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mutantdios · 4 years

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* an in-depth look into guzmán.

BASIC INFORMATION

Full name: Andreas Guzmán. Andreas is greek, meaning “strong, manly” whereas Guzmán is a castilian surname referring to a village in the region. It has no other meaning, although some sources claim it means “Good man”, referring the Visigoth words Gus man. Moreover, there’s the comparison to the Jewish surname Gusman, which is an occupational name for a metal worker. As a whole, the name “Andreas Guzmán” can be taken to mean: strong and brave good man. Pronunciation: An-drAE-as Gooz-mAAn. Strictly a Spanish pronunciation. Nickname(s): Call him Guzmán in general, if you’re unsure. X if you’re sure. Guz if you’re close, but you might get stabbed anyways. He does not accept being called by his first name -- he will ignore or correct you at best, get violent at worst. And he certainly does not tolerate nicknames surrounding his first name. Birthdate: August 20 Age: 39 Zodiac: Leo -- This fixed sign is known for its ambition and determination, but above all, Leos are celebrated for their remarkable bravery. In tarot, Leo is represented by the “strength” card, which depicts the divine expression of physical, mental, and emotional fortitude. Fearless optimists who refuse to accept failure, Leos will find their deep wells of courage grow as they mature. Gender: Cis man Pronouns: He + him. Romantic orientation: Grey-Biromantic -- it is a topic of dispute whether Guzmán is capable of romantic fixation, or feelings at all for that matter. The current stance is that he is, but it requires a lot of work and it does not happen with just anyone. More over sometimes he can be described as romance-repulsed, since he actively does not pursue romantic relationships and views them as weaknesses that can be exploited. He would know this, since he often exploits it in others. Sexual orientation: Bisexual -- he has no strict preference toward any gender, but he has been with people of all genders. Nationality: N/A -- Guzman will claim to either be American, Venezuelan or Chilean. Ethnicity: Chilean. Current location: Wynwood, Miami. Living conditions: He lives in an apartment building that he owns and rents (sometimes entirely for free) out to other mutants of low income. His own living quarters are big and comfortable and clean, almost sterile in presentation -- 3 bedrooms, 2.5 bathrooms, a spacious kitchen and livingroom, a study. He has a second safehouse at an undisclosed location in the city.

BACKGROUND NOTES

Birthplace: N/A. Hometown: N/A. Social Class: he certainly doesn’t file taxes for how much money he has, but he has the finances of the upper middle class and acts as though he is lower middle class. Educational achievements: N/A -- at best, he has a Ph. D in mathematics. At worst, he’s a high school dropout. Father: Edgardo Guzmán -- deceased. Mother: Rosario Guzmán -- deceased. Sibling(s): Alondra Guzmán -- deceased. Birth order: First born. Pets: He has a penchant for feeding strays, but does not commit to pets. Previous relationships: this he prefers not to disclose. Arrests: his rap sheet is spotless, to the point that it feels like it’s been wiped clean, without so much as a parking ticket. Prison time: None on record, but on his own account, Guzmán will occasionally recall that he was in a Brazilian max-sec prison between ages 27-29 for murder of six police men, after which he proceeded to escape.

OCCUPATION & INCOME

Current occupation: he’s a crime kingpin and head of a sizable cartel, but for the IRS he’s a business owner and landlord. Dream occupation: honestly? President of his own country. He’s working toward that. Past job(s): he will tell you any number of truths and lies regarding this topic, among which we have: mathematics professor, CIA data analyst, CIA test subject, killer for hire, smuggler, thief. Spending habits: anything he sees fit to help to his cause, he has no problem spending. He does not care about money, viewing it as a tool, a means rather than an end. This all being said, he’s excellent at money management. In debt?: No, but a lot of people are indebted to him. Most valuable possession: possessions are a hindrance. He does not care about anything material.

