The Ganges River presents a unique insight into the basics of Diarrheal Disease (DD), including symptoms, causes, long-term and short-term impacts and treatment. Further, the interaction between cultural/religious beliefs and biomedical beliefs at the Ganges River illuminates conflicts between culture and public health in the region. Hinduism, the dominant religion in India, requires ceremonial bathing in the polluted Ganges River water and is subsequently increasing the spread of DD. Despite the efforts of global health workers, Hindu ideology in India continues to take precedence over public health advice. While the developed world may have the medical knowledge to alleviate disease, it is important to understand that in some cultures, religious practices overshadow conflicting scientific evidence. There is a tension for global health advocates who strive to reduce mortality rates while respecting people’s cultures.
Diarrheal Disease in India’s Ganges River Region
The Price of Sex, produced by Mimi Chakarova, is a documentary that describes human trafficking in the sex trade and forced prostitution. Chakarova is featured on this podcast discussing the film http://ff.hrw.org/content/price-sex-0. Chakarova describes the life of poverty and destitution that repress many Eastern Europeans. Tempted by the promise of prosperity, many women believe that immigration to the west is the route to a better life. These women often come from small villages where patriarchal values leave daughters with weak family connections. Sex traffickers target these women and lure them with the promise of jobs and security. Once women are taken against their will by the traffickers, they are sold to pimps. These pimps govern complex networks of sex clubs, often located in basements of urban buildings. The process of becoming a sex worker starts with an initial “breaking period.” Women are drugged, starved, and repeatedly raped to establish absolute control over the women and their bodies. The brothels are strategically designed with one entrance and exit and are highly secured.
In this clip from The Price of Sex, Mimi Chakarova conducts interviews to access what makes women vulnerable to becoming sex workers. (http://www.youtube.com/watch?v=ClOpws3XgwY).
Since there is a high degree of secrecy involving this illegal business, the clientele is based off of word-of- mouth referrals and shared relationships. Chakarova remarks that this business is an “invisible industry,” although the women walk the streets and can often be seen from windows of urban buildings. The business of sex trafficking can operate “invisibly” because of the degree of corruption and impunity that supports the industry. Police have been cited as willing participants in the industry. Chakarova tells the story of an escaped former sex worker in Istanbul, who upon freeing herself from her captures, found a police station where she recognized officers as clients from the brothel. The police officers brought the woman back to the brothel.
Chakarova and other researchers maintain that part of the problem of sex trafficking lies with the way in which women are viewed in society. In order to draw attention to and eradicate the human sex trafficking industry, the stigma surrounding rape must be addressed. Victims of sex trafficking often feel ashamed of their past. Chakarova advocates an action plan that starts with changing the way society values women, improvement of education, and enforced penalty, arrest, public trial, and incarceration of those involved. Few women can imagine a worse nightmare that capture, rape, and imprisonment, however, this systematic dehumanizing of women for profit is a disturbing and tragic reality for an unknown number of anonymous women across the globe.
The recent release of the Kony 2012 video by the humanitarian organization Invisible Children employed a social media campaign to draw the world’s attention to Joseph Kony, his crimes against humanity, and the LRA. Directly related to global health and human rights, the video was designed to promote the goals of the Invisible Children organization; to find and arrest Kony, to improve the lives of those affected by the war through advocacy of policy change. These ultimate goals have been difficult to accomplish due to the intersecting political, social, and economic barriers to the creation of policy that would call for action. Although the video was designed with humanitarian intentions, it has fallen under a tirade of controversy where critics claim that it may ultimately be damaging to Ugandans and that it does not present a full or entirely accurate description of the political situation. This article outlines some of the key issues critics find with the project (http://www.aljazeera.com/indepth/opinion/2012/03/2012312853317675.html#).
One of the main criticisms has been that Invisible Children portray an oversimplified view of the problem, where Joseph Kony is cited as the route of all evil. In realty, many Ugandan citizens claim that the government has also committed atrocious crimes and that a plausible solution to this political unrest must address the multifaceted corruption. Another article, “Northern Ugandans Criticize NGO’s ‘Kony 2012 Campaign” claims that it is Invisible Children calling for a revolution, and not the prerogative of the citizens of Uganda and neighboring countries. (http://www.voanews.com/english/news/africa/east/Northern-Ugandans-Critical-of-Kony-2012-Campaign-142923415.html).
Amidst the criticism citing oversimplification and factual misrepresentation, the video has created a powerful momentum for change that, if given structure, has the potential to have positive results. Author Sarah Margon acknowledges the deep flaws of the campaign but recognizes an opportunity for to address these disturbing global issues of structural violence from a geographically broad and historically deep perspective.
