Showing 51 - 60 of 218 annotations tagged with the keyword "Public Health"

Tainted

Pennie, Ross

Last Updated: Sep-01-2010
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Zol Szabo, is public health doctor for the Hamilton Ontario region. He is also a single parent to a seven-year-old, Max, because his wife could not deal with Max’s physical disability. But Sol thinks there is hope for Max in an injection of a miraculous new substance called “Endotox” that may loosen the contractures of his arm. Soon he his investigating a cluster of variant CJD (mad cow) cases that may be related to Endotox. But they also seem to be connected to the grocery store where Sol does his shopping. The products that all victims had in common were an imported candy and a sausage, both Max’s favorites.

Conspiracy theories about corrupt pharmaceutical companies and the antics of a pair of unethical mink farmers lead the investigation in many different directions, all personally threatening to Sol because of the health of his son or the ire of his boss. Pressure from his superiors to avoid publicity cramps Sol’s freedom. He seeks help from an attractive woman detective who, of course, sticks with him to the terrifying (and satisfying) conclusion.

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Annotated by:
Schilling, Carol

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

As Audrey Young describes her process of becoming a compassionate internist in a besieged public hospital, she simultaneously argues for turning the hospital's patient care and financial practices into a model for improving health care in America.  Young, a compelling storyteller, first entered Seattle's Harborview Medical Center in 1996 as a third-year medical student on trauma surgery service.  She completed a residency there in general internal medicine and stayed on as an attending for six more years.  She stayed, she tells us, because she met physicians "committed to a vision of equality" who were "the sort of people I hoped to become" (xiii).   She also "fell in love" with "the story of a unique place" (xiii).  Young's stories of that often chaotic place, where ambulances regularly transport homeless, indigent, addicted, and mentally ill refugees from neighboring private hospitals, emphasizes the ways the Harborview staff manages to treat patients with dignity and to choose an ethic of hope in the face of dire circumstances.           

We quickly learn that at Harborview compassion is expressed concretely as actions toward patients.  Michael Copass, known as "the mostly benign dictator of emergency operations," pronounced the core of these actions in what came to be known as his commandments:  "1. Work hard.  2. Be polite.  3. Treat the patient graciously, even if he is not the president of the United States" (9).  Politeness always meant asking "'How may I help you, sir?'" regardless of the patient's social status or addiction history.  Politeness sometimes meant finding a way to reach the patient who regularly threatened the staff.  Young finds ways and creates a therapeutic bond.  But working hard and treating patients considerately also took measurable forms, such as not allowing emergency patients to wait.  Facing a flurry of admissions, the Emergency Department (ED) staff interpreted a young Ethiopian's complaints about pain as a drug addict's ploy.  Because Young glanced at the admissions board and noticed that he remained unattended for three hours--far longer than Copass could tolerate--she jumped into action.  He suffered, she discovered, from a collapsed lung. 

However, Young moves her narrative beyond individual doctor and patient encounters and into the larger, interrelated social and financial structures in which medicine is practiced.  For instance, she links meager funding for drug and alcohol rehabilitation programs with expensive ED admissions and rising healthcare costs.  In the chapter "Bunks for Drunks," Young visits an experimental residence that houses homeless addicts in furnished studios with private baths and cooking appliances.  Although residents can keep alcohol in their rooms and elect not to participate in the home's social services, including counseling, alcohol consumption and ED admissions decrease.  While the chapter points out the cost savings of such arrangements, Young further urges readers to value the dignity residents experience there.

In "Black Friday," Young details the hospital's tense, but ingenious responses to a Mass Casualty Incident, the result of carbon monoxide poisoning, which almost depleted the resources of all of Seattle's medical centers.  The final chapter, "A Vision," outlines how Harborview has tried to succeed as both a charitable institution and a business, as a provider of both indigent and luxury care, with the hope that others will follow the medical center's example.  However, in presenting her recommendations for "health justice," Audrey Young also makes the case that "seemingly ordinary citizens" are implicated in healthcare reform (231).  To enable their informed participation in making changes, Young includes an appendix with further readings and another that lists strategies for effecting reform.  

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Annotated by:
Henderson, Schuyler

Primary Category: Performing Arts / Theater

Genre: Theater

Summary:

This annotation is based upon the version presented at The Mint Theatre in New York City in 2010, translated and directed by Gus Kaikkonnen.  It featured Thomas M. Hammond as Dr Knock and Patrick Husted as Dr Parpalaid, with Chris Mixon, Scott Barrow, and Patti Perkins in supporting roles.