SKILLS & ABILITIES

Physical strength: Above Average | Average | Below Average -- Notes: Guzman exercises regularly (every single day) and packs a surprising amount of strength in his arms and legs, as well as enviable core strength. It is not his most flashy physical feature, he does not have a defined body but his muscles are solid and functional. Once he gets to it, he can do some good damage. Speed: Above Average | Average | Below Average -- Notes: he can run and do so pretty fast but it is not what he’s best at. His reflexes are more than decent, though. Intelligence: Above Average | Average | Below Average -- Notes: Guzmán has basically nigh-peak human intelligence. As said above, he’s very good at handling complex, abstract theoretical concepts and handling vast amounts of information information; strategizing, debate, intuitive and deductive reasoning, etc. He has extensive knowledge of math and biology (especially genetics and bioengineering) as well as neuroscience and psychology, and he’s constantly learning more about the subjects not just for practical use but for his own personal enjoyment. Accuracy: Above Average | Average | Below Average -- Notes: he’s more than a little knowleagable about gun usage and he’s a really good shot. If you’re running from him and he happens to have a gun, you better have a damn good pair of legs or hide quickly, because he will most likely shoot you. Agility: Above Average | Average | Below Average -- Notes: he’s capable of climbing and a certain degree of free running with effortless ease. Stamina: Above Average | Average | Below Average -- Notes: it’s not bad for his age and he’s fit/healthy but it could certainly be better and all that smoking does take its toll. Teamwork: Guzmán is not really fit for anything but a leadership position. He is domineering and abrasive and the only way he can accept to take a backseat is if he has a generous amount of respect toward the people in charge -- and if so, he might be able to take orders, but only if he sees them as intelligent choices. Otherwise, he will question the authority and routinely challenge it, poking holes into their logic and plans. If he is the leader, though, he’s very good at working multiple details and elements into efficient wholes. People that follow him tend to, if not trust him, respect him because of how capable he is. Talents/hobbies: he reads a lot; his apartment is cluttered with piles and piles of books, many of which are technical in nature. Plays chess and cards. Knows how to play the piano more than adequately. Exercises regularly and trains in H2H combat. Does crosswords and sudokus. Swims. Plots the fall of humanity. Shortcomings: speed and stamina. Guzmán can run fast for short speeds but can get tired relatively quickly due to his age, habit of smoking and joint problems as product of past altercations. He also does not work well in settings where he is not in charge. He is also unforgiving and unmerciful and if you wrong him it’s pointless to try to appeal to reason with him. Can be controlling. Can have difficulty expressing emotional concerns and being genuine. Languages spoken: English, Spanish, Russian, conversational Chinese. Others: ASL, morse code. Drive?: yes. He’s pretty good at driving all kinds of vehicles and motorcycles. Knows how to drive boats and some planes too. Jump-start a car?: yes. Change a flat tyre?: yes. Ride a bicycle?: yes. Swim?: yes. He enjoys swimming. Play an instrument?: Piano. Play chess?: yes, pretty well. Knows how to beat most in less than three moves. Braid hair?: Yes. Mostly in the context of what he knew to do for his younger sister. Little beyond that. Tie a tie?: Yes. Pick a lock?: Yes. Cook?: Yes.

PHYSICAL APPEARANCE & CHARACTERISTICS

Faceclaim: S. Cabrera Eye colour: Brown Hair colour: Brown Hair type/style/length: thick, long-medium length, wavy, a little unruly -- reference. Glasses/contacts?: Reading glasses. Dominant hand: Born left handed, but can use both. Height: 5′11 Weight: 176 lbs Build: lean, muscular especially in arms and legs, undefined chest, hairy. References: one, two. Exercise habits: every day, at least thirty minutes. Skin tone: Light brown, sun-kissed. Tattoos: an squared circle between his shoulder blade (x), the monas hieroglyphica on his right bicep (x), the sigil of chaos, in the back of his left hand (x), a circled dot in the pad of his left index finger (x). Piercings: none. Marks/scars: 5 cm cut on his left cheek. Stab wounds scars on his abdomen. Rough hands product of manual labor. Clothing style: alternates between casual (sweaters, jeans, boots, white or black shirts, guayaberas) and formal (suits) depending on the need. Can look either well groomed or scruffy, whatever is necessary. Jewellery: can sometimes be seen wearing chains either of gold or silver. Allergies: none. Diet: primarily vegetable based, with fish and chicken as preferred meats. Seldom eats beef or pork. Eats carbs in the form of bread and corn based doughs. Relatively healthy. Physical ailments: knees ache. Suffers from occasional paints from the left hip from when he was shot there once.

