Wisconsin's Medicaid program. The four computer kiosks -- which cost $5,000 each and were developed using funds from a $120,000 grant from the 2004 Robert Wood Johnson Community Health Leadership Program -- are being tested at three college campuses. To use the machines, women must enter their monthly income, Social Security number and release their medical records, according to the AP/Pioneer Press. Women can then order at no cost a three-month supply of oral contraceptives or contraceptive patches or 36 condoms to be delivered through the mail. A nurse later follows up with the women about their orders. FPHS hopes that state and local health departments will borrow, rent or buy the computer kiosks.

Reaction

Jim Malone, a spokesperson for the Wisconsin Department of Health and Family Services, said that the department is "intrigued" by the machines, adding that they potentially could save the state money by reducing the number of pregnancies covered by the state's Medicaid program, according to the AP/Pioneer Press. "We'll be very interested in consumer reaction to it," Malone said, adding, "Again, it's a brand-new product." However, some "conservative" state legislators were outraged" by the state's interest in the computers, according to the AP/Pioneer Press. State Rep. Glenn Grothman (R) said, "This program is for girls as young as 15, which is ridiculous," adding, "Ostentatious displays of these kiosks unfortunately encourages the perception that promiscuity is the norm." Kelda Helen Roys, executive director of NARAL Pro-Choice Wisconsin, said that the kiosks would be a "great tool" for reducing unplanned pregnancies, adding that legislators' opposition to the computers shows that their "extreme ideology just completely trumps their sense of social good and common sense" (Richmond, AP/St. Paul Pioneer Press, 8/11).

And...Nagasaki

Never forget. August 9th, 59 years ago -- the 2nd atomic bomb dropped -- this time on Nagasaki. Remembering Nagasaki is a collection of photographs taken by Yosuke Yamahata, a day after the attack on Nagasaki, and some fascinating responses and reactions to the bombing written by people from around the world.

Bilateral Trade Agreements = Blackmail?

Those pesky French people are always trying to make us look bad:

In a move reminiscent of the exclusion bilateral agreements that the US signed with regard to the jurisdiction of the International Criminal Court; the US is now entering bilateral agreements with developing countries that produce generic drugs to opt out of the August 2003 waiver agreement.

This bribery and blackmail was the focus of a statement made by France's President Jacques Chirac at the recent Aids conference in Bangkok. The Guardian of U.K. reported that Chirac accused America of blackmailing developing countries into giving up their right to produce cheap drugs for Aids victims.

Chirac said there existed a real problem of favourable trade deals being dangled before poor nations in return for those countries halting production of life-saving generic drugs. These cheap drugs compete with identical but more expensive patented varieties made by the world's largest pharmaceutical companies.

"Making certain countries drop these measures in the framework of bilateral trade negotiations would be tantamount to blackmail, since what is the point of starting treatment without any guarantee of having quality and affordable drugs in the long term?" Mireille Guigaz, France's global ambassador on Aids, said: "It is a question
between the United States and developing countries, and the way the US wants to put pressure on developing countries who try to stand up for their own industries. We do not wish countries' hands [to be] tied by bilateral agreements."

And elsewhere in the article, those Mozambicans want to develop their OWN health sector instead of depending on us... why would they want to do that?

The Mozambicans wanted to move gradually and to strengthen their health sector at the same time. They did not want to use nongovernmental organisations where the Americans would pay the salaries, buy the drugs and purchase the vehicles that would travel to the villages to distribute the drugs.

Iraqi physicians studying Hiroshima's effects...

Interesting. Iraqi physicians are travelling to Hiroshima to learn about the long-term effects of radiation. Why? Because of the use of depleted uranium in warfare in Iraq, and the 8 fold increases in child leukemia between 1998 and 2002. Some say there may be a direct link between DU and increases in cancer rates, others deny a link. I guess time and more studying will tell. Unfortunately we've littered depleted uranium, AGAIN, in our recent war on Iraq.

