Sirens and Lights

Terrorism, genocide, mass murders… the rather tragic theme of many of my books and documentaries of late. I’m not sure if it’s attempt to understand exactly how these things happen, escalate and persist for as long as they do, or simply me trying to decide if I really believe that it’s possible to prevent them (i.e. is it really so inevitable that people will do such disturbingly awful things to one another?). Of course, I do believe that it’s possible to prevent the large scale deaths, if not the initial movements, but it’s certainly more complicated than that.

For now, though, I think I’m stuck on the idea of how powerful a concept denial is in human nature- how is it that we are able to deny so strongly that bad things may happen to us? Or, as my friend pointed out, that awful things are happening to others?

A related conversation with a friend brought me to question why it is that we evolved, at the very least, to be capable of so much denial. I see can understand in the latter situation that denial is a form of self-preservation, of not feeling obligated to put oneself in danger so as to protect another…but the former doesn’t seem like it would benefit us in any way. Yet, it is such a persistent theme in the development of so many violent movements (genocide or otherwise).

My friend’s response: I think things on the scale of genocide might be good examples of culture outracing evolution

(I’ll spend more time fleshing out these ideas in future blog posts… once Friday is over!)

So i was reading another blog and came across the bizarre set of letters above…a quick click led me to the website for National Blog Posting Month, which is basically a group of people who agree to blog every day for the month of November. I’m a little behind, but I thought I’d give it a try anyway…

I’ll start with a letter I wrote to a 4th year med student friend who is currently working in rural Haiti, learning Creole and seeing patients (her work is largely clinical, as opposed to mine, which is mostly research). We’ve been comparing notes on this year– and it’s quite a contrast as she’s living in a simple room in a village while I’m living in one of the nicest/safest parts of a bustling, modern city of 9 million people…

it’s funny how we envisioned this year turning out and how it is… but in the end, i think you just have to get out there and see what you can do.

I’m so grateful to live somewhere safe and beautiful, convenient and peaceful…don’t get me wrong. I’m thankful that my biggest issue is remembering to turn on the water heater 30 min before I want a shower. and ultimately, i think it’s a balance of being inspired by people and remembering how much i love the energy, and being grateful for the sanctuary that is my home and work space, with internet that works (not always the case at the Peruvian NIH or at the university, where i have desks) and everything I need. As long as I don’t get sucked into the city life of always going out, always spending money, always needing “things to do” aside from simply living, observing, working, learning and hopefully finding a meaningful way to help.

today i made a five year old boy cry as i was removing his stitches…it was inevitable that i would eventually inflict pain on some poor child with this whole medical career, so i guess i’m glad to have gotten that rite of passage done with! the procedure went smoothly, though, despite the one really tight knot that caused all of the pain.  still, despite all of the obvious benefits, it’s still unnatural to knowingly make a little kid cry!

all in all, my first day of third year rotations was really wonderful.  i’m working in a family practice clinic in North Philly, with a patient population that includes a lot of immigrant families.  before i ran off for my Watson year, i always thought i would work with immigrant populations within the U.S. and travel on the side– the original premise of my Watson proposal actually stemmed in part from my experiences growing up as a first generation ethnic and religious minority within the U.S.   There’s so much room for miscommunication between physicians and patients, and the potential for language and cultural barriers to exacerbate these difference is worrisome to me, especially as i witness my parents and relatives aging and relying increasingly on physicians. it’s good to be working in a clinic where i can focus on bridging the divide that can exist between physicians and patients of different ethnicities…and to see how the way all of these people’s families and lives intertwine and intersect within their North Philly neighborhood.

quote from one of my favorite books, The Spirit Catches You and You Fall Down:

“I have always felt that the action most worth watching is not at the center of things but where the edges meet. I like shorelines, weather fronts, and international borders. There are interesting frictions and incongruities in these places, and often, if you stand at the point of tangency, you can see both sides better than if you were in the middle of either one.”

sweet dreams….