PSYCHOLOGY

MBTI type: ENTJ -- ENTJs are strategic, organized and possess natural leadership qualities. They are master coordinators that can effectively give direction to groups. They are able to understand complicated organizational situations and quick to develop intelligent solutions. ENTJs are outspoken and will not hesitate to speak of their plans for improvement. They are decisive and value knowledge, efficiency and competence. Enneagram type: Type 8w6 SP/SX -- KEY MOTIVATIONS: Want to be self-reliant, to prove their strength and resist weakness, to be important in their world, to dominate the environment, and to stay in control of their situation. Moral Alignment: Chaotic evil -- referred to as the “Destroyer” or “Demonic” alignment. Characters of this alignment tend to have no respect for rules, other people’s lives, or anything but their own desires, which are typically selfish and cruel. They set a high value on personal freedom, but do not have any regard for the lives or freedom of other people. They do not work well in a group, as they resent being given orders, and usually only behave themselves out of fear of punishment. It is not compulsory for a Chaotic Evil character to be constantly performing sadistic acts just for the sake of being evil, or constantly disobeying orders just for the sake of causing chaos. Temperament: Choleric -- Someone with a pure choleric temperament is usually a goal-oriented person. Choleric people are very savvy, analytical, and logical. Extremely practical and straightforward, they aren't necessarily good companions or particularly friendly. Element: Fire + Air. Emotional stability: Very emotionally stable. Seldom gets sad, angry, or caught up in otherwise strong or potent emotions. Very driven, seldom loses focus or attention in his goals and day to day affairs. Introvert or Extrovert? Action-oriented Extrovert. Guzmán enjoys being around people only on the practical sense, if it’s helping him toward the progress of his ambitions and goals. Obsession(s): mutant supremacy :/ conspiracy theories. Power. Money only in the context of achieving more power. Compulsion(s): whenever he has to sharpen a knife in his kitchen, he ends up sharpening them all. And he can’t leave a book halfway through a chapter. He has to end the chapter, so next time he sits down to read he’s starting through another. Phobia(s): none. Addiction(s): Mind games. Drug use: regularly smokes cigars or cigarettes. Alcohol use: mostly will have a glass of whiskey every few nights, no more than that. Prone to violence?: Yes. Prone to crying?: No Believe in love at first sight?: No.

MANNERISMS

Accent: faint accent that could be pinned as that of a native spanish speaker. Speech quirks: he can get pretty talkative when things come down to it. Occasionally, he will interrupt his monologuing to ask if the other person understands what he’s saying. Hobbies: elaborated above: reading, chess, crossword, sudoku, playing intruments, working out, swimming. Habits: stroking/scratching his beard, fiddling idly with the things that are in his hands, opening and closing his fists deliberately. Nervous ticks: does not give away when he’s nervous. Drives/motivations: power-seeking, revenge, general mayhem and destruction. Fears: none in the immediate sense. Guzman is not scared of death, of things going wrong, of pain. He’s died before, things have gone wrong before, he’s been tortured before. Visceral fears have no hold over him. His disquiet stems more from existential concerns. Sense of humour?: decent. Although, when he’s serious, he does not tolerate disrespect and jokes/flippant demeanors are considered disrespect. Do they curse often?: not really. Will usually only curse to drive a certain point home.

FAVORITES

Animal: wolves and all matter of felines. Beverage: whiskey and rum, water. Book: he cannot choose! Colour: warm tones. Food: rice with chicken and beans, arepas, etc. Flower: does not care. Gem: does not care. Mode of transportation: car or motorcycle. Scent: cinnamon, coffee, freshly baked bread. Sport: soccer, baseball. Weather: sunny. Vacation destination: does not care for the concept, though as a rule he prefers warmer climates.

ATTITUDES

Greatest dream goals: for mutants to be in power, and for him to be in charge of them. Greatest fear: the eradication of the mutant race. Most at ease when: he is in control of the situation at play, when things are going according to plan, when someone has reaffirmed his loyalty to him in vital ways. Least as ease when: there are variables that stop him from being fully in control, or he doesn’t know key pieces of information. Worst possible thing that could happen: dying before seeing a good portion of his plans materialized. It would be the worst, but it would be mostly inconvenient, really. Biggest achievement: helped (through direct and indirect ways) make discrimination against mutants illegal in Venezuela, Brazil, Argentina, Chile and Perú. Participated in the assassinations of authoritarian figures and anti-mutant politicians in South and Central America. Biggest regret: does not have one -- yet.

#files.#hc.

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barb31clem · 6 years

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The Mines of San Francisco

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Alon Levy has an interesting framing of some curious data on multiple people sharing bedrooms in San Francisco. He explains this in terms of people going to work in the mines or an offshore oil platform for a period of time in order to make money.

I’ve heard of Google programmers living two to three to a bedroom in Bernal Heights, not even that close to BART. I’ve also heard a story of people near the Ashby BART stop in Berkeley renting out their front porch; the person sleeping the porch was not a coder, but some of the people living inside the house were.