And the lovely effects of sanctions post-Gulf War:

"We don't have any decent facilities in Iraq to check the amount of radiation in human bodies. But we can see the incidences of cancer increased greatly during the first four to five years of the 1990s," said Salih, now studying at Hiroshima University Hospital at the invitation of a Japanese civic group.

Under economic sanctions on Iraq that followed the war, Iraqi hospitals were prohibited from obtaining essential drugs as well as new medical equipment like tools for radio therapy because the international community feared they might be used for military purposes, he said.

In other news, as some folks reflect on the 59th anniversary of the Hiroshima/Nagasaki bombings, others gather at a secret summit in Omaha, Nebraska, to strategize on expanding our country's nuclear arsenal. And rumor has it that VP Dick Cheney attended the summit. Bravo.

Is there a role or responsibility for U.S. physicians on this issue of nuclear arms? Physicians for Social Responsibility (PSR) and International Physicians for the Prevention of Nuclear War (IPPNW) are orgs that are dedicated to this cause. IPPNW has started an International Physicians Campaign for a Nuclear Free Century. Rock on...

Hiroshima -- 59 years ago today

Thanks to Zeynep Toufe and the rest of the non-mainstream media for reminding us that the United States invaded Hiroshima 59 years ago on this day in 1945. This horrible event should never be forgotten, and it should be a constant reminder of why no country should ever use nuclear technology to harm others. It's sad to know that we're the only country that has gone and used this technology to harm others, and while we warn others not to do the same, we often justify our inhumane killing of so many Japanese residents back in 1945. Sojourner's magazine has an interview with Gar Alperovitz, author of Atomic Diplomacy: Hiroshima and Potsdam. Howard Zinn discusses some of the same motivations that Alperovitz discusses, in his book, A Peoples' History of the United States. I've pasted pieces of the interview below -- pieces that address myths about the invasion, reasons for bombing, parallels to today, and citizen empowerment on the issue:

Sojourners: What's the consensus among experts about the decision to bomb Hiroshima? Was it necessary to use the bomb to forestall an invasion of Japan?

Alperovitz: The use of the atomic bomb, most experts now believe, was totally unnecessary. Even people who support the decision for various reasons acknowledge that almost certainly the Japanese would have surrendered before the initial invasion planned for November. The U.S. Strategic Bombing Survey stated that officially in 1946.

We found a top-secret War Department study that said when the Russians came in, which was August 8, the war would have ended anyway. The invasion of Honshu, the main island, was not scheduled to take place until the spring of 1946. Almost all the U.S. military leaders are on record saying there were options for ending the war without an invasion. So minimally, as Hanson Baldwin, The New York Times writer, put it, if the goal of the bombing was to end the war without an invasion, that was unnecessary, so it was "a mistake." That's Baldwin's phrase. Now, did American policy-makers know this at the time? That's a slightly different question. Many scholars now believe that the president understood the war could be ended long before the November landing. J. Samuel Walker, a conservative, official government historian, states in his expert study, perhaps with slight exaggeration but not much, that the consensus of the scholarly studies is that the bomb was known at the time to be unnecessary.

Sojourners: How do you explain the large gap between that consensus and the prevailing popular opinion, which is that the bombing was necessary to prevent the invasion?

Alperovitz: The popular myth didn't just happen, it was created by several official acts, and by many things President Truman and Secretary of War Henry Stimson did. During the early postwar period, there was a slow growth of criticism of the bomb, including from the religious community and from some of the important radio spokespersons of the time. Many conservatives at that point, actually more than liberals, were raising serious questions about the bombing. The Calhoun Commission of liberal Protestant theologians for the Federal Council of Churches-Reinhold Niebuhr and John C. Bennett were members-criticized the bombing, both as unnecessary and as immoral, a sin demanding some sort of contrition. As the criticism grew, there was an organized, semi-official response to put it down. The argument was that the bomb was the least abhorrent choice we had available. The documents available show that isn't true-but it was an extraordinarily successful propaganda effort.

