A Great Book

[MattD]

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It's based out of there. That's where their offices are.

And they do a lot of clinical work for the poor there. Just like the other sites.

Nope, because chances are good that the patients they are treating have contributed something meaningful to society.

So the 2 year old with cancer has contributed to society? The homeless man with cancer? In what way does someone have to contribute to society to be worthy of wasting resources on in a hopeless case? And when you say these Americans with cancer have probably contributed something meaningful to society, and the Africans or Haitians with AIDS have not, don't you really mean they've contributed meaningfully to YOUR society? Or are you saying that every single person from those areas is basically an ignorant savage who has contributed nothing even to their own society?

The MDR-TB thing, yes that worked and needed to be done. Why waste more money on treating these AIDS patients when it would be simpler and more cost effective just to round them up and quarantine them? That would bring the problem to a far more rapid resolution than trying to educate a mass of insipid people who lack even common sense.

I'm not even sure where to start with this statement. First off the word insipid basically means boring and insignificant. If that's what you meant, then... wow. If you actually meant ignorant, or stupid... still wow. So every African is stupid (or insignificant, whatever), or is it just every African with AIDS? Does that include the African women who are HIV+ because they are powerless to avoid sex with men with AIDS? Does it include rape victims over there? Does it include all the people who have AIDS simply because they did not know about HIV, or did not know their partner had it? Sure, there are some massively ignorant things going on over there, which are pretty infuriating to people trying to curb the spread of HIV, but to equate every inhabitant of that continent with the government officials who interfere with the treatment process is to equate every inhabitant of the USA with GWB. Whether you like dubya or not, surely you can see that his thougts aren't automatically the beliefs of everyone in the nation. Africans aren't all the same either. To say that the entire population of Africa 'lacks common sense' is pure racism, whether you want to argue about that or not. Or perhaps a term like 'continentism' or 'locationism' would seem less dirty to you. Whatever, it's all the same thing.

I was waiting for someone to not be able to take me on point and play the race card. I guess the time I spend working with people of basically every ethnic group you can name (short of Hmong, I've yet to see one of them here) at a clinic here in town is just for show. 🙄 I don't care about their race. I care about the color of their skin. If these problems were infesting a group of stupid white liberals, I'd have no problem quarantining their butts either.

What point would you like to be taken on? Your point that Paul Farmer is a 'douche'? Whatever, I don't care what your opinion of the dude is, I'm sure he doesn't either. The point that he's wasting his time? It's too early to know. The TB thing is huge, and I'm glad you give PIH credit for that, although you seem to do so almost grudgingly, as if the sin of providing primary care to poor people and trying to help those with AIDS overwhelms that accomplishment. Will his efforts in Haiti, Rwanda, and other locales make a long term difference? We'll see. It certainly won't be due to his efforts alone, as the political structure of each of these places will have to undergo a sea change for anything to take seed and grow. At least the guy is working to uphold his principles though, I'm really not sure how you can hate on somebody for that. As far as you working with all races at some clinic in town, great for you. I'm sure you give everyone who comes in the same standard of care. But I call bull**** on you claim that you would treat everyone equally. If your mother contracted HIV, you would not quarantine her and let the disease run it's natural course.

I'm not telling them not to. I'm just demanding that they be realistic in how they expend relatively limited resources. Focus on those things you can address successfully, and those people who will benefit the most and, in turn, benefit others.

The great triage argument. Kiddos, when you get into practice, remember what uncle murphy told you here. If someone comes into your clinic for help, and there's no way you can cure them, throw their ass on the street. This will save the most of your limited resources. Then, look at what kind of person you're treating. A rich person will probably be able to enjoy their life more than a poor person, so make sure you cure all the rich people first, and then the poor people with what's left over. That way you provide treatment to 'those who will benefit most'. After all, an extra year of life for a homeless man is an extra year of homelessness, but an extra year of life for Hef is an extra year in the Playboy mansion. The choice there is obvious!

Yeah, more power to him too.....he just should not expect to get his ass kissed for it. I've met the man at one of his speaking engagements (forced to attend by my then girlfriend). He's a self-righteous piece of work.

I've never met the man, so I can't comment on his self-righteousness. However, given your obvious differing philosophies, was he arrogant in self importance, or did he simply have the courage of his convictions, and it irritated you? BTW, not meant as an attack, but calling someone else arrogant or self righteous DKM? Pot? Kettle? C'mon man. I'm not even dogging you really, I have an ego too, but let's look in the mirror before calling someone else arrogant 🙂

No, you don't give a ****. Slight difference there. If it weren't for the rule against re-posting PMs, I could show you the seven or eight PMs I've gotten since I chimed in on here. Only one of them sided with you. Most of them are to the effect of "Thank you for having the balls to say it."

Fair enough. Although I'm betting there are plenty on here who agree with my viewpoint as well. My point is that if a group of people want to discuss a book with a message that they consider relevant, while you have the right to express your counteropinion, I don't see how it's appropriate to so aggressively and repeatedly attack that message. You made your point, let those who disagree have their conversation. If you want to make a thread to discuss how PIH is destroying the world, you are within your rights to do so.

Sorry, I'm probably better read in ethics than you are. Just because I disagree and reject your view as idealistic nonsense does not imply I'm ignorant of the stances you take and how you feebly attempt to back them up.

Maybe you are, maybe you're not. I don't know and neither do you. Utilitarianism has it's place in policy decisions, and is a very necessary part of such. However, on a personal level, I think that anyone who is using this as their personal ethic is allowing their own situation to bias their viewpoint. If you were born in Africa, I do not believe that you would hold the viewpoints you are expressing here. I do believe that there is a moral imperative for those who are well off to help those who are less fortunate, and I'm not going to apologize for that, regardless of any accusations of 'idealistic nonsense'. The idea that the millions in Africa dying of AIDS are unimportant, or ignorant, or worthless, or even that they don't affect us here, and that we can just let them die off and everything will be better IS, however, idealistic nonsense, although it's a pretty disgusting ideal.

Actually I read it while you were probably still in elementary school.....didn't really think it was anything special. It was better than most books out there, but then again it wasn't anything I had to change my shorts after reading either.

Nice thinly veiled ad hominem there, the classic "I'm older than you and therefore much more wise and correct in any disagreement" argument. You don't know my age, nor do I know yours. Maybe you are older. Maybe you are more experienced. But the 'wisdom' you are expressing is nothing more than spiteful, self-righteous cynicism. I'm not surprised you didn't like the paper though, it goes against your theory that your SES and location (which you obtained randomly, through no special effort of your own) make you somehow better than those who were born poor and black and in Africa, and thus more worthy of resources.

BTW, everyone else, fecal incontinence after reading a book, revolutionary or not, is abnormal and should be evaluated by a health care professional.

Then maybe Dr. Farmer needs to read it, not me. I've never claimed that.

So what are your goals? Money? Nothing wrong with that I suppose, but if you're operating on such a different paradigm, perhaps you're not really qualified to discuss the motivations of people with more generous ideals.

Once again with the racism retort.....nice......apparently you should find some good books on how to formulate a proper argument. I can recommend a few to you if you like.

