Emergency response is mentioned in the short and long term, in terms of placing infrastructure to direct and prevent diease. The authors stressed that dealing with epidemics as they happen is important to prevent further spread of diease. While long term repsonses in the past -clinics and medications- were placed, emergency response- going there and fixing the problem was stressed.
This article has been discussed by one of the authors, Farmer who has used this article as evidence of the emergent state of Hati and Rwanda in terms of structural violence. This article is published online, so it is a universal resource for people to reference in papers, college courses and the alike.
Through looking at the bibliography I can connect the dots of the problems in Rwanda and Hati that are still not solved. This article can also be considered as a continuation of this research in that aspect.
The three points that I looked up to further my understanding of the article were the PIH, how long it existed and its efforts were credible and successful in the treatment of facilitating the decrease and prevention of diease in rural areas. I looked up HIV/AIDS treatment in the US and found that up until recently, people could not afford treatment; this I found was in parallel with Hati- whose citizens could not have access to the medications they needed either. This surprised me, that a country with so much wealth, ignores its own citizens. The third point I looked up was structural violence to see if it was a credible term or if it was something made up by the author.
The article: “Structural Violence and Clinical Medicine” was written by Paul E Farmer, Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee. Paul Farmer is an anthropologist and physician who works professionally as a humanitarian healthcare worker in impoverished nations, physician at Brigham and Women’s Hospital Division of Social Medicine and Health Inequalities, Professor at Harvard University, and cofounder of Partners In Health. Bruce Nizeye is a Director of the Program on Social and Economic Rights. Sara Stulac is a Director of Pediatric Programs at Inshuti Mu Buzima, in Rwanda, and Partners In Health’s deputy chief medical officer. Salmaan Keshavjee is also a physician at Brigham and Women’s Hospital, an instructor at Harvard’s Department of Medicine, and a specialist at Partners In Health on tuberculosis.
It is important to understand the work of Partners in Health (PIH) is to assist underdeveloped countries build high quality healthcare systems, when talking about the authors’ work.
The article: “Structural Violence and Clinical Medicine” is about the social structures that play into “violence” (anything that causes harm physically, socially, or otherwise). The research seeks to establish the importance of biosocial understanding in the medical field when trying to understand medical problems.
1) Factors affecting disease (HIV/AIDS) outcome in different biosocial settings are radically different despite similar, established “risk-factors” in lifestyles/behaviors for individuals. This is because biosocial factors play an important role that is far often overlooked by current medical systems and policies.
2) mother-to-child transmission (MTCT) of HIV, antiretroviral therapy (ART) and infant formula (preventing pediatric aids transmission through mother). MTCT of HIV is driven through universal breastfeeding being mainly pushed by the existing medical structures of the local and international healthcare policy makers. They claimed that the difficulty giving access to infant formula in rural areas and stigma around signing up for an HIV project doomed it to failure; however the projects in Rwanda and Haiti proved otherwise, when the structural “violence” was addressed. This was done mainly by giving both distal and proximal support and care as well as addressing the other social-economic barriers to good medical care in these communities.
3) When locals, who are much more aware of the areas biosocial setting, implications and problems, are utilized in the medical system, the results are multifold. Proximal care provided by an accompagnateur not only reduces barriers to care such as traveling to a hospital for basic medicine, but also creates jobs that contribute to raising the quality of life which is another major factor when examining structural “violence”.
1) “…what would happen if race and insurance status no longer determined who had access to the standard of care?
…in addition to removing some of the obvious economic barriers at the point of care, the clinicians and researchers considered paying for transportation costs and other incentives as well as addressing comorbid conditions ranging from drug addiction to mental illness. They also implemented improvements in community-based care, conceived to make AIDS care more convenient and socially acceptable for patients. The goal was to make sure that nothing within the medical system or the surrounding community prevented poor and otherwise marginalized patients from receiving the standard of care.
The results registered just a few years later were dramatic: racial, gender, injection-drug use, and socioeconomic disparities in outcomes largely disappeared within the study population [35].”
2) “This model [PIH’s model], with conventional clinic-based (distal) services complemented by home-based (more proximal) care, is deemed by some to be the world's most effective way of removing structural barriers to quality care for AIDS and other chronic diseases.”
3) “While some interventions are straightforward, we also have to recognize that there is an enormous flaw in the dominant model of medical care: as long as medical services are sold as commodities, they will remain available only to those who can purchase them.”
This article draws mainly from Partners In Health projects in Rwanda and Haiti, using them as case studies to support their argument.
The article seeks to broaden the vision of the current medical system and structures by acknowledging and delivering care with the knowledge of biosocial effects.