They wanted to close down the debate for several reasons. One was to protect the president. Two, it was the beginning of the Cold War period, and they wanted no one tampering with the moral importance of nuclear weapons. The nuclear weapons build-up was going on, and they saw it as necessary to fight against communism. Any undercutting of the moral legitimacy of nuclear weapons might undercut the fight against communism. Besides, they had reputations to protect-they were all involved.

Sojourners: Why is there a responsibility in a democracy for historians to speak honestly about the past, even if they're critical of leaders or institutions?

Alperovitz: It's not just important for historians. One of the lessons from Hiroshima is how terribly small the group of people was who made decisions that had incredible world-shaking implications. It raises the most fundamental questions about the future. How do we organize decision making in a democracy when the possibility of destroying the planet is in the hands of one person? If we study the only time nuclear weapons were actually used, we might possibly learn something about how we can prevent future use.

Sojourners: Is the decision-making structure any more accountable today than it was in 1945?

Alperovitz: It's a little more complex than it once was, but I don't think it's greatly changed. I think the Gulf war decision was made very much the way the Hiroshima decision was made-by a small group in the White House, against the basic views of the military. I don't think the military wanted the bomb to be used, on the whole. They were not asked much about it. The other thing we learn from this is the way information can be manipulated so that for 50 years a whole society is taught to believe a myth. That is a critical issue for democracy. Can we find ways to challenge the myth making of a small group of elite policy-makers protecting themselves to support their policies?

Sojourners: Some people have posited a moral equivalence between Pearl Harbor and Hiroshima, especially in the response of the two countries toward reconciliation.

Alperovitz: There's no excuse for Pearl Harbor, but it is among the least of the brutalities the Japanese committed. There is the rape of Nanking, the bombing of Shanghai, the brutality against prisoners, the Korean "comfort women," the notorious Unit-731 that did vivisection on prisoners to teach medical students-outrageous things the Japanese have to come to terms with. They have a long way to go. They have come close to expressing sorrow, but not regret. Pearl Harbor was an unjustified surprise attack, but it was a military target. I think the latest figure is 2,500 people killed. Hiroshima and Nagasaki were both civilian targets predominantly-that's why they were targeted. Hiroshima was selected because it was a significant, unblemished, mainly civilian target, available for the psychological effect of terror bombing. That's very explicit in the documents; it's not controversial. That's what they were doing. And ultimately some 300,000 civilians were killed at Hiroshima and Nagasaki...

And Alperovitz on citizen empowerment on the nuclear weapons issue:

In general, there is a tendency among some politicians and military leaders, though not all, to think of nuclear weapons as essential to American security. Some keep pushing for more nuclear weapons, even though it means other people are going to get them. The notion of us having a threat is bound to create counter-threats...

What's interesting is that some of the most hardheaded Cold War politicians, Paul Nitze and Robert McNamara for instance, have been saying that these weapons may have once had a role, but they don't anymore. Now they are so easy to make and so small that they can be smuggled into this country and blow up the next World Trade Center or Oklahoma City. They are much more a threat to us than they are an advantage. The question is how we begin to move to a different stage. It's not about proliferation talks, it's about whether citizens speak up about any of these questions...

I'm from Wisconsin, the state McCarthy dominated in the 1950s. If you looked around in the 1950s, people were very frightened to speak, and the idea that you could begin moving in a different direction was ridiculous. It seems somewhat similar to the current situation. But what's obvious, if you have any historical perspective, is that these stages don't necessarily last forever...

The way you change things is by slowly beginning to push forward. Over time something begins to happen. It happened in the feminist movement, the anti-war movement, the civil rights movement. All of those movements were totally dominated by a conservative culture that didn't seem to allow any progress until people of goodwill began to build and slowly, patiently, changed the culture. I believe it's possible to do that with regard to nuclear weapons...

One of the lessons is how easy it is in our current democracy for very important things to be distorted and for people to believe-on the basis of limited information-that the only thing to do is go to war or drop a major bomb. Democratic societies are not well-structured for getting information out. I don't think any of us have faced how to deal with that.