Not trying to write a thesis, I'm just calling it like I see it. I do NOT believe you would quarantine and let die your friends or family if they got AIDS.

...I would expect the same to be done to me if I were suddenly struck down and found myself stupid and infected with something contagious. It's only a biased opinion if you don't apply it to everyone regardless of factors beyond their control (race, sex, ethnicity, height, eye color, country of origin).

But this is the very problem with your argument. You are labeling an entire group of people, whether based on skin color or location, as stupid, unable to control their impulses, and unable to contribute to society. You're not even giving them the 'benefit' of assuming their illness struck them down and made them stupid. They already were, apparently, by virtue of their birth.

Please get off your pedestal and get down here with the rest of the guilty self-absorbed white (I'm guessing you're white based on your location and the limp wristed nature of your racism argument; if I'm wrong, I apologize) liberals before develop HACE.

Yes, because EVERYONE from alabama is white. We're also all bumpkin hicks. All we do is go muddin' and rape our cousins. Oh, and go to 'dega for the big race YEE HAW! Now where'd I put my belt buckle?....

 

[Oceaner]

^ well stated 👍

 

[Kaydubz]

Guns, Germs and Steel is a good book as well for such topics as "continentism" 🙂

 

[Oceaner]

Guns, Germs and Steel is a good book as well for such topics as "continentism" 🙂

I've read Guns/Germs and Collapse, and while Diamonds arguments are compelling, something underlying principle of his correlation between ecological topography and societal topography bothered me. I still can't pinpoint it though. It's like, his argument is amazing, but he seems to be missing/oversimplifying something somewhere. Or maybe it's just me... thoughts?

 

[DropkickMurphy]

The great triage argument. Kiddos, when you get into practice, remember what uncle murphy told you here. If someone comes into your clinic for help, and there's no way you can cure them, throw their ass on the street. This will save the most of your limited resources. Then, look at what kind of person you're treating. A rich person will probably be able to enjoy their life more than a poor person, so make sure you cure all the rich people first, and then the poor people with what's left over. That way you provide treatment to 'those who will benefit most'. After all, an extra year of life for a homeless man is an extra year of homelessness, but an extra year of life for Hef is an extra year in the Playboy mansion. The choice there is obvious!

Swing and a miss (again). Greatest good for the greatest number is the basic rule of triage. It has NOTHING to do with income and everything to do with what the chances are that person will survive are. In the case of HIV, the chances of survival are effectively zero, so they would be "black tagged" in a sense. Oh, wait, maybe I should refer to it by the other term "expectant" that so you don't think I'm being racist since you apparently can't pick up on anything else.

The FIRST thing I teach ACLS students is something I learned as an EMT back over a decade ago: "Prevent when possible, treat effectively when challenged, and when all else fails, step back and provide support." Not even in the same ballpark throwing someone out on the street.....but then again you have a flair for the hyperbolic. Just because you quarantine someone, that doesn't mean you don't provide supportive treatment (think of my idea as more mandatory extended hospice for AIDS patients, less concentration camp).

To put it in terms that a first grader (or someone with the intellect of one) would understand: if you have the choice between spending $_______ on something that isn't going to work, you're wasting money. If you spend it on something that might work, that's better, but not optimal. If you spend it on the things that will definitely make a difference, then that's the best choice.

I'm not even sure where to start with this statement. First off the word insipid basically means boring and insignificant. If that's what you meant, then... wow. If you actually meant ignorant, or stupid... still wow. So every African is stupid (or insignificant, whatever), or is it just every African with AIDS? Does that include the African women who are HIV+ because they are powerless to avoid sex with men with AIDS? Does it include rape victims over there? Does it include all the people who have AIDS simply because they did not know about HIV, or did not know their partner had it? Sure, there are some massively ignorant things going on over there, which are pretty infuriating to people trying to curb the spread of HIV, but to equate every inhabitant of that continent with the government officials who interfere with the treatment process is to equate every inhabitant of the USA with GWB. Whether you like dubya or not, surely you can see that his thougts aren't automatically the beliefs of everyone in the nation. Africans aren't all the same either. To say that the entire population of Africa 'lacks common sense' is pure racism, whether you want to argue about that or not. Or perhaps a term like 'continentism' or 'locationism' would seem less dirty to you. Whatever, it's all the same thing.

Of course, if I think a group has issues as a general rule (examples: Republicans, Democrats, most Christians, white people (didn't see that coming did you?) etc) then I must be completely biased and unable to value any member of that group; if they happen to be darker than me, that immediately makes me a racist regardless of whether they are the same people you mention raping and pillaging. You need to have your sights adjusted because you sure as hell haven't hit the target yet.

Last time I checked, just like your home state isn't all white, the continent of Africa isn't all black either. There are plenty of white people over there and more are subject to this matter.

If someone had the balls to institute policies such as quarantine when this thing was starting out, the issues you bring up wouldn't be issues. But no, it's "offensive" to sequester people because they are ill.

I'm not surprised you didn't like the paper though, it goes against your theory that your SES and location (which you obtained randomly, through no special effort of your own) make you somehow better than those who were born poor and black and in Africa, and thus more worthy of resources.

You apparently missed the part where I said if I were stupid and not dealing with my condition appropriately and thereby posing a risk to society that I would pray someone would lock my ass up? How does that mean I'm more worthy of anything? Once again, you're making assumptions, yet you claim I am doing the same. Nice to see you're not a hypocrite or anything.

BTW, actually I grew up poor. I obtained my current socioeconomic status and my current location by my own hard work. Stop trying to use straw man arguments with me. It is not going to work. Neither will pathetic attempts to discredit me by making me look like a rich white snob.

So what are your goals? Money? Nothing wrong with that I suppose, but if you're operating on such a different paradigm, perhaps you're not really qualified to discuss the motivations of people with more generous ideals.

There you go assuming again. My goal is simply to be a good doc and to train others to be the same. Money, while important, isn't a driving force behind anything I do. Otherwise, I wouldn't have given up a $28/hr job to work as a research assistant.

Oh, and by the way, I crawl into burning buildings for no pay, little recognition and at a fairly great deal of risk to my own safety (oh, and the south half of our district- where most of our fire calls are for- is about 75% black if that counts for anything) .....if you really want to get into who is more altruistic, have at it.

But this is the very problem with your argument. You are labeling an entire group of people, whether based on skin color or location, as stupid, unable to control their impulses, and unable to contribute to society. You're not even giving them the 'benefit' of assuming their illness struck them down and made them stupid. They already were, apparently, by virtue of their birth.

Actually you missed the part where I basically said that about most people? I know a LOT of stupid people right here in the US of several different ethnic groups. To be completely honest, I know more white people who make me ashamed to be white by virtue of their stupidity. I'm not racist, I hate pretty much everyone equally. Some people work their way up from there.

I do NOT believe you would quarantine and let die your friends or family if they got AIDS.

Damn, I'm beginning to get tired of point out where you're making unfounded assumptions, but here's another one. I would most certainly quarantine anyone- including myself, let alone family members and friends- if I felt it was necessary to protect the health of others.

BTW, everyone else, fecal incontinence after reading a book, revolutionary or not, is abnormal and should be evaluated by a health care professional.