A middle-aged but recently licensed physician, one Dr Knock, has arrived in rural France to take over a practice purchased from the genial old country doctor, Dr Paraplaid.  Much to Dr Knock's surprise, he discovers that Dr Paraplaid has done very little over the past three decades, seeing only a few patients a week and enjoying much of the time playing pool, riding around in his jalopy, and admiring the countryside.  Feeling slightly cheated, Dr Knock realizes that the practice he has purchased at some expense amounts to very little at all. He is, however, an ambitious man.  He did not become a licensed physician in the eager flush of late adolescence but as a man of the world, or rather, a man of the entreprenurial modern world where opportunities are seized and technology is transformative.  

Once Dr Paraplaid has gone, Dr Knock promptly sets about employing the town crier to advertise his practice so that the entire valley knows he is there.  He meets up with the local school teacher and the pharmacist, enlisting them as allies.  With everybody he encounters, he smilingly and then sharply insists that unlike Dr Paraplaid, he will not go by "Monsieur" but by "Doctor".  And when he actually opens the office, he begins by offering free consultations.  Of course, he always seems to find something wrong, elaborately explaining the aches, pains, and illnesses he discovers (or induces), but the free consultations, like free "samples" are designed to create grateful customers.  Invariably, they learn that the cost of the treatment is commensurate with the exact maximum amount they could pay.  And thus, Dr Knock takes a placid, lazy practice and builds up an expanding medical business. 

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Annotated by:
Davis, Cortney

Primary Category: Literature / Literature

Genre: Anthology (Mixed Genres)

Summary:

In 2008, editor and physician Paul Gross launched a new online publication, "Pulse--voices from the heart of medicine" (published by the Department of Family and Social Medicine, Albert Einstein College of Medicine and Montefiore Medical Center). This anthology contains every poem and first-person narrative published during Pulse's first year, arranged in five sections corresponding to publication date and not to theme: Spring, Summer, Autumn, Winter, and Spring.  Paul Gross, in his introduction, states "After more than a decade of practice as a family doctor, I came to appreciate that the science I'd learned in medical school, though powerful and useful, was also incomplete . . . . it contained much truth about illness and healing, but not the whole truth" (xvii).  Like many other caregivers, Gross discovered "that writing and sharing my healthcare stories with others was therapeutic" (xviii).  He looked to "Sun Magazine" as an example of how first person narratives, both prose and poems, could turn "hurts and triumphs into something potentially beautiful, funny or moving" (xviii). 

The poems and prose that arrive every Friday online to Pulse's thousands of subscribers (and the selections in this anthology) are carefully screened by the editors according to these guidelines: the stories have to be first-person, and they have to be true, recounting the writer's own experience.  Submissions are accepted from any person involved in healthcare.  The language used must be "clear, simple language.  No medical jargon. No arcane literary devices" (xx).  Gross and his editors decided that Pulse would not be a medical journal nor a literary magazine--its purpose fell outside the perimeters of both genres--and so Pulse, and this anthology, offers work that is, in a refreshing and honest way, different from the slick or more polished poetry and prose that might be found elsewhere.

In reading this anthology from cover to cover, and so from season to season, I found that the poems and prose seemed to fall into several categories: Personal musings, in which authors relate healthcare experiences that engender intimate and revealing narratives about their own lives--among the best of these are "Well Baby Check," p.3; "Finding Innisfree," p. 31; "First Patient," p. 39; "Losing Tyrek," p. 45; "Carmen's Story," p. 62; and "Chemo? No Thanks," p. 106.  Other pieces are commentaries on the other side of healthcare, the one that cries out for reform and affects both patients and caregivers.  Among the best of these are "Redesigning the Practice of Medicine," p. 9; "A Brush with the Beast," p. 22; "Rx," p. 60; "Halloween Horrors," p. 69; and "Brain Cutting," p. 136.

Other pieces are humorous ("Aunt Helen Sees a Ghost," p. 6) or political ("My War Story," p. 11), and many poems and prose pieces speak of patient encounters or about being a patient, some more anecdotal, relating a specific incident that affected the author ("Once," p. 41) and others multi-layered, some relating medical student or intern experiences ("Jeannie," p. 48; "A View from Nepal," p. 87; "Ripped from the Headlights," p. 90; "Snowscape," p. 97; "First Night Call," p. 100; and "Wounded Messenger," p. 114.)  The "category" I found most interesting and most unique are the selections I will call "confessions."  These writings--demonstrating openess and bravery on the part of the authors--tell of regrets, mistakes, sorrows, wrong calls and other mishaps that occur, daily, in the practice of healthcare.  In these, the most human face of caregiving is revealed.  Although most of the pieces in this anthology contain elements of "confession," the most specifically revealing include "Mothers and Meaning," p. 14; "Physician's Exasperation," p. 44; "Confidential," p. 53; "My Patient, My Friend," p. 73; and "Apologies," p. 104.