Misleading on abortion disguised as abortion services

A few years ago, a friend of mine discovered, from a patient she was treating, that several businesses listed in the yellow pages under "Abortion services" are actually centers designed to convince (and sometimes guilt) women into not having an abortion, and centers that do not provide abortions and refuse to refer to centers that do. This was bothersome to us. We decided to call up a few sites listed under abortion services in our yellow pages, and talk to some of these centers, but we never carried through with it.

Finally, a precedent has been set -- Tom at healthlawblog posted about a man who was ordered to stop his "abortion services" business of pretending he was making appointments with abortion providers, for women who called his service, and instead purposefully postponed these appointments until the patients passed the time limit to legally get an abortion (24 weeks, in Louisiana). In my opinion, the penalty imposed (ordering the man to stop his business) is not enough -- he should be more severely penalized for this.

Self-directed education on obesity

I was excited to find out that Alex created his own medical school elective in obesity and nutrition. It's true, medical schools usually do a poor job of teaching students about obesity, nutrition, preventive health, behavioral interventions, and motivational interviewing. I've observed numerous gastric bypass operations, but have not gained much knowledge on counseling patients on obesity, in my medical school education. And given obesity is becoming an "epidemic" in America, it's nice to know that some students are taking initiative to learn more about how we as future docs can work with patients on weight control and loss. Like Alex, I'm interested in working with patients over periods of time to create lasting changes in health (this kind of stuff is what some -- but not all -- of my med student colleagues would call "bullshit" work, not meant for physicians). Alex writes:

The gap between our patients' expectations and the reality of what can actually be accomplished (in terms of long term weight loss) is enormous. Like lemmings, they glom on to the latest dieting trend, be it low fat, low calorie, South Beach, North Beach, East Coast, West Coast, low carb, low whatever, and they end up achieving terrible results -- and end up at a weight even greater than the weight at which they started. I never knew that taking an "obesity history" was so important to the care of these patients. The degree of baggage they carry into their subsequent weight-loss attempts figures prominently into tailoring interventions appropriately.

Mary L. wants to lose 100 pounds, but the reality of it is that she will face a tremendous uphill battle to lose just 28 pounds (10% off of the weight of her 5' 3" frame) in the next 6 months. Managing expectations is a huge part of the health care team's job. We're starting her off slow -- for the next 4 weeks, the only things she's going to do are keep a diary of her eating and exercising habits and walk for 30 minutes a day, 5 times a week. I'm rooting for her.

Harold and Kumar -- Asian-American heroes or same old hollywood?

I've been hearing great things about the movie Harold and Kumar go to White Castle, especially from Asian-Americans, which gave me some hope about the movie's Asian-American heroes. Supposedly, the movie casts them in a positive light, underdogs who entertain in a non-stereotypical fashion. But I've been a bit skeptical, knowing that Asian-Americans are often excited whenever they're cast at all in Hollywood, and tolerate a lot of stereotypes for that opportunity.

Well, my skepticism may be founded (I haven't seen the movie yet, so I'm going on hearsay -- but I was also going on hearsay from others' opinions of the movie). The group South Asian Sisters put out an "Open Letter to the Asian American Community". It's worth reading in its entirety:

We went to watch Harold and Kumar Go to White Castle because we genuinely wanted to support our Asian American brothers. After all, the media coverage told us that this movie was supposed to break stereotypes and be a positive step for Asian Americans. Asian websites raved about the film, and so we were all excited to rally around this film with the rest of the community.

We entered the theater and immediately noticed that the audience was comprised of predominantly Asian Americans. We wondered if a movie based on the same premise featuring white boys would draw a bigger crowd. The movie started, and we sat back, waiting to be empowered.

Well, it's the next day, and we're still waiting. Harold and Kumar disappointed us. They represented Asian American men as being homophobic, spineless, sex-crazed misogynists. All Asian American men should be outraged! Asian American women? Well, there was one Asian woman, and she was the stereotypical Asian nerd. Queer Asians? There were none. How would they feel safe to come on screen when Harold and Kumar are making homophobic jokes all the time? Working class Asians? Perhaps there is one- the convenience store owner. He gets beat up by the racist hoodlums, and Harold and Kumar just walk away.