I have not talked to the people in these situations, only to friends in Boston who live one person (or one couple) to a bedroom, even though they too can afford more. As I understand it, they treat the Bay Area as like working in the mines. They earn a multiple of the income they would in other industries with their education and skills, and have no particular ties to the region. (Some East Coasters have taken to use the expression “drain to the Bay,” complaining that friends in tech often end up leaving Boston for San Francisco.) The plan is to save money and then retire in their 30s, or take a lower-paying job in a lower-cost city and start a family there. … People endure this overcrowding only when they absolutely need to for work. In a situation of extremely high production amenities (that is, a tech cluster that formed in Silicon Valley and is progressively taking over the entire Bay Area), comfort is not a priority. Joel Garreau’s The Nine Nations of North America describes people in San Francisco viewing the city as utopian for its progressive lifestyle, temperate climate, and pretty landscape. Today, the middle class views the city as a dystopia of long commutes, openly antisocial behavior, human feces on sidewalks, poor schools, and car break-ins. … The mines are not a stable community. They are not intended to be a community; they’re intended to extract resources from the ground, regardless of whether these resources are tangible like oil or intangible like tech. There may be some solidarity among people who’ve had that experience when it comes to specifics about the industry (which they tend to support, viewing it as the source of their income) or maybe the occasional issue of work conditions. But it’s not the same as loyalty to the city or the region.

Be sure to read the whole thing.

One piece of color I might add is that some of the people living the “mines” lifestyle may be foreign workers who came to get US experience and pile up some cash before returning home and starting their own companies or something. (When I was with Accenture, I worked with a lot of Indians who came to the US intending for it to be a sort of job rotation. Another group wanted to permanently immigrate. Not everyone comes here for the same reasons).

The idea of a the city as a mine links to something I’ve long noticed about analysis of the creative class. The creative class is generally portrayed as a hyper-fickle group of people who, if their lifestyle and policy preferences are not catered to, will leave for greener pastures.

This vision of the creative class sees the city primarily a venue for the pursuit of self-interest. Any commitment to the local place is at best contingent. In short, all creative class types are portrayed as mining the city at some level, either for production or consumption.

Expecting creative class gentrifier types to have any interest in social solidarity when the entire concept is based on the idea that they will make a long distance geographic move at the drop of a hat if they find themselves displeased or opportunity dries up seems dubious.

from Aaron M. Renn https://www.urbanophile.com/2018/09/25/the-mines-of-san-francisco/

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topmixtrends · 6 years

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DANIEL BAXTER is a front-line physician and HIV specialist at the William F. Ryan Community Health Center in New York City and the author of The Least of These My Brethren: A Doctor’s Story of Hope and Miracles on an Inner-City AIDS Ward (1997) and the recently published memoir One Life at a Time: An American Doctor’s Memoir of AIDS in Botswana. A board-certified internist, he worked for three years at the Spellman Center for HIV-Related Diseases in New York before spending more than six years in Botswana providing direct patient care, teaching health-care workers, and mentoring physicians under the aegis of the African Comprehensive HIV/AIDS Partnerships. In 2013, he returned to Botswana for another two years to work at the country’s new medical school, heading up teams of residents and medical students at the country’s largest hospital, caring for patients with end-stage AIDS. This conversation took place over email in May and June of this year.

WILLIAM GIRALDI: One Life at a Time opens with your decision, in 2002, to leave your high-profile job as the medical director of a large community health center in New York City and move to Botswana in order to help with its new National HIV/AIDS Treatment Programme. You’d been helping AIDS patients since 1992, at St. Clare’s in Manhattan. St. Clare’s, you say, was the first time you “came up against the full horror of AIDS,” and yet that horror was diminutive compared to what you’d soon witness in Botswana, where a staggering 24 percent of the population was infected with HIV the year you arrived. You describe Botswana as “the size of France, landlocked, and mostly desert — the Kalahari comprises 70 percent of it — and it’s one the most sparsely populated countries in the world,” with a million fewer people than live in Brooklyn. What fueled your decision to move there?

DANIEL BAXTER: My decision to move at age 52 to an African country I knew next to nothing about was the culmination of a medical career which had evolved over many years, from initial ignorance of who I was, to a greater understanding of both myself and our common suffering. As with most things in life, it was a process. My medical career has spanned the trajectory of the HIV/AIDS epidemic — from the first disquieting reports in the 1980s of previously rare infections and cancers in young gay men, to the terror in the gay community, to the so-called “new face of AIDS” in drug users, women, and people of color, to the advent of life-saving treatments in the mid-1990s, to the devastation in sub-Saharan Africa, and finally to the introduction of HIV treatments there. My 43 years in medicine have been a journey of self-discovery and self-creation as I moved beyond the cluelessness of my early years of being a doctor to a greater appreciation of how my patients can teach me how to live with integrity and love, eventually — I hope — to face my own death without fear.

