Haitian patients’ belief in sorcery and TB

As an anthropologist and a physician, Farmer studies the relationship between the Haitian people’s beliefs in sorcery and TB to understand the impact, if any on the diagnosis and treatment. He found and has widely written about his belief that sorcery and cultural differences have less to do with infectious diseases than socioeconomic conditions. Farmer used his skills to educate and assure compliance with treatment regimes. He educated the people of Haiti, paid some of them to deliver medication, and gave them money to buy food.

Farmer got to know his patients and formed relationships, earning the trust of the Haitian people. He looked beyond the simple excuse of blaming the TB problem on sorcery and cultural beliefs. While it is helpful and necessary to understand different cultures, it does not prevent one from solving the problems. 2. Find and describe two additional cultural beliefs that would influence TB infection/treatment using journal articles or professional websites. A study of TB in Vietnamese refugees living in New York was complied by the New York State Health Department and the CDC in 1994.

While the Vietnamese individuals surveyed had some accurate information, they incorrectly believed that TB was in part due to hard work, alcohol consumption. They had little understanding of TB diagnosis and treatment and feared that the disease would impact their jobs and community activities. The studied concluded that the refugees brought with them inaccurate information and that New York must make a concerted effort to outreach and educate Vietnamese refugees. In 1999 and 2000, a similar study of the Somali immigrants in Seattle had the same results and showed the need for specific and targeted education to this group.

A study of rural Rwanda examined the popular beliefs and practices of the residents regarding TB. In Rwanda, there is a strong belief in herbal treatments for cough and so, many TB victims were not identified as such early on, but were rather treated with herbal remedies for the chronic cough. In some areas, residents believed that TB was the result of witchcraft and so could only be treated by local healers. 3. Draw conclusions about culturally sensitive TB treatment and its role in patient adherence to medical regime and trust in the medical system.

What Paul Farmer has shown is that it is important for medical professionals to be sensitive to the various cultures in which they work. Gaining the trust, respecting the local customs and treating people with respect and dignity can overcome much, if not all of the cultural differences in terms of medical diagnosis and treatment. While it is important to recognize and validate the local cultural believes regarding medicine, there is a risk that these apparent barriers will become an excuse not to treat.

In other word, it gives governments an excuse not to offer assistance. Blaming the medical issues and failures on cultural beliefs is short sighted and does not give problems such as TB the attention and funding they deserve. The economic issues are often the real barriers to medical treatment. The cultural differences can be overcome with education and knowledge. Social and economic inequities are largest problems to overcome, not cultural beliefs.

Farmer demonstrates that he can overcome the cultural beliefs by educating, treating and providing the resource necessary to prove to the Haitian people that his way works. Addressing the issues of cleanliness, nutrition, and clean water resulted in the positive results that the Haitian people wanted all along. Providing them with the money to buy good food, a source of clean water and showing them that the medicines he supplies work, resulted in success over the cultural beliefs that might have initially been viewed as barriers to treatment.

4. Describe the role of the government in the success or failure of TB treatment as found in the book. Researcher and public policy makes have a responsibility to focus on the local socioeconomic conditions that result in higher incidences of infectious disease and then poor diagnosis and treatment. Focusing or excusing the conditions on the existence of sorcery, voodoo or herbal remedies excuses the government from taking action. Governments have a role to assure medical access and equality.

The way to assure this by addressing the social and economic inadequacies in may develop and poor areas, such as Haiti. Farmer makes people reexamine practices and through his philosophy that “the only real nation is humanity” 5. Find two articles that talk about the role of the government and inter-governmental organizations in treating TB. An article published on treatment resistant TB in South Africa by Singh discusses the government roles in responding to the epidemic crisis in that area.

The article talks about the need to provide welfare benefits and healthcare to those effected and also discusses the possibility of detaining people for treatment as a means of controlling the outbreak and further spread of this deadly disease. While Farmer does not specifically address these issues in Haiti, one can imagine what his thought might be on the subject. Farmer would like take a step back for the forced detainment and look to engage support in the local communities for voluntary treatment compliance.

Farmer would not likely assume that people are non-compliant, needing to be detained, because they don’t want treatment. Farmer’s approach and assumption would more likely be that people are noncompliant because of a lack of basic needs, or supportive resources and of knowledge. A second article by Freidan talks about the treatment and detention of TB worldwide and notes the issue of stigma. The issue of perception and fear of TB patients caused by the stigma of the disease is one Farmer would whole-heartedly agree with.

Governments can pay an important role in terms of mass and broad based public information regarding the disease, prevention, diagnosis and treatment. 6. Compare and contrast Farmers viewpoint on the role of government and inter-governmental organizations in TB and those found in the articles. Articles on the role of government in the treatment of TB largely focus on the need for education on the diagnosis and treatment of TB> Farmer would argue that this type of education is only one piece of the response needed by governments.

Addressing the social and economic issues is the challenge. Farmers view poverty as the issue at the basis of infectious disease. If people don’t have access to clean water, good food and adequate housing, the education will not address the issue of infectious disease control. Farmer writes, speaks and practices with the goal of challenging policymakers to believe that it is possible to deliver quality health care in even the poorest of communities. Working together and gaining the support and trust of the local residents is at the heart of effective TB prevention and treatment. 7.

Summarize your arguments about the role of culture and the role of government in preventing and treating TB. I believe that Paul Farmer correctly states the need to address basic human needs and socioeconomic realities in the role of infectious disease control. Poverty and the basic inequalities of social conditions is what results in a plague of infectious disease, no cultural beliefs. While anthropologist and the public may find the cultural aspects of these poor countries interesting, placing too much focus on the cultural unfairly masks the real need for clean and healthy living environments.

The book talks about TB as an epidemic that has everything to do with social injustice and inequity. The book discusses the data gathered by working in Haiti and applies it as example as to what can be accomplished worldwide. Farmer believes his principals and practice in Haiti can be and in fact have been replicated in other poor are suffering from epidemic TB and HIV. The book talks a great deal of the partnerships that Farmer has forged with business, education, non-profits as well as governments.

This makes a good case for the need for coordinated systems, partnerships and pooled funded to meet the healthcare needs of the world poorest citizens. References Farmer, P and Leandre, F. Community-based approaches to HIV treatment in resource-poor settings. XIV International AIDS Conference, 2002 Public Health Rep. 1997 Jan–Feb; 112(1): 66–72. Singh JA, Upshur R, Padayatchi N , XDR-TB in South Africa No Time for Denial PLoS Medicine Vol. 4, No. 1, e50 doi:10. 1371/journal. pmed. 0040050 Frieden, Thomas R . Tuberculosis control: Critical lessons learnt. Indian Journal of Medical Research, March 2005

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