Swing and a miss.....damn you really can't pick up on anything can you....it was a reference to cumming in one's pants like a lot of premeds do when they read crap like Farmer's books.

Nice thinly veiled ad hominem there, the classic "I'm older than you and therefore much more wise and correct in any disagreement" argument. You don't know my age, nor do I know yours. Maybe you are older. Maybe you are more experienced.

Actually, no I was just point out that I read it back in 1993 or 1994. So what counts in your book to make one's opinion more important or valid- hell, as valid- as your own bleeding heart drivel? Do I need a picture of myself shaking hands with civil rights leaders? Do I need to go to Africa and hold a dying AIDS baby? If you're not going to go by education or experience (both of which I'm willing to bet my left testicle I have a lot more of than you), then I bet you're either a liar in class by keeping your beliefs to yourself and toeing the party line to please the professor (which makes you a hypocrite) or you're a total pain in the ass to have because you think are better than someone with far more knowledge than you will ever have. Now which is it? Either you believe these things enough to put your reputation on the line and potentially pay a price for stating them or you are simply a spineless ninny like most other liberals. I'm not saying you are or you are not, but I would really appreciate you explaining it to me.

But the 'wisdom' you are expressing is nothing more than spiteful, self-righteous cynicism.

Spiteful? Maybe, depending on whom you ask. Doesn't seem like that many people view this as spiteful or you would have more backup than you do. Self-righteous? Nope, because I don't think my idea is a perfect solution, even if it is more economical and easier to implement on a massive scale than current methods. If I was being self-righteous I would have to either think I'm better than everyone I'm willing to quarantine- and seeing as how I would lock up even people I hold in high regard, that isn't the case- or that my solution is the ONLY one that will work (see above). Just because I disagree with you doesn't make me, self-righteous anymore than a willingness to sacrifice a few to save many makes me racist, "locationist", or "continentalist". Drop the PC crap and try actually thinking of solutions rather than trying not to offend anyone or prove how much of a humanitarian you are.

 

[Julietcf14]

I love that we can easily write 2 page replies on SDN boards but, for some reason, it takes 2 days to write 800 characters on "you most meaningful service activity."

As a side note, I would also much rather READ these 2 page replies. They are much more interesting.

 

[DropkickMurphy]

I love that we can easily write 2 page replies on SDN boards but, for some reason, it takes 2 days to write 800 characters on "you most meaningful service activity."

As a side note, I would also much rather READ these 2 page replies. They are much more interesting.

You know....you're right on both points. I guess it just takes longer to make sure one's bull****, spin and lies are all in order than it does to take someone to task over something they said.

 

[beauregard]

A perfect example- in non-island form- of this that DOES exist is Harlan County, Kentucky. I worked there for a while and it is as white as driven snow, the people are uneducated (although some of them are the nicest people you could ever ask to meet) and don't have the common sense to take their hand off a hot skillet. All they care about (even at the expense of feeding and clothing their children) is access to booze, cigarettes and gas for their ATVs.

Ah home sweet home...

Disclaimer: not everyone in Harlan is like this. .

Boy best be glad he left Harlan alive.

 

[DropkickMurphy]

Ah home sweet home...

Disclaimer: not everyone in Harlan is like this. .

Boy best be glad he left Harlan alive.

No, not everyone is.....but it is the whitest town I've ever come across. I've been to Norway and seen more non-whites there. Although I have to say, by and large, the people in Harlan were extremely nice. Even the drunks in the ED were polite.

 

[Rud42]

I can't believe this one topic created such a heated debate (albeit a good read).

Are there any other good books people would recommend over any topic?

--For Biology majors, I just read two books by Matt Ridley which are very good also: "The Red Queen" and "The Agile Gene."--

 

[Kikaku21]

Swing and a miss (again). Greatest good for the greatest number is the basic rule of triage. It has NOTHING to do with income and everything to do with what the chances are that person will survive are. In the case of HIV, the chances of survival are effectively zero, so they would be "black tagged" in a sense. Oh, wait, maybe I should refer to it by the other term "expectant" that so you don't think I'm being racist since you apparently can't pick up on anything else.

The FIRST thing I teach ACLS students is something I learned as an EMT back over a decade ago: "Prevent when possible, treat effectively when challenged, and when all else fails, step back and provide support." Not even in the same ballpark throwing someone out on the street.....but then again you have a flair for the hyperbolic. Just because you quarantine someone, that doesn't mean you don't provide supportive treatment (think of my idea as more mandatory extended hospice for AIDS patients, less concentration camp).

To put it in terms that a first grader (or someone with the intellect of one) would understand: if you have the choice between spending $_______ on something that isn't going to work, you're wasting money. If you spend it on something that might work, that's better, but not optimal. If you spend it on the things that will definitely make a difference, then that's the best choice.

If you had been paying attention when you read Paul Farmer's books, you would have realized that one most effective uses of our resources is helping the poor. We can save more lives in Africa buy purchasing bednets and water tanks than we can with policy change in this country. So, you want the most bang for your buck? How about some 20 cent immunizations for kids in Haiti? Sorry, you've done a poor job at triage.

And, your solution? Quarantine? Thats f***ing cost effective! Why don't you start with Malawi, where an estimated 940,000 people have HIV. That sounds like a cheap alternative. Quarantining 940,000 people. Lets see, we have $1/day antiretrovirals, or quarantine---last time we tried to control a large segment of the population of some other country, say Iraq, it cost 300 billion. Think for more than 2 seconds about the vile s*** coming out of your mouth.

 

[DrMidlife]

I can't believe this one topic created such a heated debate (albeit a good read).

Are there any other good books people would recommend over any topic?

The Spirit Catches You and You Fall Down. It's awesome. Inspiring. Puts things in perspective. Wonderfully, fairly, objectively written.

...and now DKM will be REALLY entertaining. Put this on in the background while you read his appreciation of the book: http://www.youtube.com/watch?v=x-64CaD8GXw

 

[Rud42]

Sorry to keep posting about different books, but has anyone ever read "The Divine Comedy" I think is what it is called (the one with inferno and the other two) by Dante Alighieri? I almost bought the three books the other day but wanted to hear some comments first.

 

[MattD]

Swing and a miss (again). Greatest good for the greatest number is the basic rule of triage. It has NOTHING to do with income and everything to do with what the chances are that person will survive are. In the case of HIV, the chances of survival are effectively zero, so they would be "black tagged" in a sense. Oh, wait, maybe I should refer to it by the other term "expectant" that so you don't think I'm being racist since you apparently can't pick up on anything else.

The FIRST thing I teach ACLS students is something I learned as an EMT back over a decade ago: "Prevent when possible, treat effectively when challenged, and when all else fails, step back and provide support." Not even in the same ballpark throwing someone out on the street.....but then again you have a flair for the hyperbolic. Just because you quarantine someone, that doesn't mean you don't provide supportive treatment (think of my idea as more mandatory extended hospice for AIDS patients, less concentration camp).

To put it in terms that a first grader (or someone with the intellect of one) would understand: if you have the choice between spending $_______ on something that isn't going to work, you're wasting money. If you spend it on something that might work, that's better, but not optimal. If you spend it on the things that will definitely make a difference, then that's the best choice.

