Analyze

In Baltimore, researchers found that racism and poverty especially affected African Americans without insurance. In order to address this, they removed boundaries to care within the medical system and community so that poor patients could receive the care they needed without economic trouble. Along with this, they also established a system that relied on the community as a whole for care, taking the social stigma away from AIDS/HIV care and building ties as a whole. Within a few years, many disparities disappeared among the studied population.

Another study in rural Haiti was used to develop the PIH model of care. This model relies on an accompagnateur who is trained in drug delivery and supportive care. This allows care to be given within a village, not a clinic, and improves access to care. This model has worked to improve patient care and outcome in Haiti, Peru, and Boston.

In Rwanda, structural violence has perpetuated to transmission of disease from mother to child for decades. Access to resources such as clean water and formula, along with public health agencies promoting the merits of breastfeeding, have made it challenging to address MTCT. However, when researchers asked mothers if they would like these resources, they were eager to receive them and wanted to help in preventing further transmission. 

The article is largely a review/update on the state of the research being done into disaster-related mental health conditions. Thus all the support for the arguments is research based rather than example based. The author backs up their definition of disasters in three categories: natural, human-made nonintentional, and human-made intentional. These criteria affect the outcomes for the psyches of the victims, with the human-made disasters carrying more weight, particularily the intentional ones. 

PTSD has been continually supported in literature, and the author simply recites sources of research dating back to the Vietnam War. The WHO has since devleoped more detailed planning tools and treatment tools for victims of trauma. 

The authors also cite multiple levels of research into the risk factors for multiple mental health issues, regardless of and related to specific disasters. 

The shift in thought from prevention to response is well supported as a necessary move. This can obviously be seen by the occurrence of these accidents despite adequate regulation. Nuclear energy is a promising, but dangerous thing, and can quickly become disastrous despite efforts to maintain control. This was seen in the accident at Fukushima, following the earthquake and resulting tsunami in the region. Despite preparation for such an event and the existence of backup generators and batteries, responders were rendered useless in the efforts as they could not access the area. This is where the need for a prepared system of nuclear response is needed. Historically, such emergency response groups have been poorly resourced and short-lived, such as the Soviet Spetsatom developed after the Chernobyl disaster in 1986. This group, which focused on preserving lessons learned and developing response systems, was absorbed by a larger ministry with the goal of integrated disaster response.

Additionally, the author cites a number of factors that played a role in creating the Fukushima-Daiichi disaster, such as “environmental, social, and technical systems” that, due to their complexity and separate protocol, resulted in lack or preparedness for the disaster. Following the disaster, the response efforts were delayed by this lack of preparation, and the media called out TEPCO and the Japanese government for this. STS analysis is important in this aftermath as much as in the creation of the initial plan. By utilizing an interdisciplinary approach, the media (and the people) can be heard and used to reform existing policies, or create new ones. This establishes a continuously evolving system of response that can adapt and take into account many different view of disaster relief. 

In the aftermath of the hurricane, numerous issues arose for the evacuated citizens of New Orleans.First, the immediate affects of lack of access were apparent, such as lack of schooling, pharmacies, and employment. Then psychological affects appeared as people were told they couldn't return home, even if they were minimally damaged. The combined affects of the physical and mental conditions, combined with the lack of physicians and psychiatrists, led to a massive instability in the people. 

The government further exacerbated this instability by providing limited resources and shelter for victims. More exactly, the resources and shelter were unevenly distributed to the victims, favoring white mid- to upper-class citizens. The funds that otherwise should have gone to essential care facilities and housing, were unseen by the people. Promises of finanicial aid were never fulfilled, and no legislation (such as that in the wake of 9/11) was passed to support victims.

This leads to the creation of "disaster capitalsim" in which private companies benefit from the disaster and state-of-emergency, raising prices and suspending insurance policies. Poor government oversight of the private sector created deficiencies and health crises. 

The article concludes by suggesting the response to Katrina be examined to prevent the same mistakes from occuring in the future. However, there is a lack of optimism, as the system of response is ingrained into American Society. 

