Showing 91 - 100 of 221 annotations tagged with the keyword "Public Health"
Summary:Jordy, 17, gay, abused by his parents, has taken refuge in a New York basement from where, one night, he witnesses the brutal gang rape of a young 18-year-old. After his shouted threats scare off the attackers, the girl slips through the window into what turn out to be shared quarters. The two begin to take care of each other; she insists on his getting treatment for head wounds at a public clinic (where care is distiinctly substandard) and he becomes guardian to this young woman whose history of abuse has left her in a curious state of social alienation and innocence about what is normal. The story becomes a kind of vision quest when, faced with "Chloe's" (a name she gives herself by way of starting over) inclination to put herself in harm's way, and to flirt with suicide, Jordy decides to prove to her that the world is more beautiful than it is threatening and ugly.
This collection of essays by surgeon-writer Atul Gawande (author of Complications: A Surgeon's Notes on an Imperfect Science --see annotation) is organized into three parts (Diligence, Doing Right, and Ingenuity) and includes an introduction, an afterword entitled "Suggestions for becoming a positive deviant," and reference notes. Each part is comprised of three to five essays, which illustrate, as Gawande explains in the introduction, facets of improving medical care - hence the title of the collection: Better: A Surgeon's Notes on Performance. In typical Gawande style, even the introduction contains tales of patients - a woman with pneumonia who would have fared far worse had the senior resident not paid close and particular attention to her well-being, and a surgical case delayed by an overcrowded operating room schedule. Such tales are interwoven with the exposition of themes and the detailing of the medical and historical contexts of the topic at hand.
The essays, though loosely grouped around the improvement theme, can easily be read as individual, isolated works. The concerns range widely both geographically (we travel to India and Iraq as well as roam across the United States) and topically. For instance, we learn about efforts to eradicate polio in rural south India and the dedicated people who devise and implement the program. Another essay, far flung from the plight of paralyzed children, is "The doctors of the death chamber," which explores the ethical, moral and practical aspects of potential physician involvement in the American system of capital punishment (from formulating an intravenous cocktail ‘guaranteed' to induce death to the actual administration of such drugs and pronouncement of death).
In sum, the topics of the eleven essays are: hand washing, eradicating polio, war casualty treatments, chaperones during physical examinations, medical malpractice, physician income, physicians and capital punishment, aggressive versus overly-aggressive medical treatment, the medicalization of birth, centers of excellence for cystic fibrosis treatment, and medical care in India. The afterword comprises five suggestions Gawande offers to medical students to transform themselves into physicians who make a difference, and by including this lecture in the book, what the reader can do to lead a worthy life.
Tracy Kidder met Paul Farmer in 1994 when the former was writing an article about Haiti. They next met again in 1999 but it was only when Kidder expressed an interest in Farmer and his oeuvre that Farmer emailed him back, writing "To see my oeuvre you have to come to Haiti" (17). Kidder did just that, following the peripatetic workaholic Farmer to Peru, Russia, Boston, and wherever Farmer flew, which is anywhere there is poverty and disease, especially infectious disease.
In Mountains Beyond Mountains (MBM), Kidder chronicles Farmer’s childhood, medical school years (almost a correspondence course with Farmer’s frequent trips to Haiti), his founding of Partners in Health (PIH) and the construction of the medical center in Cange, Haiti, where "Partners in Health" becomes Zanmi Lasante in Creole.
The story of Farmer’s crusade for a more rational anti-tuberculosis regimen for resistant TB; his political struggles to wrestle with drug manufacturers to lower the price of these and medicines for HIV; his charismatic establishment of a larger and larger cadre, then foundation of co-workers; the story of Jim Kim, a fellow Harvard infectious disease specialist; Farmer’s marathon house calls on foot in Haiti; endless global trips punctuated by massive email consultations from all over the world; and gift-buying in airports for family, friends and patients--these are fascinating reading. In the end one is as amazed and puzzled by the whirlwind that is Paul Farmer--surely a future Nobel Peace Prize laureate like Mother Teresa--as Tracy Kidder was and grateful to have the opportunity to read about it by such an intelligent writer.
Thyme Gilcrest, an honor student in an upscale suburban high school, begins her short career as drug dealer by taking a friend's Ritalin and finding it useful as a "study drug." Though she has suspected she might have ADHD (attention deficit hyperactivity disorder), her parents don't think so; what she does know is that the drug helps her focus and perform with reassuring reliability. Gradually, experimenting with the effects of other drugs--Adderall, Xanax, Zoloft, Valium, and others easily found in medicine cabinets or in the purses of parents' party guests--she finds herself able not only to "manage" her own mood swings and compensate for the effects of the Ritalin, but also to supply a growing number of friends who trade in prescription drugs.
