Haiti, Fukushima, Chernobyl: What do we learn from disasters?

It is now two years since the Tohoku earthquake and subsequent triple meltdown at the nuclear plant in Fukushima.  Sarah Phillips, an anthropologist who has spent most of her professional life studying Chernobyl and the Ukraine, has a very thoughtful piece on how similar the two nuclear disasters turn out to be.  It’s a long article, so here’s the tl;dr:

Pripyat

“Fukushima is Chernobyl. Independent of the system (Japanese, Soviet), nuclear technology requires disregard for the public, misleading statements, and obfuscation in multiple domains (medicine, science and technology, governance). As anthropologist Hugh Gusterson notes, “The disaster at Fukushima has generated cracks in what we might call the ‘social containment vessels’ around nuclear energy—the heavily scientized discourses and assumptions that assure us nuclear reactors are safe neighbors.” Comparing the nuclear accidents at Chernobyl and Fukushima shows that “peaceful” nuclear technology is anything but.”

Fukushima

This week, in Maternowska’s Reproducing Inequities, we have also been reading about Haiti and the spectacular failures of development organizations to effect significant or lasting change for poor Haitian women.  It has now been more than three years since Haiti’s massive 2010 earthquake, and life for many Haitians is not better.  The cholera epidemic that began in the country in October 2010 continues to claim Haitian lives.  The same patterns Maternowska identifies for Haiti’s reproductive health and family planning policy have played out in the wake of Haiti’s natural and unnatural disasters: a lot of money spent very unwisely, and then a discourse that blames Haitians and “culture” for the lack of results.  We are left with the sense that Haiti, like other regions of extreme poverty, is hopelessly undevelopable, and so funding is limited to basic humanitarian interventions addressing immediate needs, rather than addressing the underlying structural factors that relegate Haiti to perpetual vulnerability to the next disaster.

haiti_011113_rebuild_dg_06_14744017

Paul Farmer and Catherine Maternowska both identify this sense of hopelessness for what it is: a disavowal, a racist cop-out, and a justification for continuing the same development strategies that fail to address the actual long-term needs of poor people, despite overwhelming evidence of their inadequacy.  The real tragedy that emerges from reading Maternowska, or following Farmer’s tremendous success in the country with his clinic and with Partners in Health, is the recognition that developing Haiti and alleviating poverty is not actually that difficult.

A surprising model for health system improvement

In the debate over how to improve health care in the US, systems in other countries are often held up as models.  You know, countries like Rwanda.

Yes, Rwanda.

A thought provoking piece yesterday on The Atlantic made that comparison, citing analysis by Dr. Paul Farmer.  From the article:

Over the last ten years, Rwanda’s health system development has led to the most dramatic improvements of health in history. Rwanda is the only country in sub-Saharan Africa on track to meet most of the Millennium Development Goals. Deaths from HIV, TB, and malaria have each dropped by roughly 80 percent over the last decade and the maternal mortality ratio dropped by 60 percent over the same period. Even as the population has increased by 35 percent since 2000, the number of annual child deaths has fallen by 63 percent. In turn, these advances bolstered Rwanda’s economic growth: GDP per person tripled to $580, and millions lifted themselves from poverty over the last decade.

One explanation for this dramatic improvement is that the genocide in Rwanda allowed for a clean slate upon which a new program could be built.  Farmer and others reject this explanation, however.  A recent report focuses more on interdepartmental coordination and central planning with health as a priority.  The article is a good summary and the BMJ research paper with Farmer as lead researcher has more details.

The last lepers, and the lack of African surgeons: two articles in The Atlantic

The Atlantic had two good articles out over the winter break that I’m just getting to now; I’m posting them here not because they’re extraordinarily well-written or insightful, but because they’re about topics that deserve greater attention.

The first considers leprosy and the difficulty of eradicating a disease.  In medical anthropology class, I had mentioned that in human history we have successfully eradicated only one disease (of humans) globally: smallpox.  Given our resources in global health in the 21st century, why is it so hard to accomplish the eradication of disease?

Leprosy is a good example of how hard this push can be.  It’s hard to study and the routes of transmission aren’t that well understood (not unlike its close relative, Buruli ulcer).  Worse, it develops very slowly, is easily misdiagnosed, and treatment efficacy is limited.  And social stigma, although its role can easily be exaggerated (something we’ll be thinking about in class), has also played a significant role in rendering the disease and its victims invisible.

The second article concerns a topic that badly needs more discussion: the astounding lack of qualified medical personnel to treat sub-Saharan African populations (the article references a study that finds 9 surgeons per 6,000,000 people in Sierra Leone; I would guess that this is only slightly lower than the West African average).  The results are predictably horrific: inadequate care, malpractice by the undertrained and/or under-equipped, and a system that has little power to retain the qualified.  It’s not a perfect article, but I’m glad that it does two things beyond simply raising the subject: it references Paul Farmer and Jim Kim’s paper on the need for surgeons in the developing world; and it mentions that half of US foreign aid in global health goes to getting ARVs for the HIV+, but a negligible amount goes to training qualified surgeons in poor countries.  Many doctors I work with themselves note this strange disparity between funding and the most pressing medical needs.

Paul Farmer at The Feast

Paul Farmer’s talk at The Feast — with Arcade Fire — on the 25th anniversary of the founding of Partners in Health:

http://new.livestream.com/feastongood/challenges/videos/4460531

(Sorry, can’t seem to embed this one.  The audio quality improves after the whispery first minute or two.)

Paul Farmer on health as a human right, tomorrow

The Feast social innovation conference kicks off in New York City today. It brings together people from different fields and walks of life — “doers” rather than “do-gooders”, as they say in The Feast manifesto — to discuss ways to improve the world.

One of the speakers this year is Dr. Paul Farmer, founder of Partners in Health, a name familiar to students who took AN333 last semester.  Best part: his talk on health as a human right will be streamed live tomorrow, Thursday October 4, at 11:30am. Tune in at new.livestream.com/feastongood/challenges

Paul Farmer’s bio from The Feast’s site:

Medical anthropologist and physician Paul Farmer is a founding director of Partners In Health (PIH), an international non-profit organization that provides direct health care services and has undertaken research and advocacy activities on behalf of those who are sick and living in poverty. Dr. Farmer is the Kolokotrones University Professor and Chair of the Department of Global Health and Social Medicine at Harvard Medical School; Chief of the Division of Global Health Equity at Brigham and Women’s Hospital; and the United Nations Deputy Special Envoy for Haiti, under Special Envoy Bill Clinton.

Dr. Farmer and his colleagues in the U.S. and in Haiti, Peru, Russia, Rwanda, Lesotho, and Malawi have pioneered novel community-based treatment strategies that demonstrate the delivery of high-quality health care in resource-poor settings. Dr. Farmer has written extensively on health, human rights, and the consequences of social inequality. His most recent book is Haiti After the Earthquake. Other titles include Partner to the Poor: A Paul Farmer Reader, Pathologies of Power: Health, Human Rights, and the New War on the Poor, The Uses of Haiti, Infections and Inequalities: The Modern Plagues, and AIDS and Accusation: Haiti and the Geography of Blame. Dr. Farmer is the recipient of numerous honors, including the Margaret Mead Award from the American Anthropological Association, the Outstanding International Physician (Nathan Davis) Award from the American Medical Association, a John D. and Catherine T. MacArthur Foundation Fellowship, and, with his PIH colleagues, the Hilton Humanitarian Prize. He is a member of the Institute of Medicine of the National Academy of Sciences and of the American Academy of Arts and Sciences.