You've either backed up from your original stance here, or you just weren't clear on it originally. Your earlier statement was that they should just round all the HIV+ people into quarantine and let nature take care of the problem. You mentioned nothing about supportive care, indicating that you would let the patients all die as quickly as possible to get rid of the virus reservoir. If this is not what you intended to put forward, then I apologize, but it IS what you said. I wouldn't choose quarantine as a first choice in handling this sort of situation, and at this stage in the game isn't a viable option, but in the beginning of the epidemic, had I been a policymaker, I'd have certainly considered it. However, reality being what it is, even if you did quarantine these people, the supportive care that I'm now hoping you would be amenable to providing is pretty much the same care that people want to provide now -- standard drug cocktails and nutrition.

And for the record, AIDS is not a death sentence in this day and age. Look at Magic, for a celebrity example. He's been positive and kickin' it forever now. The question here is why does he deserve the best treatment out there, and the poor teenage girl in Africa doesn't?

Of course, if I think a group has issues as a general rule (examples: Republicans, Democrats, most Christians, white people (didn't see that coming did you?) etc) then I must be completely biased and unable to value any member of that group; if they happen to be darker than me, that immediately makes me a racist regardless of whether they are the same people you mention raping and pillaging. You need to have your sights adjusted because you sure as hell haven't hit the target yet.

The fundamental difference here is that poor Africans didn't choose to be poor, African, or to get AIDS. Republicans and Democrats choose to be in those groups and associate themselves with those ideologies. Christians choose continuously to hold to a certain set of beliefs. If you have a problem with white people as a generality, that's just as racist as having a problem with blacks, or latinos, or whatever. If you're willing to look at somebody and make assumptions about them based on the color of their skin, that's racism. Just accept it. I'd say 99% or the population of the world, not just America, has some level of racism to them, so it's rather silly to try to claim otherwise about yourself. I make no such claim, although I try to limit those types of ideas when I catch myself entertaining them. If you're espousing a view that is racist, just own up to it. I'm not labeling you, I'm labeling the opinion, so get off the defensive. And as far as the rapers and pillagers are concerned, lock 'em up, cap 'em, whatever, they're below respect. But don't group their entire population in with them.

Last time I checked, just like your home state isn't all white, the continent of Africa isn't all black either. There are plenty of white people over there and more are subject to this matter.

Your point?

If someone had the balls to institute policies such as quarantine when this thing was starting out, the issues you bring up wouldn't be issues. But no, it's "offensive" to sequester people because they are ill.

I agree, that would have been effective. I question the ethics, but I don't doubt the efficacy.

You apparently missed the part where I said if I were stupid and not dealing with my condition appropriately and thereby posing a risk to society that I would pray someone would lock my ass up? How does that mean I'm more worthy of anything? Once again, you're making assumptions, yet you claim I am doing the same. Nice to see you're not a hypocrite or anything.

I didn't miss it, I simply made a distinction. You stated before that if you were 'struck stupid' you would hope someone would take care of that for you. Your previous comments indicated that you believed that ALL Africans are stupid. Be honest, and if you deny this, I'll just take your word for it, there's no point in arguing. But you're saying it's ok in Africa, and that it was ok in Cuba, for the governement to say "ok, you, you, and you have AIDS, so you have to come to this quarantine away from the rest of society, and live out your days in an AIDS camp", but I'm betting that here, at your home, if you had AIDS you would expect for the government to wait for you to demonstrate your 'stupidity' and your inability to deal appropriately before they lock you up. Right? You'd want to start off with the benefit of the doubt, right? If not, I'll at least grant you consistancy, and we'll have to agree to disagree on the ethics. I sure hope ya don't get elected to office one day though.

BTW, actually I grew up poor. I obtained my current socioeconomic status and my current location by my own hard work. Stop trying to use straw man arguments with me. It is not going to work. Neither will pathetic attempts to discredit me by making me look like a rich white snob.

Unless you were born in a gutter, my guess, and yes it is a guess, is that you still were born with more opportunity than the population we're discussing. I'm not trying to make you look like a rich white snob, nor am I attempting to use a straw man argument. I'm simply trying to acknowledge the fundamental difference in opportunity between someone born in the USA and someone born in the Congo.

There you go assuming again. My goal is simply to be a good doc and to train others to be the same. Money, while important, isn't a driving force behind anything I do. Otherwise, I wouldn't have given up a $28/hr job to work as a research assistant.

Good for you, and likewise. I also gave up a lucrative career, although I'm not going to try to use that to make myself look good. All I'm trying to say is that if you claim to strive for compassion for your fellow man, you sure do seem callous toward the HIV+ population. I'm not saying you make that claim, just that if you do, I wish you'd universalize it.

Oh, and by the way, I crawl into burning buildings for no pay, little recognition and at a fairly great deal of risk to my own safety (oh, and the south half of our district- where most of our fire calls are for- is about 75% black if that counts for anything) .....if you really want to get into who is more altruistic, have at it.

Thanks for being a firefighter. Nothing but respect there. I won't get into a discussion of so called altruism here because a.) that's a whole 'nother debate and b.) at that point I'd just be nitpicking your choice of words, and I'm not quite that desperate 🙂

Actually you missed the part where I basically said that about most people? I know a LOT of stupid people right here in the US of several different ethnic groups. To be completely honest, I know more white people who make me ashamed to be white by virtue of their stupidity. I'm not racist, I hate pretty much everyone equally. Some people work their way up from there.

So you're basically a misanthrope? That explains a lot, if so. Wish you'd mentioned it up front, it sets the stage to which people should consider your argument.

Damn, I'm beginning to get tired of point out where you're making unfounded assumptions, but here's another one. I would most certainly quarantine anyone- including myself, let alone family members and friends- if I felt it was necessary to protect the health of others.

And would you deny yourself or those others treatment for their disease, and let it die out? If not, then this is the same misunderstanding as mentioned before.

Swing and a miss.....damn you really can't pick up on anything can you....it was a reference to cumming in one's pants like a lot of premeds do when they read crap like Farmer's books.

Forgive me for mistaking crapping your pants with squeeging your pants. You weren't clear, and diarrhea is less embarrassing than premature ejaculation, so I was giving you the benefit of the doubt. It was a joke anyway. You do know what a joke is, right?

Actually, no I was just point out that I read it back in 1993 or 1994. So what counts in your book to make one's opinion more important or valid- hell, as valid- as your own bleeding heart drivel? Do I need a picture of myself shaking hands with civil rights leaders? Do I need to go to Africa and hold a dying AIDS baby?

Your opinion is plenty valid. You're free to express it. I simply disagreed with it. YOU were attempting to marginalize MY opinion by claiming greater age, experience, or whatever.