“So, instead of continuing to debate the strengths and weakness of the Kony2012 video, or attack Invisible Children for their lack of financial transparency, let’s figure out how to turn this momentum into a constructive opportunity that can result in smart policies that will have a positive, real-time impact in the affected areas of central Africa. Let’s harness this energy and turn it into something productive that ensures we’re telling the right stories, inspiring well-informed advocacy, and working together across governments, academia, grassroots activists, and local populations to help bring this chapter of the LRA — and the impact in affected areas — to a close.” – Sarah Margon (http://thinkprogress.org/security/2012/03/08/440851/defense-kony-invisible-children/?mobile=nc).
Paul Farmer’s chapter Rethinking Health and Human Rights concludes his book concerning “health, human rights, and the new era war on the poor.” The passage explores human rights violations in relation to social and economic rights. In discussions of structural violence, Farmer enforces a “geographically broad and historically deep” approach to analysis and policy improvements. This theme is integrated into his work on global human rights violations and social inequality. Farmer describes his approach to the analysis of pathologies of power, “Anthropology – in common with sociological and historical perspectives in general – allows us to place in broader contexts both human rights abuses and the discourses (and other responses) they generate. Furthermore, these disciplines permit us to ground our understandings of human rights in broader analyses of power and social inequality.” (Farmer 219). Farmer uses his experiences in Russia, Haiti, and Chiapas to illustrate people’s suffering in his narrative of human rights violations. Epidemics of poverty and lack of access to resources compound issues of inequality and public health standards.
The World Health Organization has published material on the epidemic of tuberculosis in prisons http://www.who.int/tb/challenges/prisons/story_1/en/. Tuberculosis and diarrheal disease have in common an association with poor living standards. Both health issues are deeply tied to those afflicted with poverty and disadvantaged by systems of structural violence.
A Russian prison cell and inmates. Farmer describes his experience working in prisons and states, “tuberculosis has become the leading cause of death among Russian prisoners.” (Farmer 214).
This week we read our final piece for course, which is also the closing chapter of Paul Farmer’s Pathologies of Power, entitled “Rethinking Health and Human Rights – Time for a Paradigm Shift.” In it, Farmer drives home the assertion that “public health and access to medical care are social and economic rights” that should be guaranteed to all (217). The chapter revisits many of the grim realities faced by those who seek to ensure medical access for populations too poor, too disenfranchised, and too discriminated against to receive it. Farmer also admits the boundaries and limitations of this goal; he writes that bureaucracy and institution will always stand in the way of human welfare as long as there is profit involved with keeping the world’s poor majority subjugated by the world’s rich minority.
Paul Farmer’s emotive closing statements are echoed in the audio clip called “This I Believe,” which is a recording of Farmer’s recitation of an essay he wrote about the major values and objectives he’s developed while working to ensure health care and human rights to the globe’s most impoverished communities. Originally recorded and aired on National Public Radio (NPR), the full clip and transcript is available here.
Below is one particularly moving excerpt that calls on us to join the “movement to prevent human suffering”:
“I believe in health care as a human right. I’ve worked as a doctor in many places, and I’ve seen where to be poor means to be bereft of rights … Of course such a world is a utopia, and most of us know that we live in a dystopia. But all of us carry somewhere within us the belief that moving away from dystopia moves us towards something better and more humane. I still believe this … We must also call attention to the failures and inadequacy of our own best efforts. The goal of preventing human suffering must be linked to the task of bringing others, many others, into a movement for basic rights.”
I hope these words resonate and stir within you the same impetus they have in me.
Dr. Paul Farmer is a founding director of Partners In Health, an international organization that provides health care to people living in poverty. Above, Farmer examines a child at a mobile clinic in Haiti.
In chapter 9, Paul Farmer discusses the importance of addressing human rights in the process of addressing health care-considering that health care IS a human right. In order to battle the inequalities that exist in international public health, it is essential to promote human rights and health care as a fundamentally important right. Paul Farmer discusses the role AIDs has played in medicinal and public health, in that (quoting Jonathan Mann) “promoting and protecting health and promoting and protecting human rights are inextricably connected.”
This concept should be considered in public health advocates’ battle of diarrheal disease. Without addressing access to water and access to health care, the battle of diarrheal disease is a losing cause. Access to medicine is a fundamental right of humans. Access to water is a fundamental right of humans. To die of a disease that is cheaply curable and easily avoidable is a violation of a human’s natural rights. Governments have a responsibility to battle diarrheal disease because according to the declaration of human rights, people are have the right of “freedom from fear and want”. People contract diseases because they have a want- clean water. In order to battle diarrheal disease, one must battle the root of the issue, which is that people have a right to adequate, clean water and adequate nutrition. Provides these fundamental rights and we will see the positive repercussions in the decrease of diarrheal disease.
The Absolutely True Diary of a Part-Time Indian tells the story of Arnold Spirit Jr. growing up on a rural reservation in Washington. Junior’s parents are uneducated and do not provide him with a strong support system. Burdened by serious health problems, Junior is frustrated by the lack of opportunities on the reservation. Junior describes his background, “My parents came from poor people who came from poor people who came from poor people.” The story documents Junior’s struggle to overcome the structural forces, his race, culture, socioeconomic status, that threaten to limit him to the same future as his parents and past generations. Junior’s story is undoubtedly inspiration, but he is the exception to an otherwise damning pattern of poverty experienced by many reservation communities.