It is amazing how many important life decisions, e.g., choosing a professional career, can be made without any serious introspection. Such was the case with my going to medical school. I was finishing undergraduate work at Ohio State University, with a degree in chemistry, but the option of pursuing a PhD in some aspect of that discipline sounded boring. Talking more out of my ass than really speaking my heart — I didn’t know my heart very well at the time — I told people that I didn’t want to relate to just test tubes, chemical reagents, and the occasional PhD student down the hallway, and that I wanted more human interaction, thus choosing medicine. Although I also mouthed the bit about wanting to help sick people, I really had no idea about human suffering, especially my own. Plus, my low draft number and the deferment for medical school heightened my commitment to medicine and to helping others.

Doctors, like soldiers, typically enact the necessity of emotional suppression in order to get the job done. Remember Milton’s line from his great masque Comus: “Those budge doctors of the Stoic fur,” in which “budge” means “burly” or “strong.” But what’s clear from your book, and from what you say here, is that you wanted no part of that: you came to see that your commitment as healer required your deep emotional engagement and even the acknowledgment of your own weaknesses.

Yes, during the decades after Ohio State I learned and then practiced the mechanics of medicine, but not the art of caring, of understanding the suffering of my patients and applying it to my own life. I assiduously avoided emotional involvement in my patients’ suffering, cultivating a studied detachment, which, sadly, even stifled my emotional response to the terminal cancer afflicting my closest friend from Ohio State: I remember visiting John Rock in the hospital — he was the first of my many unrequited loves — and having no reaction to his profound wasting and imminent mortality. To my eventual shame and regret, I didn’t even tell him that I loved him during that last visit, a few weeks before he died in 1977. If I couldn’t be moved by John’s suffering, how could I be expected to empathize with my patients?

But the terrifying advent of HIV/AIDS in the early 1980s shattered my detachment, since, as a sexually active gay man, my own complacent life was now directly threatened. As reports of strange and fatal infections percolated down to my private practice in Iowa, I tried to learn as much as possible about this new virus, especially its modes of transmission, primarily to protect myself from what back then was certain death. Geography probably saved me: had I lived in one of the major urban areas, I most surely would have perished with so many others.

But over these early years of the epidemic, my ongoing interest in HIV medicine gradually evolved into more than just a self-protective stance. Although the science of HIV was intriguing — a beyond-microscopic virus infects the body’s important immune cells, causing devastating infections — it was the philosophical and ethical aspects of this new disease which seized my attention. I reacted with horror at how HIV-infected people were treated as lepers, or worse. Maybe because I was still in the closet and had always felt an outsider in the macho medical group I worked at in Iowa, I somehow identified with the shame and guilt which had been infused into this anonymous virus. HIV had become associated with hatred and intolerance toward “the other,” people who were different and judged to be not “normal” or even worthy of love and caring. I suppose it was the stubbornness I had inherited from my mother, but I was outraged at how HIV-infected people were regarded as untouchables.

You did eventually relocate to the city, first DC and then New York, a move you discuss in One Life at a Time but also in your first book, The Least of These My Brethren. This strikes me as an intensely courageous move since you knew that the work there would be terrifying and that you yourself might be at risk. But moving to those cities was also an essential prelude to your decision to go to Botswana.

Yes, I moved from Iowa to Washington, DC, in 1989, primarily to learn more about HIV, and there I saw firsthand how the gay community, which, to be sure, had suffered immensely from the plague, too often looked on HIV as their own special Calvary. The smug, politically correct posturing of many of the leaders of the gay community was very off-putting, especially since by then it was known that the major targets of HIV were IV drug users, women, and people of color. Thus, in 1992 I leapt at the opportunity to move to New York City, to work in a decrepit, hole-in-the-wall AIDS ward at St. Clare’s Hospital, where I cared for the so-called “new face of AIDS” among the so-called lowest of the low: the drug addicts, the homeless, the prisoners and ex-prisoners. Somehow, even though there were no effective treatments, my work at St. Clare’s seemed more real, more vital, since these were people who had been outcasts even before HIV had struck them down. At St. Clare’s I realized that we are all HIV-positive in this weary sojourn of life, regardless of whether our HIV tests return positive or negative. This seemingly trite but crucial insight — that we are all on the downward spiral to the grave, some of us rapidly and others more leisurely — this insight should mitigate the shame and discrimination so rampant back then.

After moving on to work at the Ryan Community Health Center, where many of our HIV patients were among the dispossessed and marginalized, I eventually sensed that with the new effective therapies and the generous social services for our HIV patients, HIV care in the United States was largely on track, that the emergency was passing. After attending the 2000 International AIDS Conference in Durban, South Africa — the first such meeting in a non-Western county — I learned of the full scope of the catastrophe facing sub-Saharan Africa and felt a moral imperative to help. Just as when I accepted the job at St. Clare’s, I had no idea what I was getting myself into when I accepted the job in Botswana, but I felt that my experience in caring for AIDS patients and witnessing death and suffering at St. Clare’s would prepare me for the onslaught in Africa. But as my book chronicles, I was wrong.