Some articles in light of the UN summit/MDGs:

http://www.economist.com/printedition/displayStory.cfm?story_id=4401628&fsrc=RSS

http://www.economist.com/printedition/displayStory.cfm?Story_id=4408187

These are similar to the article I posted before on Brasil’s anti-poverty measures, but are still worth reading…the whole issue looks interesting, but I’m still working on fitting in reading it with studying :P. at least i have some more time now that the nytimes opinion columns are no longer free on-line….( )

It’s a holiday in Rio, so I went out for a walk to one end of Copacabana….there’s a fort with pretty views of the entire copa shoreline all of the way out to pao de acucar, one of rio’s cartes postais (it means sugar loaf, it’s a big hill…and no, i don’t know why it’s so famous!). the fort has a cute cafe, where i sat for most of the afternoon and read/wrote a little. thank goodness the sun is out again. this is not a city meant for rainy days…

Folha de Sao Paulo - AIDS: Actions in the US Call for Breaking Patents 13 Maio 2005

Objective is to pressure the Brazilian government to confront the pharmaceutical industry; Sao Paulo will also have a protest today

Actions in US call for break of patents
PEDRO DIAS LEITE
DE NOVA YORK

International groups aligned themselves with Brazilian NGOs and launched protests in New York, Washington and Paris to pressure the Brazilian government to break patents on three AIDS medications. Today the activists will hold a protest in front of the Brazilian UN Mission in Manhatttan, New York. Another action is planned for Washington. Yesterday, a group had already protested in front of the Brazilian embassy in Paris. In Brazil, the protest is planned for 1 pm, in the Praça da Republica, in Sao Paulo.

“We had many discussions about whether or not to criticize Brazil, but we believe that in this instance they [the government] is giving up its moral authority,” said Shanti Avirgan, of the NGO Act Up, which considers the country “a model for others” on the question of AIDS. These groups affirm that the Brazilian government had set a deadline of one month, on March 15th, to break the patents on three AIDS medicines if the pharmaceutical companies did not cede the right to produce the medicines. These three drugs make up around 80% of the money spent on medications to fight the disease, today around R$560 million.

Almost a month after the date of the ultimatum passed, according to national and foreign NGOs, the Brazilian government still has not taken any action. “We are launching an appeal to Brazil to show its teeth and doesn’t make any more empty promises,” which only threaten, but don’t break, the patents.

WTO Rules
The groups want Brazil to use a rule of the World Trade Organization which authorizes the breaking of patents in cases of national emergency. In Paris,two representatives from the dozen, were received formally by a functionary of the Embassy. Today, there should be about 15 people at the protest in New York, and the representative of the UN has already said that a small group would be met, said the NGO.

When, in the middle of the week, more than one hundred groups from civil society called on Brazil to break the patents, the government called the demand “ingenious”. For the organizations, meanwhile, Brazil’s leadership in the past is important, not only to maintain the current policies on AIDS but also for other countries around the world. “The success of the Brazilian program was only possible through the local production of generics. This policy brought the prices of antiretrovirals down internationally. The Ministry of Health needs to act against the pharmaceutical industry, not only for the Brazilian people but for people with AIDS
around the world, said Sean Barry, of Health GAP (Global Access Project).

(http://online.wsj.com/home)

HEALTH
Brazil Refuses U.S. AIDS Funds, Rejects Conditions
By MICHAEL M. PHILLIPS in Washington and MATT MOFFETT in
Rio de Janeiro
Staff Reporters of THE WALL STREET JOURNAL

May 2, 2005; Page A3

Brazil refused $40 million in American AIDS grants to protest the U.S. requirement that recipients first sign a pledge condemning prostitution. Brazil’s decision escalates a global fight over the moral strings President Bush and his conservative allies in Congress attach to foreign assistance, especially when it comes to sex, drugs and AIDS prevention in developing nations.

Brazil is seen by some as a model in the battle against the spread of AIDS, and Brazilian officials say that is in part because they deal in an accepting, open way with prostitutes, homosexual men, intravenous-drug users and other high-risk groups. The Brazilians say it would hobble their work if they complied with U.S. demands and forced groups that implement AIDS programs — including prostitutes’ associations — to condemn prostitution.

