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By Scott G. Knowles: As part of the STL Anthropocene Field Campus the research team visited the Wood Refinery Refinery History Museum on March 9, 2019. This museum is located on the grounds of the Wood River Refinery, a Shell Oil refinery built in 1917 and today owned by Phillips 66. The site is Roxana, Illinois, just upriver from Granite City, and just over two miles from the convergence of the Mississippi and Missouri Rivers. Sitting on the actual grounds of the refinery, the museum is an invitation to think across the micro, meso, and macro scales of the Quotidian Anthropocene, in terms of geography and also in terms of time. This refinery was built at the crux of the WWI, at a time when United States petrochemical production was entering an intensive phase of production, invention, corporate structuring, and global engagement. The museum is an invitation to think across temporal scales, backwards to the start of the refinery--through the individual lives of the workers and engineers whose lives defined the refinery--and forward to indeterminate points of future memory. This photo captures a key moment in an informal interview we did with one of the history guides. He had worked in the museum for decades before retiring. He explained to us that the museum sits in the former research facility of the refinery--and the glass plat he is showing reveals a beautiful artifact, a photograph made of the complex when it was built. Our guide only showed us this collection of slides after our conversation had advanced, perhaps after he was sure we were truly interested in his story, and the deeper history of the refinery. The pride in the place, the community of workers, and the teaching ability of the museum was manifest. The research team felt impressed, but also concerned about the health impacts (and naturally the environmental impacts as well) of the refinery. There was a mismatch in the scales--the memory of the individual tied to emotions of pride and knowledge of hard work done there--and the Anthropocene, global scale of petrochemicals. How do we resolve this mismatch? The glass plate is somehow a clue.

 In 1991, the Public Health Service articulated a vision for primary prevention in Strategic Plan for the Elimination of Childhood Lead Poisoning, a departure from previous federal policy focused on finding and treating lead-poisoned children. This publication detailed a 15-year strategy for primary prevention and offered a cost-benefit analysis to demonstrate the monetized benefits of this approach. A strong national effort to follow this strategy developed but was eventually abandoned.

The organized campaign against universal screening began in California, where letters questioning the reported prevalence of elevated BLL began appearing in pediatric journals and newspapers. These letters acknowledged receiving editorial assistance from Kaiser Permanente Foundation Hospitals and argued that money spent on screening, treatment and abatement would be harmful to more worthy public health efforts. The AAP president took up this attack on universal screening as well, and efforts for universal screening were gradually eroded. 

Needleman identifies racism and the belief that lead poisoning “is a product of poor mothering, not of environmental pollution” as a driving factor shaping lead detection and prevention efforts (or the lack thereof) … “this weighting of personal choice or behavior over environment is a tool used to shift responsibility away from health authorities or polluters and onto the victim” (1875).

The film looks at the struggles of the doctors in MSF while on missions in third-world countries. These issues stem from lack of supplies, quality of the facilities, and high patient influx. The doctors in the film are burning out quick, with way too many responsibilities to tkae care of. The setting is in Liberia and the Congo during a period of war. The film also examines the tensions developed between the doctors due to differences in style, knowledge, and culture. The clash of personalities and reasons for being in MSF also contribute to the tension. 

The film largely plays on emotional appeals and drama. By documenting the interviews of the doctors, which often are about the other doctors, the viewers see just how hard it is to detach ones self from their work. There is a scene in which the doctors talk about how, despite all the issues they face in the medical setting, everything at the end of the day is about personal relationships. It even briefly touches on sex between the medical staff and how that contributes to the care given. Since the film is based on personal interviews, little to no scientific information is given about the disease and injuries seen; its all based on personal opinion. 

The stakeholders in the film would be the doctors, the local health ministry, and the patients themselves. The doctors were the most focused on, and they were put into a lot of situations in which they were the sole decision makers. However, many times the decisions weren't life or death, but death or comfort. For instance, Davinder was in a situation where a child was inexplicably swelling all over his body. The doctors weren't well equipped for diagnosing his illness, and thus the child was doomed to worsen and die. A nurse informed him that the mother had taken the child and left, to which Davinder remarked that he couldn't blame them. He believed the comfort of the child in somewhere without his care was worth just as much as, if not more than, his care in the hospital. This was quite different than Kiara's opinion that they needed to stay in the hospital. She blamed it on a lack of confidence in medical ability, while he saw it as being human.

Following the time on the mission, the doctors all had to decide what was next. Dr. Brasher left MSF to practice medicine in Paris, while Dr. Gill went to Australia to become a pediatrician, with no plans of returning to MSF. Dr. Lapora was promoted to Emergency Coordinator, and established three more missions in other parts of the world. Dr. Krueger still works with MSF and has been on a number of other missions. All of the doctors continued medicine, but their experiences in Liberia dictated their plans on whether to continue this service.  

Emergency responders as a unique group aren't discussed or portrated in the film. However, the doctors had to take on the role of emergency responders often, while not neccesarily being emergency doctors. The question in the film became whether or not the doctors were prepared for these roles, and if they had the energy to dedicate to them. Some doctors burn out, and others thrive, but regardless they are challenged to make sacrifices that emergency responders often must decide on. 

The film would have the most impact on the general population, like something that would be played on a news channel before prime time. The level of emotional appeal and interpersonal drama is enough to keep anyone intersted for the length of the film. The film does however paint the experience in a negative light, which could discourage professionals from pursuin mission worlk. Thats why the general population would be most receptive to the struggles. Its easy for them to say "I would do something like that if...." without having the ability to do anything. 

The film doesn't look much at the people's experience with MSF. There are no interviews of the patient's themsleves. The film touches on the local health officials' opinons, but not much on the actual patients'. It doesn't highlight their sturggles as much as I believe it should. 

The film provided general facts about MSF and the conditions in Lieria and the Congo, but no detailed medical statisitics. There wasn't any comparison of the issues in this mission versus those on other missions. The film could have included more on the factors that contribute to the diseases themselves, rather than the barriers to treating them. The film also needed more on the exact amounts of supplies that were given relative to what one would have in a clinic elsewhere. 

The film looks at the work of MSF as an immediate relief effort, without too much in terms of long term sustainability. The doctors discuss this and how they can leave the clinic with some form of ongoing care, but that the infrastructure of the country itself does not support long term medical facilities. They look at it as an immediate fix to a forever existing problem. MSF is only there to help while they are there.