I also took to Botswana my growing animus toward what I felt were the spoiled, demanding, and entitled patients in America, who, I maintained, had no clue about the real suffering I knew I would find in Botswana. I thought that my prior AIDS work had given me a perfect understanding of life, suffering, and my own heart. Little did I know at the time how my arrogance would pull me down into the maelstrom of AIDS in Africa — soon after I arrived, I had two patient catastrophes, largely due to my hubris and rank ignorance of how things were in Africa. But after deconstructing me, Africa’s infinite time and space allowed me to soldier on, to save myself. I came to understand that the only person I can ever “save” was myself — if I was lucky — and that all I could do for my patients was give them precious extra time to save themselves, if that was indeed even necessary. As I soon learned, most of my patients in Botswana had a deep spirituality that gave them strength to confront AIDS. Legion were the times an AIDS patient would recount to me her unfathomable woes but then conclude with the resolute assertion, “But God is good.” This optimism in the face of profound adversity also buoyed me up whenever I found myself nearly drowning in the sea of need there.

To save yourself spiritually by saving others, yes. I’m thinking of Allan Gurganus’s show-stopping novel Plays Well with Others, about the scourge of HIV and AIDS in Manhattan in the early 1980s, and how those brigades of loyal and courageous gay men rushed in to nurse their stricken when the health-care apparatus and our government was pitiably, unforgivably slow in giving support or even acknowledging the scourge. Tens of thousands went to the grave before President Reagan could even utter the word “AIDS,” and so the gay men were mostly on their own to nurse one another. Gurganus’s novel is a lovely, lasting homage to those many Whitmans among the wounded. Did you see a similar breed of care and camaraderie during the AIDS pandemic in Botswana?

That’s a very interesting question, and one that highlights the different approaches people in Botswana took in addressing the AIDS crisis. It’s probably best to look at it from the standpoint of first the patients and then the local health-care workers and outsiders like myself involved in implementing the National HIV/AIDS Treatment Programme. This Programme was the first such comprehensive initiative in Africa and, in a way, was a massive public health “experiment” to see if Africans could really do it, that is, rescue people from AIDS on a massive scale.

First the patients: For countless generations, the Batswana had shared a deeply held sense of community, with the family and the village taking center place. In fact, in Botswana, AIDS really was “a family affair,” with multiple members of a family stricken with the disease and the remaining healthy ones looking after their sick relatives. The combinations and permutations of such family dynamics were many: an elderly aunt could be caring for her young niece, or vice versa; a younger sister could be looking after her much older brother or, if the brother had already succumbed to the disease, his wife and their children, and so on. Many times, HIV-infected children orphaned when their parents died from AIDS would be taken in by distant relatives. There were really no social services for families to draw upon — the only government-provided “entitlement” AIDS patients got was a monthly food basket consisting of flower, some canned goods, rice, and vegetables. Family members were also enlisted to help their infected relatives with taking their HIV drugs — the National Programme strongly encouraged every patient to have an “adherence partner,” to be sure the patient took the medicines regularly and without fail. Indeed, many times the patient would be so far gone, wasted away and suffering from HIV dementia, that they could never be counted on to remember to take their medicines, and a devoted adherence partner, usually a family member, would be their only salvation, ensuring that they took their drugs and eventually recovered.

I’d say no place better illustrates the Batswana’s sense of community in combating AIDS than the cramped waiting rooms in the HIV clinics throughout the country. There wasn’t the sepulchral silence of waiting rooms of HIV clinics in New York City, where patients studiously isolated themselves from the others. Rather, in Botswana the clinic waiting rooms, always jammed beyond belief with patients, friends, and family members, rang out with what seemed like hundreds of voices competing for attention, as people shared the latest village gossip, or attested to the healing powers of the new HIV treatments, or traded tips on how to counteract their side effects. Although shame and stigma about HIV was rampant throughout the country, somehow, in the clinics, these negative feelings were largely left at the door, as everyone struggled against the plague, seemingly in unison. In fact, the loud scenes in the HIV clinics reminded me of the noisy bantering I would always hear in the locker room of my gym, where the guys would playfully chat about sports and girls, all at the top of their lungs.