The author cites a number of cases in which the law proved difficult to enforce. One example is seen when looking at the difference in residency application acceptance rates between different locales/prefects. The much larger and metropolitan areas would accept down to 47% of the applications, indicating a possibly fair division of candidates reviewed. Other more rural areas would accept over 90% of the applications, showing almost no distiguishment between ailments. The question becomes whether this is reflective on the doctors' judgements of "serious ailment" given location, the political beliefs of the prefect, or simply the lack of caring whether someone emmigrates or not. Another example of the flaws in this law is highlighted by a personal anecdote from a patient. The patient was given a diagnosis when originially coming to France on a personal visa. They were told their condition was quite serious and would require ongoing care. However, when the doctor who diagnosed him was asked to sign for evaluation for the residency permit, the doctor changed his diagnosis to something much less serious. The political thought behind the poicy came into play and interrupted the normal proceedings, tearing doctors between their obligations to the law (and only allow exceptional cases) and to medicine (and err on the side of caution).  

The author also highlights the development of this law and its effects in three stages. Pre-1990: Serious illness was a factor in residency completely at the discretion of local government. Immigrants were seen as workers and they served that purpose only. If a worker was sick, they were of no use to society. 1990-1998: Illness was more often factored into the decision making process, but those allowed to stay received no paid employment or social wellfare benefits. Post 1998: Written into law, ill immigrants were allowed to stay with the opportunity for pay and legal status in France. 

The 1814 burning of the Captiol Building was in response to the American's burning fown York. The British decided to return the favor and burn down the captiol buildings and other cities in the Union. The building itslef had structural issues with poor ventilation, rotting timbers, and leaking roofs. In the efforts to reconstruct the capitol building, the engineer was met with public criticism, which could be considered out of line to an expert. He stated that the buildings left from the fire were already doomed, regardless of the fire's destruction. Other questions were brought by the public after the fire, such as the defense of the capitol and the war of 1812 itself. The engineer, Latrobe, conducted his own "investigation" of the buildings. In the end, the investiagtion revealed that the public was not as concerned with the how, but more the reasons why. 

In 1850 , a boiler exploded in the basement of a printing press factory in Manhattan. The diasaster led to a number of workers, notable children and adults alike, being trapped in the rubble in need of rescue. These rescue attempts were repeatedly halted in order to put out emerging fires around the explosion site. The total death toll was 67, with an additonal 50 injured. Seventeen jurors were brought to the site to observe the boiler (what remained of it) for its strength and fitness for use. Out of all the witnesses called forward for questioning on the boiler's fitness, numerous named any number of issues, specific to their area of expertise. The engineer who designed the boiler stated it was not properly constructed wiht numerous defects. The maker of the boiler had examined the boiler and found cracks prior to the explosion. The end result of the investiagtion revealed that the public had a fair amount of knowledge on the workings and issues with boilers. The incident also effected change in the inspection policies. 

The Iroquois Theater Fire happened in part due to the design of the theater and in part from the mistakes of the managers of the building. Exits were blocked or locked. The investigation revealed that the inspections of the theater were never truly enforced and many things did not meet code (such as fire sprinklers placement). The public, in this case, played a crucial role in pushing for a public investiagtion of the Iroquois, and other theaters. 

The rise and emergence of infectious diseases has led to a number of puclic health "scares" over the years. The creation of national and international frameworks, as well as focus groups, has brought the struggle of infectious diseases like AIDS to light. Looking at diseases with the combined inputs of governmental and philanthropic organizations has had a positive influence on the fight against them. In the realm of bioterrorism, many factors are at play. First is the terrorist act itself and the social issues that lead to a terrorist being created. Then there is themethod, which is the numerous diseases that can be weaponized. These diseases are researched at the government level as potential additions to the arsenal of weapons a country has. However, they are also used at the individual level. With highly educated individuals and any number of social ideologies, the risk for bioterrorism increases. By looking at bioterrorism through the lens of both a social expert and scientist, the roots of bioterrorism can be examined. 

The causes for these examinations are events that have had a largescale effect on multiple levels of expertise. These "focusing events" have a lot of factors and players, and thus require a lot of different views to analyze, as the article argues. 

The author uses historical accounts, statistical data, and current research to support the arguments/points made in the article.