The Pornography of Poverty

May 21, 2007 at 11:02 am (Links)

Check out this post on one of our tagged blogs, Technology, Health, and Development.

It raises an interesting point about how we see the impoverished parts of the world and reminds us that we might want to change that.

Also check this site out for some really insightful little video interviews on the subject.

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A System of Incentives?

May 21, 2007 at 1:42 am (Michael's Posts)

I’m reading this book Hospital by Sydney Lewis (as I mentioned previously) and it’s raising interesting questions. One of the things that came up today is how we get doctors to take care of poor people. The doctors’ testimonies in the book seem to indicate that the only way they got the system of care to work at County (at least in the 60s and 70s and 80s) was to employ a large number of interns and residents whose goal was to further their education by working at County. The idea was that if you could make it through County, you could make it anywhere. In the most sceptical light, it was a super resume boost. The overwhelming majority of them didn’t remain in practice at County and they didn’t remain in practice in the service of poor people, either. Now this may be the bias of the interviewed doctors (because they often did spend a lot of time there) but it also raises an interesting question: without plenty of money, how can you get quality people to provide care to poor people? What other incentives might draw people to these situations? Is the incentive of an education-in-the-trenches morally okay? I mean, are the people who are providing care in those circumstances doing so for the right reasons? Does that matter?

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Class Consciousness!

May 15, 2007 at 2:51 am (Michael's Posts)

Huh! What is it good for!

Well, I don’t know yet. However, I’m reading a book by Sydney Lewis about Cook County Hospital (It’s called Hospital. I added it to my book list post) and various people have brought up the issue of class.

Even though this book is about a hospital in Chicago, this question applies to all of the work that we have talked about in this forum. It’s an uncomfortable question (talking about money is never easy) but it is really necessary to address for all global health folks.

A lot of people have said that the issue of class in this public medicine mecca is always there. This may seem obvious, but it’s important (maybe?) to remember. The interns are mostly from the middle or upper class and surely the doctors are mostly from a similar background. Class awareness plays a prominent role in the questioning of new interns, according to one attending physician who discussed the important questions for candidates for residency. He wants people to at least be honest and aware of the fact that there is a huge gulf between provider and patient.

Some of the time the question of race division is raised and people choose to rephrase it as a matter of class. I think that in America the two are linked deeply, if not inexorably. So we must address both and we ought to understand that they ought to be addressed together. Or must we? In my experience, it’s been a mixed bag as far as what works the best as an approach to these issues. However, I have been finding (and other race-conscious white folks I know find this as well) that if you look through all that stuff and simply be in contact with the humanity of the person you’re talking to, it works pretty well. But does this mean ignoring the differences? Does it mean discounting them?

As far as provider-provider divisions are concerned, it seems that the bottom line for the black people I have read interviews from is whether or not the white intern or doctor or fellow nurse has a funky attitude or not. I find this to be true in my own experience as a volunteer.  However, I have witnessed otherwise and I’ve talked to some of the attendings I work with now about a racial division in the clinic. They have said it’s alive and well and troublesome.

Are these divisions important to recognize? Well, doctors from well-to-do backgrounds can think that a patient’s inability to rustle up bus fare or find a caretaker for a child are poor excuses for missing a clinic appointment. In reality, these are life truths for the patient that appear as very real barriers to getting care. According to some of the health workers interviewed in the book, poor people complain about discomfort less than the more well-off. This might contribute to a tendency to report feeling “fine” when they are in pain, which in turn can make it hard to know if a medicine is working or appropriately dosed. In these cases, a class awareness contributes to respecting and working with a patient’s life difficulties instead of getting impatient with them for missed appointments.  It also helps a doctor think about how to ask better questions of their patients so as to get the best information from them.

I have also been reading that people are people are people and that we should treat everyone like a human being.  With equal compassion and care, is all this discussion of class really all that important?  That sounds flip, but if we really think about it, what part of the class discussion do we need and what part do we not need?

I’ll probably post on this more as I read and think.  Please comment!!

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Advocates Wanted

May 7, 2007 at 1:22 am (Michael's Posts)

I hope to never be at a party as sad as the one I attended at Cook County a couple weeks ago. The medicine Division Head was there as was the director of the clinic I work in. As were most of the doctors who were in clinic that day. As were a few of the doctors and nurses who were being fired.

As I have mentioned before, Cook County (Chicago and a few of its surrounding suburbs) is downsizing its health operations. What this means is the county is over-budget and they’re cutting jobs to bring balance to the fiscal situation. Never before, however, have the doctors who sacrifice more lucrative practices to treat needy patients had their positions in the county in danger. Many doctors and nurses were sent pink slips this spring and many more will recieve sad mail in the fall.

The really awful part about this method of budget-balancing is that it occurs not on the backs of the doctors (it’s hard to be unemployed for a very long time as a doctor. At least as far as I can tell). I’m not worried about these people, at least. They are compassionate, wonderful doctors and will find gainful (and most probably much more lucrative) work elsewhere. The sad part of this story is the people who they serve will continue to see the little bit of assistance they recieve from the county dribble away.

Richard J Daley and his cronies have screwed the poor people in this city over and again and they always get away with it. This is the same attitude that saw the destruction of public housing along with exuses that were was no money in the budget to rebuild. However, there’s money to build an olympic village, apparently (we’re the US bid for the 2016 games) and money to go forward with the beautifucation of downtown (everyone who visits here says that it’s a very beautiful city. Well, it is. The part of it you’ve seen, at least.) They’re doing it again and getting away with it again. How? How can the county government cut services to thousands of people and not have some kind of backlash?

This is an important topic to discuss as the questions of “Global health” hinge greatly on the willingness of governments to help the disenfranchised. Chicago’s government is doing, well, a piss-poor job of standing up for the destitute in its boundaries. Why? Whose job is it to stand up for them if the state won’t? How can we make them change their minds?

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