In addition to their innate sociability, the Batswana lived in the moment, and their zest for living leavened many of the sad stories I encountered there. This was a country where the application for a driver’s license asked me: “Are you, or have you ever been an imbecile?” and where the daily tabloids were replete with stories such as “City Police Arrest Serial Donkey Rapist.” Indeed, my book is far from doom and gloom — far, far from it — and even the most pathetic situations were often, ironically, tinged with humor and levity.

There are similarities there to what one sees enacted so beautifully in Gurganus’s novel: all those loyal dear ones at the sides of their dying. In your book, though, you express regret that the benevolence of the Batswana toward their own was not always replicated at other levels, especially among those Western hawkers and hoodwinks who’d showed up to get rich.

Yes, unfortunately, the sense of camaraderie and shared community that the Batswana relied upon to get through their AIDS crisis didn’t always carry over to the people who were treating them and implementing the Treatment Programme, especially among outsiders like myself. By the time I arrived in Botswana, approximately six months after the first patients started treatment, the country was awash with Westerners who were ostensibly there to help its fledgling Treatment Programme. In addition to the worthy goal of trying to help people with AIDS, there were three other major enticements for us Westerners to come there: trips to the game reserves up north to see wild animals — you haven’t lived until you’ve seen an infinity of elephants, their young in tow, meandering down to the river at sunset, kicking up a golden scrim of dust — plus, the irresistible lures of profitable consultancies and cutting-edge medical data to publish and add to your CV. Although very little aid from the West ended up in people’s pockets there — Botswana is pretty graft-free, at least for Africa — the millions of dollars from the West, primarily the United States, spawned all sorts of consultancies, which, of course, paid generous fees to their directors. As I wrote, a colleague of mine, an internist from India, once loudly proclaimed, “There’s money to be made from AIDS, and I intend to have some of it!”

But in all fairness, there were also good people from the West. If it weren’t for several young doctors from Harvard, who were in the country to start up an important clinical research project, the Treatment Programme wouldn’t have started when it did in early 2002. Frustrated with the red tape typical of such a monumental public health project — one of the legacies of the British was a bureaucracy that gave new meaning to the word “Byzantine” — the Harvard doctors, with crucial help from their Batswana nursing staff, just started treating patients, thus bringing into being Marina Hospital’s HIV clinic, the first in the nation.

How did the Batswana doctors and nurses react to the epidemic? Your book has loving portraits of some pretty impressive and merciful people.

Yes, the Batswana health-care workers — the doctors, social workers, and, above all, the nurses — more often than not emulated the shared sense of community of their patients and were empathetic and understanding of their patients’ needs. The nurses were teachers and mentors for their patients, who, after all, were often friends, neighbors, and even relatives. The nurses were helpful in assessing whether or not a patient was ready to start HIV treatment — more often than not, they knew all sorts of personal details about my patients — and I almost always followed their advice in this regard. The nurses were also responsible for adherence education, which was given both one-on-one and in group sessions, which usually included hymns, Bible readings, and prayers by one of the local pastors. Imagine something like that here in New York! Like worried and scolding mothers, nurses in Botswana’s AIDS clinics would beat into their patients two cardinal precepts: HIV therapy was lifelong, and it had to be taken one hundred percent of the time, usually interspersed with loud exhortations to “condomize, condomize, condomize!” It was as if the honor of your family, your village, even the entire nation was on your shoulders as an HIV patient. During my stay in Botswana, there were many nurses whose compassion and dedication to their patients were truly impressive. In particular, I remember Rachael, a clinic nurse in an out-of-the-way dilapidated hospital in the remote Kalahari Desert, who knew so much about the personal lives of the patients I saw with her, and whose love for her fellow sufferers — she was HIV-infected but, “Thanks be to God,” doing well on treatment — humbled me. As I wrote in my book, she probably had helped many more patients than I ever did.

At one point early in the book you speak about the South African president Thabo Mbeki, who as late as 2000 was still putting forth the belief that HIV didn’t cause AIDS. Mbeki’s Minister of Health, Dr. Tshabalala-Msimang, was known as “Dr. Beetroot” because she distrusted Western medical science and somehow convinced herself that beets, garlic, and herbs would cure HIV. This ignorance, according to a study done several years ago, probably caused the deaths of 300,000 South Africans. You also say at one point that in Botswana, AIDS “was sometimes regarded as a curse” inflicted by “a powerful witch doctor.” We in the West might have a hard time understanding the cultural realities that spawn such thinking. How do you understand them?