If you're not going to go by education or experience (both of which I'm willing to bet my left testicle I have a lot more of than you), then I bet you're either a liar in class by keeping your beliefs to yourself and toeing the party line to please the professor (which makes you a hypocrite) or you're a total pain in the ass to have because you think are better than someone with far more knowledge than you will ever have. Now which is it? Either you believe these things enough to put your reputation on the line and potentially pay a price for stating them or you are simply a spineless ninny like most other liberals. I'm not saying you are or you are not, but I would really appreciate you explaining it to me.[\QUOTE]

What are you talking about? Reformulate that question into English, (sorry, unfortunately I'm enough of an ugly American to not be bilingual) and I'll be happy to explain it. I'll be happy to discuss my ethical beliefs with anyone, whether that be some random professor(I'm really not sure where you're going with that one) or anyone else. BTW, I love just how personal you've tried to make this little debate, what with the spineless ninny and bleeding heart liberal comments. Is that what they teach in those argument formulation books you mentioned before? I'm impressed if so.


Spiteful? Maybe, depending on whom you ask. Doesn't seem like that many people view this as spiteful or you would have more backup than you do. Self-righteous? Nope, because I don't think my idea is a perfect solution, even if it is more economical and easier to implement on a massive scale than current methods. If I was being self-righteous I would have to either think I'm better than everyone I'm willing to quarantine- and seeing as how I would lock up even people I hold in high regard, that isn't the case- or that my solution is the ONLY one that will work (see above). Just because I disagree with you doesn't make me, self-righteous anymore than a willingness to sacrifice a few to save many makes me racist, "locationist", or "continentalist". Drop the PC crap and try actually thinking of solutions rather than trying not to offend anyone or prove how much of a humanitarian you are.

 

[DropkickMurphy]

And, your solution? Quarantine? Thats f***ing cost effective! Why don't you start with Malawi, where an estimated 940,000 people have HIV. That sounds like a cheap alternative. Quarantining 940,000 people. Lets see, we have $1/day antiretrovirals, or quarantine---last time we tried to control a large segment of the population of some other country, say Iraq, it cost 300 billion. Think for more than 2 seconds about the vile s*** coming out of your mouth.

Yeah, but you figure $1 per day over the course of 5 years (just to pick a reasonable life span for HIV pts on older meds and an easy number to multiply) times 94,000....that comes out to $34.31M just for one country.

How about some 20 cent immunizations for kids in Haiti? Sorry, you've done a poor job at triage.

And yes, a $0.20 vaccine is a great way to utilize our resources. If you noticed, I recommended something like this in one of my first posts. If you took the money the AIDS project is wasting in Africa you could vaccinate 171.5 MILLION people against diseases that can be controlled. Why blow that money on an incurable illness when you can manage other issues far more effectively? THAT is my point and suggestion, not some form of vile mistreatment.

Who said the west had to do it? We get the local tribes people to do it for us. You give them sufficient incentive (food, cash, etc) and you'd probably get damn good results. The other alternative is to shut off immigration from the continent and let them fend for themselves. There was a thing on the Onion a while back that was damn funny: http://www.theonion.com/content/video/in_the_know_is_our_wealth_hurting

 

[DropkickMurphy]

You mentioned nothing about supportive care, indicating that you would let the patients all die as quickly as possible to get rid of the virus reservoir.

Sorry, I kind of figured that you understood quarantine involves treatment, even if it is just palliative in nature.

If you're willing to look at somebody and make assumptions about them based on the color of their skin, that's racism. Just accept it.

I accept that completely. But that is not what is happening here. That is where all the bickering has stemmed from I think. While no one is completely without bias (myself included), this discussion was not based on that.

So you're basically a misanthrope? That explains a lot, if so. Wish you'd mentioned it up front, it sets the stage to which people should consider your argument.

Well, sort of. I'm not really a complete misanthrope, because if I were I couldn't survive in this line of work. More I just think people should be held accountable for their actions regardless of their origins, etc. Most of the people I have a strong dislike for are people who refuse to do this. Anyone else, they are OK in my book although I don't get too emotionally wrapped up in them that's all.

Good for you, and likewise. I also gave up a lucrative career, although I'm not going to try to use that to make myself look good. All I'm trying to say is that if you claim to strive for compassion for your fellow man, you sure do seem callous toward the HIV+ population. I'm not saying you make that claim, just that if you do, I wish you'd universalize it.

I do universalize it. That's why I could never be a politician. It's just that this discussion was focused (initially) on Farmer and his cronies work in Africa so that is where I focused my discussion on for the most part.

 

[DropkickMurphy]

The Spirit Catches You and You Fall Down. It's awesome. Inspiring. Puts things in perspective. Wonderfully, fairly, objectively written.

...and now DKM will be REALLY entertaining. Put this on in the background while you read his appreciation of the book: http://www.youtube.com/watch?v=x-64CaD8GXw

I feel the need to point out the worst book ever recommended to premeds, because if I don't some bleeding heart little dipwad will come in here and post about how it is such a great book......the book? The Spirit Catches You and You Fall Down...... 😡

It is the most worthless piece of bleeding heart, politically correct bull**** I have ever had the displeasure or reading. It's the sort of thing that aggregiously affluent white suburbanites read in order to make themselves feel better about their shallow existence and to feel superior because the "understand" the plight of the "poor" Hmong family. It's the liberal equivalent of masturbation since it benefits no one else but themselves- it certainly doesn't benefit pediatric patients to allow the ignorance, stupidity or just plain backwardness of their parents to cost them their health and/or their lives....all so we don't offend someone and can be "culturally sensitive".

I am not one who normally advocates banning books nor burning them. That, however, is one book I personally would like to see every copy of burned down to ashes and then the ashes pissed upon to make them cool enough to be loaded into bags for disposal in the deepest, most dank recess of an abandoned guano mine that can be found. Then the full length of the mine should be rigged with explosives which would be set off after someone makes sure all of the bats are out safely.

Anne Fadiman should be summarily executed- preferrably in a slow, meaningful and excruciatingly painful manner (think crucifixion above a nest of fire ants)- not lauded for writing that piece of drivel, because it was so slow, pointless and excruciatingly painful to read. The child's parents should have rotted in prison for letting their own superstitions get in the way of proper medical care for her, not been used as fodder for an insipid book. And I don't mean a soft American prison, I'm talking an S-21 style Cambodian prison.

If we can't say "s__t", "f__k" or "mother____er" on SDN without it being replaced automatically with **** then I request that the title of a book that is best described as being suitable for wiping the **** from one's butt should be similarly blocked from public view.

[/rant]

 

[Oceaner]

I can't believe the ridiculousness of this discussion, quarantine people infected with HIV? quarantine everyone who has any sort disease? Have you ever taken a statistical epidemiology courses? Containment simply does not work, and is a waste of money time and effort, when above a certain percentage of a population is infected.

What are you even arguing? 😕

 

[Kikaku21]

Yeah, but you figure $1 per day over the course of 5 years (just to pick a reasonable life span for HIV pts on older meds and an easy number to multiply) times 94,000....that comes out to $34.31M just for one country.



And yes, a $0.20 vaccine is a great way to utilize our resources. If you noticed, I recommended something like this in one of my first posts. If you took the money the AIDS project is wasting in Africa you could vaccinate 171.5 MILLION people against diseases that can be controlled. Why blow that money on an incurable illness when you can manage other issues far more effectively? THAT is my point and suggestion, not some form of vile mistreatment.