For some time, since she hardly fits the profile of a drug dealer, she is able to remain in denial about her growing preoccupation with obtaining and distributing drugs. Only when one friend gets caught, another commits suicide, and a boyfriend confronts her does she decide she needs to be done with personal use and disengage from the network of codependent "friends" who have come to rely on her for their drugs of choice. In the final chapter, in her college dorm, she once again faces the temptation to deal when she overhears new acquaintances asking where they might get Adderall or Ritalin or Stratera. They're willing to pay.
This powerful book of black and white photographs contains four sections labeled: I. The End of Manual Labor, 1986-, II. Diverse Images 1974-87, III. Famine in the Sahel, 1984-85, and IV. Latin America, 1977-84. In addition, photographs accompany the prose-poetry opening essay, "Salgado, 17 Times," by Uruguayan writer Eduardo Galeano and the concluding essay, "The Lyric Documentarian," by former New York Times picture editor Fred Ritchin. This oversize book concludes with a list of captions for the photographs and a detailed two-page biography of Salgado. Essentially the photographs cover Salgado’s impressive work from 1974-89.
Every image is of a person or people. Many are suffering, many are starving, grieving, keening, dying, displaced. Many are children. Many are laboring under impossibly harsh conditions such as the teeming, mud-coated manual laborers of the Brazilian Serra Pelada gold mine. An Ethiopian father anoints the corpse of his famine starved, skin and bone child with oil. An old man, squinting in the sun, leans over to touch the arm of an equally thin and weak man in a Sudanese refugee camp. Rarely, the people are smiling or celebrating.
The photographs are global: Angola, Bangladesh, Bolivia, Brazil, Chad, Cuba, Ecuador, Eritrea, Ethiopia, Mali, Mexico, Portugal, Sudan, Thailand, and more. As Galeano notes, "This much is certain: it would be difficult to look at these figures and remain unaffected. I cannot imagine anyone shrugging his shoulder, turning away unseeing, and sauntering off, whistling." (p. 7) [156 pp.]
In this account of early practitioners and advocates of 'inoculation,' or the use of tiny amounts of smallpox contagion to induce a mild case of smallpox and immunity, author Carrell weaves prodigious historical research with fictionalized dialogue to create a tale of two prominent figures: Lady Mary Wortley Montagu of London and Dr. Zabdiel Boylston of Boston. Both Lady Mary and Boylston suffered scarring from smallpox, and, by living in the early 18th century, both witnessed the devastation of epidemics in terms of public health and private loss.
Both were also aware of the use of inoculation to prevent severe disease in Turkey (Lady Mary visited with her ambassador husband) and in Africa (on the advice of Cotton Mather, Boylston interviewed Africans, slave and freemen, living in Boston). Both faced formidable challenges and risked personal security to promote the use of this technique. Both proved their belief in the technique by the inoculation of their own children. And both, perhaps, met. At the behest of the Royal Society, Boylston traveled to London, witnessed numerous inoculations, and presented his Boston experience to the Society.
The book also chronicles the natural course of the disease, its various symptoms, forms and popular treatments, and the political impact of smallpox on the royal families of Europe and business interests in Boston. The medical research of various doctors is detailed. In particular, selected Newgate prisoners were offered pardon in return for participation in an experiment conducted by Mr. Maitland, who also inoculated Lady Mary's children. These experiments were used to test the safety and efficacy of inoculation prior to royal inoculation.
Ultimately, detractors of inoculation ceased their vitriolic attacks, as the risks of inoculation were proven to be far lower than exposure without such protection. The success of inoculation paved the way for Edward Jenner, often called 'the father of immunology,' to successfully use cowpox to induce smallpox immunity later in the 18th century.
Summary:Sarah and Peter Bedford are sailing with their parents off the coast of Indonesia when the tsunami strikes. As they attempt to escape, their father breaks his leg. Their mother insists the children run ahead, so they do, up the hills into the jungle. Sarah later finds her mother, dead, on the beach, but not her father. Peter is soon running a fever and Sarah embarks on an arduous overland journey to try to get him help. At the same time Ruslan, an Indonesian boy, has taken his own escape route out of his village, and is looking for his father, along with many who are searching for missing relatives. Ruslan and Sarah recognize one another when their paths cross, as he had waited on her family on an earlier stop in his village. Together, with a few other refugees, they make their way to another village where Peter may be able to receive help in a makeshift hospital. Ruslan is threatened by an additional danger, since his family are partisans in a local conflict, and he is suspected of activity on behalf of the rebels.
The authors analyze developments in the scientific article in Europe from the seventeenth century to the present. They devote a chapter to "style and presentation" in each century, and a separate chapter to "argument" more specifically in each century, in French, German, and English examples. They find a remarkable similarity of style already evident in seventeenth-century examples, demonstrating that scientific authors were already addressing an international audience. Seventeenth-century articles show an "impression of objectivity" and "a movement toward a more impersonal style" (47), although the English examples were somewhat more personal, less quantitative, and less interested in explanation than were the French examples, and the prose overall is hardly what we would currently expect from a scientific article.
