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).
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.
This week’s reading, “Sterilizing Vaccines or the Politics of the Womb: Retrospective Study of a Rumor in Cameroon” discusses the historical, political, national, and regional contexts that shaped public opinion of the public health initiative vaccination campaign and lead to the miscommunication and spread of rumors about the effects of the vaccinations. This vaccination campaign was conceived without regard for the cultural context within Cameroon. At the time of the vaccination campaign, a separate government endorsed campaign promoting family planning was concurrently in effect. The association of these two separate campaigns led to a growing suspicion and mistrust of the vaccinations. Although public health officials understood the agenda of the campaign was to devote resources to widespread vaccination of the public again neonatal tetanus, inadequate attention was given to the education and “sensitizing” of the recipients who perceived the vaccinations as foreign and potentially harmful. Combined with a mistrust of national government and conflicting views between local, regional, and national interests, the rumors surrounding the vaccines caused girls to choose suicide over vaccination and eventually led to the end of this unsuccessful and largely misunderstood public health campaign.
Oral rehydration therapy has been proven to be an effective agent in the fight against diarrheal disease. This simple packet of solution works to hydrate human bodies and immediately improves health conditions. While this treatment is used across the globe, in lecture we discussed why these oral rehydration solutions have not been even more effective. Western views interpret them as a miracle cure-all, however, mothers who endure great hardship to bring their sickly children to hospitals or clinics understand that their children need medical attention yet sometimes this simple solution is not perceived as an adequate measure for the direness of the situation. This website (http://rehydrate.org/ors/ort.htm) provides in depth information about the use and distribution of oral rehydration therapy.
This map illustrates the global distribution of Oral Rehydration Therapy.
“Can the Mosquito Speak” is a study of the structural factors that led to the malarial outbreak that spread from Sudan and along the Nile Valley from 1942-1944. This health epidemic was compounded by man-made environmental changes; dam construction across the Nile River, use of synthetic chemicals, and political unrest. “Dams, blood-borne parasites, synthetic chemicals, mechanized war, and man-made famine coincided and interacted. It is not surprising to see disease brought by environmental transformation, industrial chemistry shaped by military needs or war accompanied by famine.” (Mitchell p.22). These factors interacted to produce an environment vulnerable to the spread of disease. The dam construction led to water shortages and lack of irrigation which decimated crop production throughout the Nile Valley. Synthetic chemicals were employed to combat the mosquitoes. The wartime movement of people to and from foreign places may also have facilitated the transportation and spread of the disease carrying mosquito. Together, these factors contributed to the aggressive transmission of malaria within communities and across vast distances.
Diarrheal disease is also affected by compounded structural factors. Poverty, access to clean drinking water, nutritional education, and access to treatment are some of the most important proximate issues of the global diarrheal disease problem. Diarrheal disease is treatable; however, solutions such as oral rehydration and plumpy’nut only treat the symptoms and not the underlying issues. Diarrheal disease is a health epidemic specific to developing countries where poverty and lack of access to clean water are often the primary contributors to diarrheal disease. Like the malarial outbreak, optimal treatment must not only address the observable symptoms but, most importantly, must effectively identify and address the ultimate structural and underlying factors.
This article http://www.ncbi.nlm.nih.gov/pubmed/18579873 further discusses “disease of poverty” and the especially high risk of mortality for infants and children.
Phillip’s article discusses the “semiotics of food in Tanzanian politics.” Food is available to Tanzanians through several processes. Phillips explains that “food of wealth” is associated with political reciprocity, while “food of the farm” is associated with reciprocity among group members. The resulting relationships are gendered; women control “food of the farm” and men control “food of wealth.” This power dynamic creates familial relationships that leave women largely responsible for the nutrition of their children. Singidans also receive food through the distribution of food aid by their government. The politics that dictate who receives this food aid is differentiated among economic groups where the poorest families often receive the majority of the aid. As a result, families that fall in the middle and are still plagued by hunger often go without aid.
Water as a scare resource.