Who said the west had to do it? We get the local tribes people to do it for us. You give them sufficient incentive (food, cash, etc) and you'd probably get damn good results. The other alternative is to shut off immigration from the continent and let them fend for themselves. There was a thing on the Onion a while back that was damn funny: http://www.theonion.com/content/video/in_the_know_is_our_wealth_hurting

While vaccines are a great idea, I would hardly address treating HIV as a waste of money. Are you aware of the villages in Africa where the work force has effectively all been wiped out by HIV? There are villages with adolescents and grandparents, because the entire middle generation has been wiped out by HIV. I am not willing to make the ethical judgement of inaction here, as you are.

Oh, but wait, you don't want inaction, you want quarantine. I almost forgot. So we can go to the African village and pay the grandparents to keep the kids in the play pen and not spread the HIV they were born with.

Or we could do the humane thing and start trying to help these people.

 

[Kikaku21]

I can't believe the ridiculousness of this discussion, quarantine people infected with HIV? quarantine everyone who has any sort disease? Have you ever taken a statistical epidemiology courses? Containment simply does not work, and is a waste of money time and effort, when above a certain percentage of a population is infected.

What are you even arguing? 😕

Sigh. Yeah.. And we are going to pay the Africans to contain themselves. DKM is out of his mind.

 

[Oceaner]

I feel the need to point out the worst book ever recommended to premeds, because if I don't some bleeding heart little dipwad will come in here and post about how it is such a great book......the book? The Spirit Catches You and You Fall Down...... 😡

It is the most worthless piece of bleeding heart, politically correct bull**** I have ever had the displeasure or reading.

You sound really reasonable there... 🙄 yes the "hippies" are out to get you.

 

[MattD]

I feel the need to point out the worst book ever recommended to premeds, because if I don't some bleeding heart little dipwad will come in here and post about how it is such a great book......the book? The Spirit Catches You and You Fall Down...... 😡

It is the most worthless piece of bleeding heart, politically correct bull**** I have ever had the displeasure or reading. It's the sort of thing that aggregiously affluent white suburbanites read in order to make themselves feel better about their shallow existence and to feel superior because the "understand" the plight of the "poor" Hmong family. It's the liberal equivalent of masturbation since it benefits no one else but themselves- it certainly doesn't benefit pediatric patients to allow the ignorance, stupidity or just plain backwardness of their parents to cost them their health and/or their lives....all so we don't offend someone and can be "culturally sensitive".

I am not one who normally advocates banning books nor burning them. That, however, is one book I personally would like to see every copy of burned down to ashes and then the ashes pissed upon to make them cool enough to be loaded into bags for disposal in the deepest, most dank recess of an abandoned guano mine that can be found. Then the full length of the mine should be rigged with explosives which would be set off after someone makes sure all of the bats are out safely.

Anne Fadiman should be summarily executed- preferrably in a slow, meaningful and excruciatingly painful manner (think crucifixion above a nest of fire ants)- not lauded for writing that piece of drivel, because it was so slow, pointless and excruciatingly painful to read. The child's parents should have rotted in prison for letting their own superstitions get in the way of proper medical care for her, not been used as fodder for an insipid book. And I don't mean a soft American prison, I'm talking an S-21 style Cambodian prison.

If we can't say "s__t", "f__k" or "mother____er" on SDN without it being replaced automatically with **** then I request that the title of a book that is best described as being suitable for wiping the **** from one's butt should be similarly blocked from public view.

[/rant]

Based SOLELY on this recommendation, I may have to check out this book ;-)

Does she try to justify what happens, or is the book's goal to help people understand what their thinking is so that they can better find a way to 'get around' these beliefs and get the kid the help he/she needs. Like I said, haven't read it, but I do see it thrown around a lot.

Also for the record, I'd like to point out regarding all the talk of Paul Farmer from before, Mountains beyond mountains, by Tracy Kidder, is a rather inspiring book about how one person can make a difference (whether you agree with the difference trying to be made I don't want to argue about anymore). The books actually written by Farmer, however, are in fact very hard to read, repetitive, and while I think they contain a lot of good points, do tend to be rather rediculous in the lengths to which he blames EVERYONE but Haiti's own government for their plight. I think this may be what you're getting at, DKM?

 

[DropkickMurphy]

quarantine everyone who has any sort disease?

When the hell was that suggested?

Have you ever taken a statistical epidemiology courses? Containment simply does not work, and is a waste of money time and effort, when above a certain percentage of a population is infected.

Yes I have. The one thing you're missing is the statistical model you're using is probably based off of a disease that is easily transmissible by means other than intimate contact as is the case with HIV. Many of them are based on droplet or vector borne diseases. To my knowledge, there has never been a real world qualification of such a model for quarantine in HIV or a disease with a similar transmission profile.

Treatment does not do anything for containment in this case because it does not do anything significant to transmission rates (since single antiretroviral regiments utilizing the older agents seldom get the viral load down to a sufficient degree to reduce the risk) but it does prolong the window of opportunity for transmission.

 

[DropkickMurphy]

Are you aware of the villages in Africa where the work force has effectively all been wiped out by HIV? There are villages with adolescents and grandparents, because the entire middle generation has been wiped out by HIV.

Quite aware.

Or we could do the humane thing and start trying to help these people.

Short of massive education which is slowly making a dent, but it probably won't bring the problem under control (or anywhere close to it) in our lifetimes or the emergence of a cure, name me one thing that is going to stop the spread of this disease in these people. That next generation will make the same mistakes their parents made and we'll see a perpetuation ad nauseum unless something different is tried.

 

[DropkickMurphy]

You sound really reasonable there... 🙄 yes the "hippies" are out to get you.

What the hell are you talking about? 😕

 

[DropkickMurphy]

Does she try to justify what happens, or is the book's goal to help people understand what their thinking is so that they can better find a way to 'get around' these beliefs and get the kid the help he/she needs. Like I said, haven't read it, but I do see it thrown around a lot.

Basically she outright vilifies the docs for not being sensitive enough and THAT is why there was a bad outcome. A small degree of blame is placed upon the child's parents but not nearly sufficient. In other words, doctors are horrible human beings unless they let cultural sensitive take priority over clinical intervention.

 

[Rud42]

Also for the record, I'd like to point out regarding all the talk of Paul Farmer from before, Mountains beyond mountains, by Tracy Kidder, is a rather inspiring book about how one person can make a difference (whether you agree with the difference trying to be made I don't want to argue about anymore).quote]

Thank you for understanding the original post.

 

[Oceaner]

When the hell was that suggested?

Yes I have. The one thing you're missing is the statistical model you're using is probably based off of a disease that is easily transmissible by means other than intimate contact as is the case with HIV. Many of them are based on droplet or vector borne diseases. To my knowledge, there has never been a real world qualification of such a model for quarantine in HIV or a disease with a similar transmission profile.

Treatment does not do anything for containment in this case because it does not do anything significant to transmission rates (since single antiretroviral regiments utilizing the older agents seldom get the viral load down to a sufficient degree to reduce the risk) but it does prolong the window of opportunity for transmission.

So you are limiting the quarantine to people with HIV only? None of the other communicable STIs? Where do you suggest we put the 40+ million of them? Hawaii maybe? Would the US be able to spare a state that has infrastructure?

How about people with TB? Should we also quarantine the people who develop active cases of TB? the millions of them? Where do you suggest? Russia maybe? Let's go one step further and quarantine the 2 billion people that have TB... why the hell not.