Editor's note: Coincidentally, a recent relevant paper on confessional writing by physicians expounds further on this topic:"Bless Me Reader for I Have Sinned: physicians and confessional writing" by Delese Wear and Therese Jones (Perspectives in Biology and Medicine, Vo. 53, No.2, Spring 2010, pp. 215-30).

 

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Annotated by:
Mathiasen, Helle

Primary Category: Literature / Nonfiction

Genre: History

Summary:

The Crimean War (1853-1856) holds a place in the history of medicine, specifically, the history of nursing. For as the British public read the 1850s Times reports about the total lack of care suffered by their wounded in this conflict, a British nurse, Florence Nightingale, volunteered to recruit a team of nurses to aid the suffering men. The Times created a relief fund for the sick and wounded, and Queen Victoria, an enthusiastic supporter of this war against Russia, sponsored an even larger fund. Female nurses had a reputation for drunkenness and promiscuity. Nightingale made it a point to recruit nuns and women from the lower classes who would be more manageable than educated, upper class women. Three black nurses applied, including Mary Seacole, but they were rejected.

The Turks, British allies, allowed Florence Nightingale the use of their army barracks at Scutari, across from Constantinople: "'I have been well acquainted with the dwellings of the worst parts of most of the great cities of Europe,' Nightingale wrote,' but have never been in any atmosphere which I could compare with that of the Barrack Hospital at night'" (111). Open sewers ran beneath these vermin-infested structures  which were crammed with sick soldiers lying on the filthy floor. There were no supplies and few doctors. Typhus, typhoid, cholera or dysentery killed many patients. Nightingale's meticulous statistics showed alarming escalation of mortality rates; she believed in cleanliness and fresh air but not in the germ theory of disease. When comparing her numbers with those of other military hospitals, Nightingale understood that soap alone would not save the men.

Rappaport describes the nursing offered by army wives, widows and other volunteers, including French nuns. The women's living conditions, especially during pregnancy and childbirth, often resulted in sickness and death. Others volunteered as cooks, including Elizabeth Davis who alleged that while "...she and the other nurses dined on the stewed-up, tough old meat used to make soup for the patients, Nightingale ‘had a French cook, and three courses of the best of every kind of food ... served up everyday at her table'" (168-169).

Nightingale became famous as the heroine of the Crimean War. She is known now as the founder of professional nursing. Recent research has questioned whether Nightingale was the real angel of the Crimea. Rappaport investigates the work of the Jamaican nurse, healer, and entrepreneur Mary Seacole, one of the 3 black nurses rejected for service in the Crimean War. She financed her journey to and stay in the Crimea herself. She built a British Hospital in the Crimea, and treated the wounded at Balaklava there and in the field. The soldiers called her Mother Seacole because she cared for their material and spiritual needs. She sold gin and raki and home-cooked meals, and went bankrupt because too generous with credit. Seacole recouped her losses and achieved bestseller status with her memoir, Mrs. Seacole's Wonderful Adventures in Many Lands (1857), the first memoir by a black woman from Britain.

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Annotated by:
Nixon, Lois LaCivita

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

The story is based on an actual 1950's trip by two university friends, Ernesto 'Che' Guevara (Gael Garcia Bernal) and Alberto Granado (Rodrigo De la Serna). Guevara is studying medicine, Granado biochemistry. They plan to travel from Buenos Aires across the Andes Mountains to Chile, Peru, and, then, to Venezuela. Before too many miles their derelict 1939 motorcycle fails, and the two young men continue by whatever means is available. The journey intent is one of adventure--drinking, meeting women, seeing the world.

The young men do discover South America's impressive natural beauty but more strikingly, their eyes and sensibilities are directed to abject poverty and shocking injustices. These blatant inequities, as well as an extended period of time in a leper colony, contribute to the reframing of their original happy-go-lucky adventure and explain, in part, the impulses that eventually would shape Guevara's role in the Cuban Revolution.

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Summary:

This anthology is part of an emerging literature of HIV/AIDS in Africa. It offers individual stories about the impact of HIV/AIDS in Africa as a means of countering the mind-numbing statistics on infections and deaths. As the literature of the AIDS crisis in the United States in the 1980s and 90s brought to the general public the subjective experience of HIV/AIDS and thus strengthened the socio-political will to combat the virus, so this emerging literature of AIDS in Africa will deepen awareness about the crisis, engender sympathy for the individuals who suffer from it, and ideally help to shape an effective response to alleviate the devastation being wreaked by this epidemic.

