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Empirical points

margauxf

“Under a 1986 federal law titled the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are required to treat people who come to the ED presenting with an emergency medical condition, defined as a condition that, without treatment, will likely lead to serious impairment or death. … EMTALA is one of the largest federal mandates to provide services to have gone unfunded (Friedman 2011); costs instead fall on states and local health care systems.” 481

Quotes

margauxf

“In bringing ethnographic attention to hot spotting as a technique of governance, we find that it provides lifesaving humanitarian interventions while operating within the racialized structures of violence that produce continual life crises. The institutional rationality of hotspotting and the encounters of care that it produces illustrate the often-contradictory role of medicine in the lives of poor people: both caring and coercive, it intertwines care and violence.” 475; “we conclude by suggesting that economic investment and return are becoming a reigning logic in the governance of poverty, generating hot spots as sites of interest for both policing and health care and decentering normative assessments of deviance, illness, and social problems” 476; “Neoliberal social assistance, as it is practiced in the health care safety net, is conceptualized as an “investment “in the population, as a strategic and targeted deployment of basic resources, one that promises to generate a return on investment for the state or health system in the form of cost savings.“ 485

 

Summary

margauxf

 The authors examine the practice of “hot spotting,” a form of surveillance and intervention through which health care systems in the US intensively direct health and social services towards high-cost patients.  Health care hot spotting is seen as a way to improve population health while also reducing financial expenditures on healthcare for impoverished people. The authors argue that argue that ultimately hot spotting targets zones of racialized urban poverty—the same neighborhoods and individuals that have long been targeted by the police. These practices produce “a convergence of caring and punitive strategies of governance” (474). The boundaries between the spaces of healthcare and policing have shifted as a “financialized logic of governance has come to dominate both health and criminal justice” (474).

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ciera.williams

This study examined the risk of acquiring Ebola Virus Disease (EVD) by healthcare workers in the setting of general hospitals and isolation units. By looking retrospectively at the Ebola Outbreak in Sierra Leone, the relative levels of risk to healthcare workers were computed and compared. The reasoning for these levels was also examined through interviews of surviving workers and the families/associates/colleagues of the deceased workers. The interviews reviewed common actions (and lack there of) for affected workers. This revealed certain themes that should be visited when reveising/creating hospital infection prevention and control policies.

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ciera.williams

In the case of this study, the vulnerable population examined was healthcare workers in Sierra Leone during the outbreak. These workers were found to be at a significant level of risk for transmission for a number of reasons. These include proximity to the virus (due to the occupation), lack of training in the area of infection control, and cultural factors (such as prevalence of self-medication and home management of illness). Nurses as a whole were most affected, with over half of the infected members. 

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ciera.williams

The data acquired in this study can be used not only for improvement in policies and training for healthcare workers, but also to examine the risk factors for the disease. One example is the age and gender disparities in those nfected. These could be explained by the typical age and gender of healthcare workers, but could also show a trend in risk when coupled with patient data. The data on the districts and their infection rates can be used to help pinpoint the origin of infection. 

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ciera.williams

The study was published in BMC Infectious Diseases, a peer-reviewed journal on the prevention, diagnoisis, and management of infectious disease. The journal seems to be genrally well respected.

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ciera.williams

This was a retrospective study. While not the most accurate and well supported way to conduct a study, due to the effects of recall bias, it was really the only way to gain the data that was presented in the report. There isn't really anything new about the style of research. 

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ciera.williams

At least one further study has been conducted using this data. A more focussed paper on the Kenema District in Sierra Leone was written, addressing the staggering number of cases with infected healthcare workers. The paper is titled "Facors Underlying Ebola Virus Infection Among healthcare Workers, Kenema, Sierra Leone, 2014-2015."  The paper reached similar conlusions as the original one, with a need for better practices in infection control and prevention.