I am sorry to be blunt, but I've never heard a more stupid, less thought out idea to deal with the HIV/AIDS epidemic. Please say this to anyone remotely educated in public health and get ready for major LULZ.

A combination of socioeconomic improvement + education + prevention + treatment is the best and the ONLY solution. The only argument between experts is how much of each, and how to allocate resources.

 

[DropkickMurphy]

The books actually written by Farmer, however, are in fact very hard to read, repetitive, and while I think they contain a lot of good points, do tend to be rather rediculous in the lengths to which he blames EVERYONE but Haiti's own government for their plight. I think this may be what you're getting at, DKM?

I will agree that the books Farmer himself wrote aren't very "reader friendly", but then again he probably has a 170+ IQ and judging by my admittedly brief interaction with him, his people skills are marginal at best....those two combined tend to make for something less than a page turner. But yes, one major issue I had with some of his theories on what is wrong was that personal responsibility is not emphasized. It's always someone else's fault. Sometimes there is such a thing as being TOO empathetic towards a group where it clouds your judgment and leaves you open to missing obvious issues or solutions.

 

[MattD]

What the hell are you talking about? 😕

you don't know about the hippie hit squad?

 

[DropkickMurphy]

Would the US be able to spare a state that has infrastructure?

Well, we aren't doing much with Wyoming....and we could use the labor to extract the coal.......

I AM KIDDING. PLEASE DON'T TAKE THAT SERIOUSLY

None of the other communicable STIs?

Name another common and lethal STI with a mortality rate >95%.

I am sorry to be blunt, but I've never heard a more stupid, less thought out idea to deal with the HIV/AIDS epidemic.

Oh well, it never would have flown anyhow and I knew that from the get-go. I was mainly using it just as source of good debate, and because often times throwing out a ridiculously implausible idea will bring about better responses of ideas that might be feasible.

A combination of socioeconomic improvement + education + prevention + treatment is the best and the ONLY solution. The only argument between experts is how much of each, and how to allocate resources.

Agreed.....although the day the economy of Africa (once again, only using it as an example since it is the worst afflicted continent) actually improves significantly I will be shocked. I still think treatment is only going to prolong things though. Prevention and education are the key elements.

 

[DropkickMurphy]

you don't know about the hippie hit squad?

I didn't think liberals believed in guns. 😉

 

[Oceaner]

Also for the record, I'd like to point out regarding all the talk of Paul Farmer from before, Mountains beyond mountains, by Tracy Kidder, is a rather inspiring book about how one person can make a difference (whether you agree with the difference trying to be made I don't want to argue about anymore). The books actually written by Farmer, however, are in fact very hard to read, repetitive, and while I think they contain a lot of good points, do tend to be rather rediculous in the lengths to which he blames EVERYONE but Haiti's own government for their plight. I think this may be what you're getting at, DKM?

MattD, personally I enjoyed his books more the MBM (which I enjoyed tremendously), but I might be the only person haha. 😛 I know what you are taking about in terms of the blaming, but at the same time hear me out: throughout his books he often complains about the tendency in the various fields to blame victims (e.g. they're not following the routine, they are not helping with their superstitious beliefs etc.) I think what he is trying to do is to counter that. At the same time for instance, a place like Haiti has a very complex history, and at the end of day unless you expect him to go into the historical background (which is fun to do on ones own time) he sort of goes back to the roots which are ultimately roots of colonialism and the oppression of a group of people. Essentially I don't think one can judge what he is saying purely on face-value, but one must have a background of the places he is talking about.

 

[Oceaner]

Well, we aren't doing much with Wyoming....and we could use the labor to extract the coal.......

Please... the sick have standards. 🙄

(no offense to the... Wyomingites? )

 

[Rud42]

I think the only way to end this debate is someone here needs to find a cure for HIV/AIDS that is cost effective and somehow give this to everyone with the disease. Plus, think, you would really be killing two birds with one stone; you would probably get automatic acceptance/full ride to medical school of your choice if you could find the cure..... though you might have made enough money with the drug to sit around for the rest of your life and not go through the hassel of medical school/residency.

 

[MattD]

I didn't think liberals believed in guns. 😉

They kill you with kindness.... duh!

 

[DropkickMurphy]

Please... the sick have standards. 🙄

(no offense to the... Wyomingites? )

As the shirt I sell says, "Wyoming- America's Siberia".

 

[DropkickMurphy]

They kill you with kindness.... duh!

I'd rather be shot.

 

[Oceaner]

I'd rather be shot.

no hugs?

 

[DropkickMurphy]

no hugs?

Depends on who's hugging me.

 

[DonkeyD]

I hate to come out of my lurking, but having actually been to Haiti and worked in free clinics down there I think some things need to be pointed out.

From dropkick "He's a shining example to a bunch of wide-eyed premeds that reality be damned, you too can shuffle off your mortal coil helping people who would likely cut your throat just to say they did (or for your wallet, either way)."

You might have been thinking about Darfur here, but I haven't felt threatened at all in Haiti.

"No, but it seems pointless to go to a country with NO tangible infrastructure at all and try to fix problems when someone who is knowledge and driven could make a difference here."

A third-world country has lots of problems, lack infrastructure and lack of medicine being just two of them. With that attitude nobody would ever even try to help. I'd like to point out that in addition to running medical clinics the organization I've been to Haiti with has built loads of hand operated pumps to provide fresh water.

"As I said, there are a lot better places- geographically speaking- we could be spending the money."

WE is the wrong word here. It's his own money, or money given to him. Why do you take issue with what he does with it? Go start up your own deal to help where YOU think YOU could do the most good.

From ecking: "They have their own priorities and they themselves are not interested in what Western medicine has to offer."

This again could be talking about Africa, and I can't say anything about that. But I have seen patients referred to us from voodoo doctors, so I think there's a little bit of interest in what western medicine can offer.

"The government is corrupt and untrustworthy. Who are you going to give the medicine to? What use is your millions of dollars when they meet skeptical villagers and corrupt officials?"

You give the medicine to the people, who aren't skeptical. Haiti has the most corrupt government in the Western Hemisphere, so giving it to anybody above the end user is a fool's errand.

We're not all that different Dropkick, I work EMS in an urban system and somewhat of a cynic and misanthrope myself when I pick up the same people day in and out that are actively trying to kill themselves or just flat out abusing their medicaid cards. I also throw all those feelings away when I actually feel like I've "helped" somebody. BTW thanks for being a volunteer firefighter, lots of respect there. I also wonder sometimes if throwing money at AIDS in Africa is the best way to go when there are other ways to perhaps do more good.

I just don't have a problem with Paul Farmer spending private money to make parts of Haiti a better place. The deck is stacked against those people just because of where they were born and I find that unfair. Paul Farmer is trying to give them a better chance and I think the world could be a better place with more people like him.

 

[DrMidlife]

I feel the need to point out the worst book ever...[/rant]

Awww, that's a recycled rant. And I lobbed it high and slow for you. Although I forgot how funny the guano mine part was.

(This exchange brought to you by Pinko Commie Liberal Hippies for At Least Minimally Humorous Conversations with The Other Side.)

