According to Google, this article has been cited by 370 other papters since its 2006 publication. Moreover, any article discussing Farmer, Partners in Health, or any of the other authors alludes to this and several other reports.
Paul Farmer: American anthropologist and physician best known for his work combating tuberculosis in developing countries. Co-founder of Partners in Health, an organization dedicated to establishing and developing health care systems in under-served areas.
Bruce Nizeye: Engineer who works with Partners in Health directing the building program. Rwandese by birth and survivor of the Rwanda Genocide.
Sara Stulac: Associate physicain in Global Health Equity at Brigham and Women's hospital. Clinical Director for PIH in Rwanda
Salmaan Keehavjee: Associate professor of global health and science medicine at Harvard Medical School. Specializes in tuberculosis research and proliferation.
The report quite clearly details the need to change our approaches to healthcare and epidemic emergencies. Currently, we seem to address these events in a singular method, and are unwilling to alter this approach. This is partially due to the narrow scope of patient care; for the most part, administering care to patients follows a standard guideline that does not seek to reach beyond that singular case. It is beyond the scope of a practitioner to attempt to mitigate socioeconomic discrepancies within their clinics alone. However, as Farmer and his colleagues argue, broadening this standard is necessary to combat illness. Biosocial factors, not just medicinal factors, need to be tackled in order to fully combat disease.
The majority of the information obtained for this report comes from the work of the four authors. As members of Partners in Health or clinicians, these individuals have seen first hand the effects of social violence in patient care. Moreover, they have witnessed the effectiveness of addressing these ills to better patient outcomes. Some information was also gathered from past studies, including a report by Moore et al. detailing Baltimore's racial discrepancies in care and patient outcomes.
"Third, we have seen that structural interventions can have an enormous impact on outcomes, even in the face of costeffectiveness analyses and the flawed policies of international bodies"
"These are not the tasks for which clinicians were trained, but they are central to the struggle to reduce premature suffering and death. The importance of structural interventions for the future of health care means that practitioners of medicine and public health must make common cause with others who are trained to intervene more proximally."
"Pioneers of modern public health during the nineteenth century, such as Rudolph Virchow, understood that epidemic disease and dismal life expectancies were tightly linked to social conditions"
1) Partners In Health: Mostly known for its work within Haiti and its attempts to alter WHO tuberculosis protocols, this agency appears to be spreading into other international protocols as well. It would be interesting to see what other areas and epidemics they are currently focusing on.
2) Breast feeding is cited as being a factor of mother to child (MTC) HIV/AIDs transmission. For whatever reason, there seems to be a certain fixation with the "Breast is best" ideology. I would be interested to see where and why this ideal started.
3) As is discussed in the article, the PIH model heavily relies on instituting proximal healthcare into these areas. This, within itself, seems to have a huge impact on serving needy areas. It would be interesting to see how mobile clinics and proximal care during an ongoing disaster effect patient outcomes and care.
Often considered a "social disease" HIV/AIDS can be linked to certain social groups and subsequent behaviors within these groups. Taking this a step further, poor prognosis in treatment can be linked to social stratification. In the early 90's in Baltimore, a study was performed that linked race to reception of timely medical intervention. Modifications to the programs, such as removing insurance status as a determining factor for care, drastically reduced racially-biased outcomes. In the Rwandan campaign, Partners in Health instituted proximal care to rural regions-- the areas where care was most significantly lacking. This, in turn, can greatly mitigate the effects of social violence. Moreover, structural interventions (such as changing the accepted and prescribed practices of international bodies) can greatly reduce the effects of disease within a population. This includes such things as when and how drugs are administered, who is receiving medications, and changing conventional practices proven to enhance the spread of disease.
The report includes almost four pages of reference materials. These mostly include other journal articles or medical reports. The report, for the most part, seems to be grounded in a significant amount of medical and sociological studies and journal articles. However, there are a few government agency reports, including a National Health Institute report.
When administering healthcare or combating epidemics, there's often an unaddressed social factor. Far more often, the focus remains on the scientific and biological aspects of the disease without delving into the social circumstances surrounding its prevalence. Healthcare typically narrows the scope to just medical intervention, instead of looking at the overarching conditions. Farmer and his colleagues give several examples of successful bio-social interventions; these methods allow physicians and healthcare workers to successfully treat patients in all aspects of the disease. Moreover, they contend that treating epidemics in this way helps to prevent the manifestation of social inequalities in healthcare.