“We can’t control [the disease] with principles that are Manichean, theological, fundamentalist and Shiite,” said Pedro Chequer, director of Brazil’s AIDS program and chairman of the national commission that made the decision to turn down further U.S. money as long as the antiprostitution pledge requirement remains in place. He said the commission members, including cabinet ministers, scientists, church representatives and outside activists, viewed U.S. demands as “interference that harms the Brazilian policy regarding diversity, ethical principles and human rights.”

Brazil appears to be the first major recipient nation to take such a definitive stand against U.S. efforts to link billions of dollars in foreign aid to conservative responses to social ills. Some Republican lawmakers in Washington are pressing to cut off federal grants to those who don’t support the president’s views promoting sexual abstinence, condemning prostitution and opposing clean-needle exchanges for drug-users. Meanwhile, the White House has steered more federal money to groups that bring a religious orientation to overseas health programs.

“Obviously, Brazil has the right to act however it chooses in this regard,” said Sen. Sam Brownback (R., Kan.), one of the leaders of the conservative cause on Capitol Hill. He said he hoped the money would be redirected to countries whose AIDS policies are more in line with those of the Bush administration and the Republican-controlled Congress. “We’re talking about promotion of prostitution, which the majority of both the House and the Senate believe is harmful to women,” he said.

Last week, Brazilian authorities wrote the U.S. Agency for International Development, one of the main distributors of
official American aid, explaining the decision to reject the remainder of the grant, which began in 2003 and was to run through 2008 for a total of $48 million.

The American money was a small part of Brazil’s overall anti-AIDS push. About 90% of Brazil’s total funding for AIDS programs comes from its own revenue, with 7% or 8% coming from the World Bank and the rest from the U.S. and other governments. Dr. Chequer said the Brazilian government would increase its funding to make up for the lost U.S. funds.

USAID spokeswoman Roslyn Matthews said yesterday the agency is still reviewing the Brazilian decision. “This is an evolving situation,” she said. “We are in the process of determining next steps.”

Prostitution isn’t a crime in Brazil, and prostitutes’ associations are among the most active groups engaged in anti-AIDS work. The U.S. money was to have included $190,000 for eight prostitutes’ groups around Brazil, according to Gabriela Leite, coordinator of the Brazilian Network of Sex Professionals and a former prostitute. Ms. Leite said she participated in lengthy discussions with
USAID to ensure that American money went only to AIDS education and prevention, and not to other prostitutes’
rights issues. The result was a 50-page agreement, she said, but it broke down because her group was unwilling to condemn
prostitution.

Brazil’s approach to the AIDS epidemic is considered a model by some scientists and public-health specialists. The government encourages abstinence and sexual fidelity, but its prevention efforts focus more on condom education and distribution. In addition, since 1996 the country has provided free, life-extending antiretroviral drug cocktails to anyone infected with HIV.

The result is a spread of HIV far less serious than had been feared. In 1992, experts forecast 1.2 million Brazilians would carry the AIDS virus by 2002. Instead, there were an estimated 660,000 cases. World-wide almost 40 million people are thought to be infected with HIV.

“Why should we adopt a different orientation if we have been successful for the more than 10 years?” asked Sonia Corrêa, a Brazilian AIDS activist and co-chair of the International Working Group on Sexuality and Social Policy, a global forum of researchers and activists.

The antiprostitution pledge requirement came out of two 2003 U.S. laws, one dealing with AIDS and the other with forced prostitution or sex trafficking.

Write to Michael M. Phillips at _michael.phillips@wsj.com_
(mailto:michael.phillips@wsj.com) 1 and Matt Moffett at
_matthew.moffett@wsj.com_
(mailto:matthew.moffett@wsj.com) 2

Guess who’s heading back to Brasil?! I’m sitting here, wrapping up my first year of med school, armed with tickets back to Rio in just 2.5 short weeks….

I’ll be leaving May 15th for Rio, where I’ll spend 6 weeks working with the Johns Hopkins’ Center for TB Research/Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE).

….then, I’m heading to South Africa…details on that to come