 

[Kaydubz]

Basically she outright vilifies the docs for not being sensitive enough and THAT is why there was a bad outcome. A small degree of blame is placed upon the child's parents but not nearly sufficient. In other words, doctors are horrible human beings unless they let cultural sensitive take priority over clinical intervention.

That is not the message I got out of that book whatsoever. If you want to interpret the book based on differing weights on blame, then by all means do so. The book simply exposes an instance that cultural divisions were strong enough to influence the medical outcome overlooked by well-meaning doctors. The doctors are not portrayed as "horrible human beings." Was I horrified by the mother's behavior, yes. Was Fadiman perhaps leaning toward the cultural sensitivity side? Sure. But for those with an open mind, the book simply tells a story of how the various cultural and societal factors contributed to a tragedy. Though I'll agree that it was obviously the mother's fault, the point of the book is specifically that it is NOT as simple as blaming an end result on one or a few individuals. The book tells a very encompassing story of how the situation came to be.

It's not a matter of cultural sensitivity, it's a matter of being aware of cultural factors, I highly recommend both of DKM's least favorite books 🙂

 

[DropkickMurphy]

though I'll agree that it was obviously the mother's fault, the point of the book is specifically that it is NOT as simple as blaming an end result on one or a few individuals.

Like hell it isn't. The kid should have been taken from the parents as soon as it became obvious they were endangering the child. Cultural sensitivity takes a backseat to someone's life any day of the week. Once again this is where that theory that one doesn't have to take full responsibility for their actions and the repercussions of those actions (or inactions) comes into play. I don't care if your culture, your religion, your ethnicity, the fact that you're obese, a drunk, a victim of domestic violence, or whether it was by an act of commission or an acto of omission; if you caused harm to come to someone who you are supposed to protect, especially a small child then your ass needs to be severely punished in a manner that the American justice system is ill-equipped to dole out because of the douchebags at the ACLU.

Being aware of cultural factors can help avoid needing to have a child removed from the parents' custody (at least temporarily) but it should not be done at the last minute in a case where there is overt signs the parents are going to cause the child harm.

 

[DropkickMurphy]

You might have been thinking about Darfur here, but I haven't felt threatened at all in Haiti.

Darfur was one of the places I had in mind when I said that. The DRC was another. Nepal is at times similar, because of the Maoist rebel insurgency. In fact, a trip I had planned to Nepal to teach was cut short because the US Embassy effectively told us it was not safe to go into the area we were headed to.

A third-world country has lots of problems, lack infrastructure and lack of medicine being just two of them. With that attitude nobody would ever even try to help. I'd like to point out that in addition to running medical clinics the organization I've been to Haiti with has built loads of hand operated pumps to provide fresh water.

There will be a PM coming your way regarding this......

I also throw all those feelings away when I actually feel like I've "helped" somebody.

Same here. If I come on SDN and have very little negative to say, chances are good I feel like I've done something meaningful for someone recently.

 

[Kikaku21]

Quite aware.


Short of massive education which is slowly making a dent, but it probably won't bring the problem under control (or anywhere close to it) in our lifetimes or the emergence of a cure, name me one thing that is going to stop the spread of this disease in these people. That next generation will make the same mistakes their parents made and we'll see a perpetuation ad nauseum unless something different is tried.

Right. This isn't working, not even a little:

http://www.earth.columbia.edu/millenniumvillages/

I'd find something on improvement of HIV patients in central Haiti, but I'm to tired. Point is, aid can help if its done well.

 

[DropkickMurphy]

As I said education's making a dent, but it is not the ultimate solution.

As for economic development initiatives, all it will take is something to destabilize an area- which isn't much in many third world countries, it happens quite frequently- and you will see all that hard work will be for naught.

They are parts of a solution, but it's not a complete solution. We will not have a solution until we have a cure or a vaccine (or somehow mass euthanasia of AIDS patients suddenly becomes acceptable; I AM NOT ADVOCATING THIS IN ANY WAY).

 

[Kikaku21]

As I said education's making a dent, but it is not the ultimate solution.

As for economic development initiatives, all it will take is something to destabilize an area- which isn't much in many third world countries, it happens quite frequently- and you will see all that hard work will be for naught.

They are parts of a solution, but it's not a complete solution. We will not have a solution until we have a cure or a vaccine (or somehow mass euthanasia of AIDS patients suddenly becomes acceptable; I AM NOT ADVOCATING THIS IN ANY WAY).

Yes, they are all parts of a solution. As someone mentioned earlier, there are a LOT of problems in say, Africa. Farmers are trying to subsist on land that is Nitrogen depleted on what is essentially a giant plateau with no naviagable rivers to bring goods to market, European farming subsidies that undercut their sales, corrupt governments (in about 50% of the countries) that f*** entreprenuership, no decent roads, and no primary medical care in a drought prone area with a holoendemic malaria burden unlike anywhere else in the world. So, yeah. Obviously education is only part of the solution.

But, I don't believe this situation is hopeless. Again, I point to the Millenium Villages in my last post. There is some evidence that well directed aid can address tons of these problems. Especially in coutries that ARE relatively stable. Sure, Zimbabwe and Sudan are not good examples, but we could make real progress fighting poverty in places like Malawi and Tanzania, where the government is not corrupt to the point of sickness and there is relative peace.

Basically, writing all these people off as hopeless is not a value judgement I am willing to make.

 

[DonkeyD]

"If I come on SDN and have very little negative to say, chances are good I feel like I've done something meaningful for someone recently."

I'm the exact same way about my mood being wrapped up in how my patients are doing. My last two shifts have been so soul-crushing I hate people so much I think I hate myself for being one.

 

[DropkickMurphy]

"If I come on SDN and have very little negative to say, chances are good I feel like I've done something meaningful for someone recently."

I'm the exact same way about my mood being wrapped up in how my patients are doing. My last two shifts have been so soul-crushing I hate people so much I think I hate myself for being one.

My last noteworthy call (I've run a lot of fenderbenders the past few days, but nothing else) was wrestling an 80 y/o for his inhaler. He had ODed on albuterol because he mistook a panic attack for a COPD exacerbation and then made things worse by MULTIPLE doses of albuterol (one you get past three neb treatments or 4-6 puffs within an hour, you really aren't getting any additional benefit). His inhaler had been refilled four days before and it was 3/4 empty by the float test method (I checked when we got to the hospital because the doc wanted an idea of how much he had taken recently). There's ~240 effective doses in that particular brand of inhaler to give you an idea how much he had used. Another clue was the heart rate of >170. I have to give the man props, he's a tough ol' "bastard" (his words, not mine).

Crap like this frustrates me because it happens WAY too often in COPDers.......a lot of them have concommitant anxiety disorders that go untreated and when they do flair, they get treated with albuterol and this only feeds a psychological dependence and exacerbates the anxiety. This was the THIRD time in four months we've dealt with this same situation with this same patient.

The funny part of this is one of my fellow firefighters is sporting a blackeye courtesy of this guy. The patient clocked him one when he tried to get the inhaler. If it had not been for the fact that Brent got his ass kicked by a geriatric, I probably would have gone home and cried....I was that frustrated.