Then there are the non-Asians. The African Americans include a crazed fast food employee and a guy in prison reading a book on civil disobedience. There is Maria, perhaps Latina, who strikes Harold's fancy. She has very little to do other than look pretty. It still bewilders us why she would make out with him in the elevator after he has stank White Castle breath and can't even carry on a decent conversation. Finally, the white women. They are overly sexualized and throwing themselves all over Harold and Kumar, who are only interested in "fucking" and getting some "pussy".

Harold and Kumar disrespect women in multiple ways throughout the movie. Women are either objectified and horny for them or asexual and undesirable. The most disturbing scene in this movie was when Kumar fantasizes about a giant bag of marijuana. The ganja is personified as a woman who has sex with him, brings him coffee, and becomes the recipient of domestic violence followed by his "loving" apology.

Note that we're discussing Harold and Kumar the characters, not John Cho and Kal Penn the actors. We recognize that actors are put in a compromising situation to succeed in a white-dominated entertainment industry. Therefore we encourage the community to support Asian American artists while putting pressure on the entertainment industry to represent us more fairly and accurately. We also ask the community to view the media critically and not blindly endorse any representation of a particular segment of the Asian community as being positive for all Asian Americans.

We wish John Cho and Kal Penn luck in their careers and hope to see them in bigger and better roles.

Sincerely, South Asian Sisters

Blogitol -- conquer those feelings of guilt about not-blogging!

I don't think I've reached the point of feeling guilty (yet) about not posting more often to this blog, though I could see it happening sometime in the future. Posting on "to the teeth" is somewhat therapeutic for me, and also allows me (sometimes, when i'm not typing stream-of-conscious-ly) to organize my thoughts and try to write well. But when I don't get to it, I don't get to it. At least I try to keep my daily reading of things newsworthy alive (and that's therapeutic for an otherwise solely-med-school-focused day).

Jay Smooth discusses the guilt factor in blogging, as he refers to the Blogville for Dummies manual. I agree with him that I often don't have time to expound on an article I find fascinating or thought-provoking, and don't consider it right to just link to the article... and by the next day it's too late, I've got 13 more article I'd like to expound on. And so on and so forth. Sometimes I wonder why the articles that I end up posting to "to the teeth" make the hit versus the other many that I read that don't. The posts that show up are all over the place, quite a lack of focus (but hey, that's me. Some say lack of focus, I say "big picture" is cool). On the other hand, Andru's posts to the site are much more focused, which is real nice.

And Jay Smooth has a brilliant idea for a drug that pharmaceutical companies can create (I'm sure there's an ever growing market for it!) -- Blogitol, or something to stop that feelin' o' guilt and shame for not blogging for a bit.

Update to my post on Cuba, and comments on comments...

I've got just a few minutes to write this before going into an umbilical hernia repair operation, so forgive the stream-o-consciousness of this post.

So, I got blasted in the comments, about my previous post about Cuba and their AIDS program. By stating the internment was "not cool" I meant that it was outright unjust and inhumane. No doubt. And I didn't mean to sound as if I was condoning the current 8 week mandatory sanitorium education. This is a mistake that happens when typing stream-of-consciousness in a few minutes. The point of that sentence, and I should have spelled it out so as not to mislead on my opinions on this matter, is that somewhere between the 5 minutes of education that many (obviously not all) patients in America get about HIV when they test positive, and the 8 weeks that Cubans get, would be appropriate -- possibly a structured day or something like that, with education, answering of questions, social services information, and social support, etc would be really helpful for patients who get diagnosed with HIV. Mandatory? I'm not sure. But free (or even paid for, for patients missing a day of work? Yes, many benefits to patients and society).