Although the eighteenth-century examples should, perhaps, be considered part of a larger period that included the seventeenth century, Gross et al do track a movement from impersonal to personal style, nominal to verbal style, and minimal presentation to more elaborate presentation during this period. Also, the French examples continue to approximate more closely to twentieth-century norms of scientific style, reflecting their more professionalized community. Overall, the authors characterize much of the eighteenth century as a period of "consolidation and altered emphasis," with "relative stability" of style (116), although the last quarter of the eighteenth century showed a sharp rise in standardization and standards for accuracy and precision.
Gross et al note that nineteenth-century prose still addresses amateurs as well as professionals, and they comment on its persistent difference from "the highly compressed, neutral, monotonal prose" of late-twentieth-century science(137). However, the English and German examples do become more professional in their use of impersonal style, and examples demonstrate a consolidation toward a more "homogeneous communicative style" (138). They also note that the nineteenth century exhibits a "master presentation system approaching maturity," with "title and author credits, headings, equations segregated from text, visuals provided with legends, and citations standardized as to format and position," as well as standardized introductions and conclusions (138).
They find that the combination of an increasing "passion for factual precision" and systematization produces more careful theorizing generally in science during this period, even as individual sciences specialize and diverge (158). Increased attention is given to the process by which facts are linked to theory, and to the role of evidence, governed by an "overriding need for explicitness" (160).
Twentieth-century examples include shorter sentences with more information packed into each by way of "complex noun phrases with multiple modifications in the subject position, noun strings, abbreviations, mathematical expressions, and citations" (186). The scientific article is now generally marked by high incidence of passive voice and low incidence of personal reference, along with a "master finding system" made up of "headings, graphic legends, numbered citations, numbered equations, and so on" (186). They argue that the current state of the scientific article reflects an evolutionary process whereby "current practices are a consequence of the selective survival of practices that were, persistently, better adapted to the changing environments of the various scientific disciplines over time" (212).
The book opens with a thought "exercise": thirteen short essays, each in a different national voice and beginning "We, the people of a nation . . . " The honest, intelligent "speakers" love their countries and traditions; however, they try to express the ugly truths about their homelands as challenges for the future.
For example, American smugness over its know-how and wealth combines with American failure to recognize the resentment sparked elsewhere by these same attributes. Similarly, the mutual intolerance of Canada's linguistic and religious duality is portrayed as a grotesque irony. The U.S.S.R. has exchanged an old tyranny for a new; Japan must face the issue of controlling its population, if it is to control its impulse to aggression.
Chisholm then returns to his role as a socially committed psychiatrist who hopes to avert a war that could annihilate the human species. World aggression, he writes, is caused by the "anxiety" that emerges from intolerance typifying narrow parental guidance and even narrower systems of education and religion. People must learn to be comfortable with differences in population, race, language, and wealth. The message is simple: "anxiety" leads to "aggression." The book ends with a ideal curriculum for "world citizenship," surprisingly different from any currently in use.
In 1921, the twenty-four year-old Scottish medical graduate, Andrew Manson, takes up an assistant’s position in a small Welsh mining town. He is idealistic, but he quickly learns that his training is inadequate and that his hemiplegic employer will never return to practice. Manson must do all the work for a pittance and bad food. He befriends another assistant, the surgeon Phillip Denny, whose fatal flaw is devotion to drink. Together they solve the town’s problem with typhoid by blowing up the sewer.
Manson’s escape comes in a new job in a larger town and marriage to the equally idealistic Christine. She encourages him to continue his studies and to conduct research on the relationship between dust inhalation and tuberculosis. The results include higher degrees and international recognition, but they also bring about the wrath of the town’s antivivisectionists. To add to the gloom, Christine looses a much wanted pregnancy and the ability to have children.
The Mansons leave Wales for London, where Manson hopes to extend his research within a government agency. Quickly disillusioned by bureaucracy, he is lured into society practice and slowly abandons his ideals in exchange for prestige and wealth. Christine is increasingly unhappy, but his response is annoyance with her and an affair with a married woman. When one of his new associates botches an elective operation on a trusting patient, he realizes the colleague is nothing more than a society abortionist and that he and his new friends are little better.
He decides to sell his practice and renews contact with Denny to establish a group consulting practice "on scientific principles" in a carefully chosen Midland town. He also helps the tubercular daughter of an old friend to an unorthodox (but effective) pneumothorax in a clinic run by Stillman, an American who does not have an MD. Just as he and Christine have rediscovered joy in each other and their future together, she is killed in a freak accident. Only days later in the depths of grief, he is brought before the General Medical Council on charges of unprofessional conduct laid by his former associates. He acquits himself brilliantly and leaves with his old friend Denny for work in the Midlands.