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The Pearl Diver

Talarigo, Jeff

Last Updated: Jan-21-2010
Annotated by:
Miksanek, Tony

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Leprosy looms large in this story about transformation and loss set in post World War II Japan. A nineteen-year-old pearl diver notices a numb red spot on her forearm. Later on, another blemish appears on her lower back. These two lesions are manifestations of a mild case of leprosy. Her infection will be arrested by medication and never get any worse. The girl is forcibly transported to the Nagashima Leprosarium, an island where she will spend the rest of her life except for a few brief excursions and one extended "escape" at the age of sixty-four.

Despite the introduction of new and effective drugs--Promin (sulphone) and dapsone--authorities still fear allowing the leprous patients to return to society. Inhabitants of the sanatorium are admonished on arrival that their past is erased. Each individual must begin a new life and select a new name. The protagonist chooses the moniker Miss Fuji. She is a kind and sensitive young woman who eventually functions as a nurse and caregiver for the other patients incarcerated in the sanatorium. As a punishment, Miss Fuji is required to attend abortions and dispose of the dead fetuses.

As the decades pass, conditions on the island improve. The number of residents with leprosy still living there dwindles from about two thousand people to six hundred. Even a bridge connecting Nagashima to the mainland is constructed. It no longer matters. Emotional and psychological barriers remain. When Miss Fuji has an opportunity to create a new life for herself away from the sanatorium, she still returns to the place and the people that have been her home and family for so many years.

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Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Subtitled "Tuberculosis and the Social Experience of Illness in American History," the book chronicles the medical and societal treatment of tuberculosis in the United States from the perspective of individuals who suffered from the disease. The author includes illness narratives derived from letters and diaries of the afflicted; her analysis spans the period in American history from the nineteenth through the first half of the twentieth century.

The book is divided into four sections. Part I, "The Invalid Experience: New England Men, 1810-60" and Part II, "The Female Invalid: The Narrative of Deborah Vinal Fiske, 1806-44" reveal an interesting contrast in the medical/societal treatment of tubercular men and women, and the resulting differences in their lives as "consumptives." Whereas men were expected to seek a cure by embarking on sea voyages and other travel, women remained at home and sought to control the disease by adjustments in domestic life. For men this meant major disruption and even change of career along with a sometimes exhilarating change of scene; for women it meant relentless anxiety and elaborate coping strategies.

Part III, "Health Seekers in the West, 1840-90" describes the role of cure-seekers in the westward migration and demonstrates how the culture of the time, an optimistic faith in nature and in the economic promise of the newly settled western territories, was reflected in the treatment regimen for tuberculosis. Interestingly, much of the promotional effort to bring "consumptives" west was initiated by physicians who were themselves tubercular.

The final section, "Becoming a Patient, 1882-1940," moves into the modern era with the discovery of the tubercle bacillus, public health measures, and the illness narratives of people who were confined in sanatoriums. Rothman points out that this period marked a transition away from the patient’s ability to understand and determine his/her treatment to one more like the current one in which the medical establishment is the authoritarian "expert."

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A Civil Action

Harr, Jonathan

Last Updated: Jan-14-2010
Annotated by:
Aull, Felice

Primary Category: Literature / Nonfiction

Genre: Investigative Journalism

Summary:

The author, who writes and teaches nonfiction writing, began research on the lawsuit that forms the fascinating subject of this book in February, 1986. While the book focuses on Jan Schlichtman, the lawyer for the plaintiffs, and on his strategy in the case, there is much here that is relevant for health care professionals.

The lawsuit, which lasted nine years, concerned the tragic consequences of exposure to toxic waste: deaths from childhood leukemia; skin rashes, nausea, burning eyes, and other ailments. It was brought by eight families who lived in Woburn, Massachusetts against two companies, W. R. Grace and Beatrice Foods. The lawsuit claimed that these companies were liable for illnesses and deaths attributable to trichloroethylene (TCE) contamination of the water supply.

The story of how the families and the lawyers pieced together the fragments of the puzzle to determine cause and effect is gripping. One gains an appreciation for environmental epidemiology and the difficulty of reaching conclusions when only a small number of individuals are affected. Medical experts, public health specialists, geologists, civil engineers, government agencies, and the intelligence and driving motivation of the affected families and their lawyers were all necessary to establish the credibility of the claim.

In the end, however, the financial power and stonewalling of the companies, and the partiality of the presiding judge for one of the defense lawyers resulted in a verdict that favored the defense. Jan Schlichtman, the plaintiff's lawyer, was forced to declare bankruptcy.

Only when the Environmental Protection Agency (EPA) decided to launch a clean-up and filed suit against W. R. Grace and Beatrice Foods to pay a share of the cost, was any semblance of justice obtained. The EPA project will take 50 years, and even so, "all parties agree that it will prove impossible to rid the site of TCE and perc [tetrachloroethylene] completely . . . . " (Afterword; p. 494) Nevertheless, most of the families have not moved.

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