Also -- I often hear the statements made from one of the commentors -- that these poor countries steal "someone else's work", for example in reverse engineering AIDS drugs, and then can afford to sell these drugs at lower prices. It's such a complete myth that the reason AIDS drug prices are and were so high in America has to do with compensating for drug companies' research and development costs. It's a well known fact that companies spend way more on marketing than on R&D. Second, taxpayers finance more than 55% of drug research and development (thanks to Graham for this link) so I think it's blasphemous for American private drug companies to be patenting these drugs -- ESPECIALLY the crucial LIFE-SAVING drugs -- for 20 years, and reaping all $$ benefits from them, AND charging whatever the heck they want to charge for them. Only because of activists' work in this country and abroad, did the cost of AIDS drugs come down from $12,000 for a cocktail for a year per person, to less than $200 for the same. Who's to say, given the above information, that other countries should not be able to reap the benefits of lifesaving drugs, given the above information? I applaud countries like Cuba for not being dependent on America for drugs (and a note to the commentor -- America would not ALLOW these life-saving drugs to be sold to Cuba, so what's a country to do if it wants to save its own peoples' lives?) and countries like Brazil for revolting against international trade rules that were created by rich countries to make poor countries pay exorbitant prices for drugs.

Ok, that's my morning rant :> Back to work...

Can we take some lessons from Cuba on AIDS prevention and treatment?

So yes, it's true that in the 1980's, Cuba placed many of its HIV-infected patients in "sanitoriums" for extended periods of time, and that's not cool, but I was impressed by an article in the Toronto Star about Cuba's more recent innovative methods of prevention and treatment of HIV+ residents.

Cuba's right smack in the middle of an area hit hard by the AIDS epidemic, yet the infection rate in Cuba is less than 0.1 percent. Until recently, the country had a mandatory HIV testing program. And now, with voluntary testing, if you are HIV+, you are required to spend 8 weeks in a sanitorium to receive education and drug support (as compared to the "five minutes' worth of education" that Dr. Barksdale of the American charity Cuban AIDS Project states).

Waaaaaay back in 1983, before Cuba even HAD any reported cases of HIV+ people, the country set up a National Commission on AIDS that discussed strategies and started an educational program for its 11 million residents. In comparison, as we in the U.S. were dealing with a raging epidemic, former President Reagan only started talking about the issue near the end of his 2nd term in office (and only after much pressure by Congress).

What I find really striking is the fact that Cuba was not allowed access to HIV drugs that the U.S. manufactured because of the economic embargo we have on Cuba, but by 2001, Cuba was producing its own generic versions of these drugs! Unlike our wealthy country with our private pharmaceutical interests, Cuba is offering its drugs at much cheaper prices than market costs, to other Latin American countries. The country is sending doctors and nurses around the world to treat AIDS. In addition, Cuba's offering to train doctors and nurses from Latin American countries at no cost! (similar to the Latin American School of Medicine in Cuba that's training several hundred American students FOR FREE).

As I mentioned above, not everything Cuba did in its efforts to contain HIV was ethical. But that doesn't mean we can't learn something from this "developing" country that's a hop, skip, and a jump away from the coast of Florida.

A Funny thing happened while in the waiting room...

I just received this joke by email and had to share it:

There's nothing worse than a snippy doctor's receptionist who insists you tell her what is wrong in a room full of other patients. I know most of us have experienced this, and I love the way this old guy handled it. An 86 year old man walked into a crowded doctor's office. As he approached the desk, the receptionist said, "Yes sir, what are you seeing the doctor for today?"

"There's something wrong with my thing," he replied.

The receptionist became irritated and said, "You shouldn't come into a crowded office and say things like that."

"Why not? You asked me what was wrong and I told you," he said.

The receptionist replied, "You've obviously caused some embarrassment in this room full of people. You should have said there is something wrong with your ear or something and then discussed the problem further with the doctor in private."

The man replied, "You shouldn't ask people things in a room full of others, if the answer could embarrass anyone."

The man walked out, waited several minutes and then reentered. The receptionist smiled smugly and asked, "Yes?" "There's something wrong with my ear," he stated. The receptionist nodded approvingly and smiled, knowing he had taken her advice.

"And what is wrong with your ear, Sir?"

"I can't urinate out of my ear!" the man replied.

The doctor's office erupted in laughter.