Diarrheal disease, malnutrition, and dehydration are intrinsically related problems and coupled with a drought create a situation of vulnerability. The linked article discusses the relationship of international food prices to hunger. http://blog.bread.org/2008/04/index.html
In arguing that health care is a human right, one signs on to a lifetime of work dedicated to erasing double standards from rich and poor. Again, the question of social and economic rights is raised, first and loudly by the poor, and then timidly and reluctantly by the rest of us. (Farmer, 103).
Paul Farmer states that there is a “double standard of medical ethics” between the developing and the developed worlds and uses this comparison to draw attention to the differential standards of care between the rich and the poverty stricken. Diarrheal disease is largely a product of social inequality, where those with the means to access resources, like clean water, are exempt from the consequences of untreated diarrheal disease. Strategic treatment and prevention approaches are an integral part of social action plans to combat the underlying causes of diarrheal disease. The painful irony is that 4,000 children die every day from a disease which is entirely curable. Initiatives to promote breastfeeding practices, nutrition education, clean water practices, oral rehydration therapies (http://rehydrate.org/rehydration/index.html), and zinc supplementation (http://rehydrate.org/zinc/index.html) have been recognized and put into policy in places like India where diarrheal disease is a common and stigmatized affliction of the poor.
http://www.indiawaterportal.org/post/2901. This “Call to Action on Diarrheal Disease” details the necessary initiatives to change the structural issues that lead to diarrheal disease.
“Diarrhea disease remains one of the leading causes of child deaths worldwide”
Pain is often impossible to verbalize. So often crimes go unpunished simply because victims do not know how to express their pain. Words are powerful, but often they are used to do harm rather than create change or cry for help. And why is it that some issues are easier to talk about than others? Why do some atrocities get so much attention while others go unspoken? As Chiwengo explores “which factors explain the prominent positions the oppression of Afghan women and human trafficking have held in the American media and the silence that shrouds the fate of Congolese children, men, and women?”. There are certainly diseases that are easier to talk about than others. It is easier to talk about Leukemia that to talk about AIDS. It is easier to talk about a leg broken by violence than to talk about a heart broken by rape. It is easier to discuss the effects of Pneumonia that to discuss the effects of diarrheal disease.
As defeatdd.org states “even though we have the knowledge and solutions in and to defeat diarrheal disease, the issue can be difficult, even taboo subject to discuss.” Unlike other diseases that may be a long way away from finding the cure, doctors have the resources to defeat diarrheal disease. There are relatively inexpensive and available medicine that cures children that are dehydrated from diarrheal disease. However, for many reasons people are not using the medicine that is available. One possible reason for this could be the stigma that diarrheal disease carries. In a lot of communities, diarrheal disease is an indication of poverty and poor hygiene. Often victims of cholera are viewed as social outcasts and rejected from their communities. There are many other factors, but bottom line, diarrheal disease carries a certain stigma that causes it to be less publicized both in Western media and less verbalized in the communities themselves.
Paul Farmer tells the story of three patients; Brenda, Sanoit, and Olga, who were afflicted with illness and encountered a great deal of circumstantial hardship in seeking medical care. Farmer uses these cases to highlight inequalities in access and distribution of health care. Farmer aims to provide a comprehensive critique of the social injustice brought about by “for-profit health care.” This article further discusses the concern of a health care system seeking revenue. http://www.scu.edu/ethics/publications/iie/v1n4/healthy.html.
If structural violence and inequalities are to be combated, a reevaluation of medical ethics must ensue. The medical field cannot adhere to the values of a market economy by which the rest of the country operates. Labeling medical care as a commodity inherently implies that this service should be available only to those willing and able to pay. With the exception of the United States, developed countries across the globe have recognized health care as a human right and not a profit driven business.
http://www.youtube.com/watch?v=68vsqLbk0X0 – This video published by the World Health Organization discusses the epidemic of communicable diseases, including diarrheal diseases, in Somalia. Much of Paul Farmers work brings attention to the growing inequalities that provide health care to those who can pay for it, ignoring those humans desperate for health care but unable to pay for it. “We thus find ourselves at a crossroads: health care can be considered a commodity to be sold, or it can be considered a basic social right.” (Farmer 175).