The Havasupai Indian tribe has maintained residence in the Grand Canyon over the past 800 years. At the bottom of the Grand Canyon, resources to promote prosperity, education, proper nutrition, and to support a healthcare system are limited. The 600 member tribe has been allocated to a reservation where poverty and illness are the standard. As a result of a combination of these issues, tribe members have seen increasing rates of obesity and diabetes. Recently, the shocking prevalence of diabetes within the tribe has been a center of controversy as Arizona State University’s research methods have been called into question. Read more about this controversy here http://www.nytimes.com/2010/04/22/us/22dna.html?pagewanted=all. The ethics of the university’s research was challenged because further research of blood samples obtained from tribe members than was conducted and published without the knowledge or consent of participants. Cases such as the Tuskegee syphilis experiment have previously brought attention to the ethics of medical experimentation.
Much the same way certain populations are predisposed to diarrheal disease due to their socioeconomic, geographic, or cultural standings, both Arnold and members of the Havasupai tribe face difficult futures compounded by the structural forces that control their access to opportunities like healthcare and education.
Blood Journey – This video documents the experience of Havasupai Tribe members as they challenge the ethical conduct of researchers at Arizona State University.
In his piece Culture and the Evolution of Obesity, Professor Peter J. Brown of Emory University’s Global Health Institute explores the social factors that contribute to dangerous diets — specifically obesity. Brown rejects the traditional view that human predisposition to obesity and fatness are situated solely within the context of biological evolution, in favor of the notion that “the etiology of obesity must account for the social distribution of the condition with regard to gender, ethnicity, social class, and economic modernization … this distribution, which has changed throughout history, undoubtedly involves cultural factors” (Brown 1991: 31). Brown argues that obesity and hunger are situated instead in a dynamic landscape of networks, institutions, cultural beliefs, and biological evolution, which all fuel the startling rate of obesity in both developed and developing regionsof the globe.
Most countries have extreme numbers of simultaneous underweight and overweight BMIs
Absolutely True Diary of a Part-Time Indian by Alexie Sherman is a children’s novel that portrays the life of an American- Indian boy called Junior, and reveals the structural and social problems of an American Indian reservation. Although Alexie’s humor softens the harsh realities, the truth of the situation rings true to the reader. The poverty and social prejudice against the Indians is undeniable and leads to a cycle that the Indians cannot escape. Junior transfers schools because he is alcohol is the only route that the kids at his school are going down. He is the only one who is seeking to leave the reservation and faces prejudice from both his own people and the white world. He is putting himself in the white world because he understands the reality that if he want to be successful this is the only way for him to do it.
Throughout the book, cartoons that Junior draws reveal profound realities of his situation. One depicts how he imagines his parents to be if they had had the opportunity to pursue their dreams. It reveals the truth that because they were Indians they would never have access to the opportunities that white people have. It shows his mom as a school teacher and his father as a jazz musician. This is contrasted to the description of how his father actually is… an alcoholic.
This book is a prime example of the 1/3 World View in which every country has a third world aspect to it. While it is easy to understand how people are dying of diarrheal disease in Third World Countries, it is easy to neglect the realities of poverty and disease and oppression in our country. According to Kilgore’s research that, “Infant mortality due to diarrhea (per 100 000 live births) averaged 12.8 and was found to be high for blacks (33.1) and for residents of the southern United States (18.5).” While the rate of infant mortality is far lower in America than in developing countries, examination of where death by diarrhea disease occurs reveals where the structural and social defections lie in America.
Would you expect this home to be located in Arizona, USA in an American Indian reservation??
The global health community needs to move beyond simply keeping AIDS patients alive, and focus more on improving quality of their lives. A paradox has developed in countries where large proportions of the population are dependent on antiretroviral treatments to survive the virus. These people claim that though they are being kept alive by the drugs, their “principle complaint” is still gnawing hunger. Psychiatrtist at the University of Washington, Ippolytos Andreas Kalofonos, examined this connection between ARV disbursement and food disbursement in Mozambique. Kalofonos asserts that current HIV/AIDS interventions may be procuring peoples’ lives, but they are failing to address these people’s hunger and ensuing competition over scarce resources.
An additional underlying consequence of 1st world aid disbursal to the 3rd world is that it prolongs post-colonial structures of power by disabling developing countries from independently and internally overcoming health crises. Plumpy’nut is one example of how 1st world interventions can foster dependence in the 3rd world. Critics of the “miracle peanut solution” quip “How is [Nutriset, the company that engineered Plumpy’nut] addressing the need for poor people in Haiti not to be dependent on outside intervention in the first place?”
Pro-Plumpy'nut advertisement from UNICEF.