Well, remember that many of us in the West are also enamored of unproven treatments such as crystals, aroma therapy, megavitamins, and a host of herbal “medicines,” probiotics, and anti-oxidants. And many people in the States put great stock in Zodiac signs and horoscopes. Likewise, for countless generations the Batswana had looked to the heavens for answers, and many believed that, as part of an unforgiving Mother Nature, the behemoth of AIDS had to be placated with their own versions of crystals, anti-oxidants, and aroma therapy, often provided by a witch doctor or “traditional healer.” At the KITSO course, the “HIV 101” training for the country’s health-care workers I headed up for many years, I would joke that in Botswana these unproven treatments — “muti” — were called “traditional medicines,” whereas in America we called them “alternative medicines,” neither of which had FDA approval and both of which relied entirely on “the placebo effect.” Yet, the miracles of the HIV medicines introduced into Botswana from the West gradually chipped away at the seeming invincibility of AIDS, and with it, the invincibility of the old gods and ancient beliefs of its people.

The cultural and spiritual consequences of the major perturbations wrought by the West’s intervention in Botswana’s HIV crisis are yet to be fully reckoned. Every so often during the first couple of years of my stay there, various journalists and freelance writers from the states would interview me about the country’s HIV/AIDS Treatment Programme, hoping to write a definitive account of the great public health initiative unfolding there. I would always be courteous — usually they paid for our lunch or dinner — but I couldn’t give them the scoop, the juicy news, or, in some cases, the scandals they were looking for. Indeed, even 16 years after the Treatment Programme began, I don’t think the final story can yet be written. Before the AIDS crisis hit Botswana, it was really a quiet, sleepy country — in my book I described it as the African version of Switzerland — and in a matter of a few short years it was overwhelmed by both skyrocketing deaths from AIDS and us crazy people from the West with our frantic efforts to force the country into the West’s medical mold of regular doctor visits. It’s not that the Batswana didn’t care about their people dying from AIDS, but they felt that much of the solution was in God’s hands, not ours. My book tries to describe the seismic changes that have shaken this tiny country as it confronted both the horror of AIDS and the onslaught of us Westerners with our HIV drugs and our own cultural values.

Tell me your prognosis for the AIDS situation in Botswana. Things there today are different from what they were when you first went there in 2002, thanks in large part to the National HIV/AIDS Treatment Programme to which you contributed so much. Does your hope remain buoyed?

The prognosis is very good! Yet, there still are people falling through the cracks, not getting HIV tested for whatever reason — shame and stigma still are problems there — or testing positive and not following through and getting treatment. When I returned in 2013 to work in the medical school there, I had thought that the success of the HIV/AIDS Treatment Programme — over 95 percent of Batswana eligible for treatment were receiving it — meant that there would be only rare patients with end-stage AIDS, but I was wrong: at Marina Hospital, the country’s major referral center where I headed up teams of residents and students, there were too many patients with all sorts of terrible complications of AIDS. It’s the old question, “Is the glass seven-eighths full or one-eighth empty?” Even in neighboring South Africa, which has the largest HIV treatment program in the world, the statistics are heartening: over 60 percent of the HIV-infected population is on treatment. Of course, there would be even more, if it hadn’t been for President Mbeki’s willful ignorance at the turn of this century.

Indeed, Botswana’s HIV/AIDS Treatment Programme has progressed over the past 16 years to the point that its “first-line” treatment regimen is identical to that here in the West. The challenge now facing the country is addressing the many non-HIV medical conditions there, which have largely been neglected over the years because of the country’s mobilization to save people from AIDS. When I was there, I saw many patients with strokes and heart attacks that were complications of untreated high blood pressure, or end-stage kidney disease from out-of-control diabetes. And screening for colon, cervical, and breast cancers was nonexistent. Now that HIV is largely under control, the country will hopefully devote more resources to these problems, which affect far more Batswana than HIV does. As a sort of silver lining to the turmoil of the past two decades, the health-care infrastructure and training the AIDS crisis created should give the country a leg up in addressing these non-HIV medical conditions.

Over the past several years, all of the major international AIDS conferences have been devoting more and more of their scientific sessions toward searching for a cure, late-breaking research into either eradicating HIV from the body or, perhaps more realistically, finding a “functional cure,” where HIV is still in the body but remains quiescent without the patient having to take any HIV medicines. Sixteen years ago, when I first arrived in Botswana, such talk would have been regarded as pie-in-the-sky, even delusional. But let’s remember how only 18 years ago, at the Durban AIDS Conference in 2000, talk about just getting large numbers of Africans on HIV drugs was regarded by many of us in the West as an unattainable goal. So such a cure, when it is found, might someday come even to Botswana. One of the many lessons from Botswana’s successful HIV/AIDS Treatment Programme is that we must never underestimate the resiliency and indomitability of the human spirit. My book is a “one life at a time” testimony to this human spirit, and, I hope, a tribute to both the doomed and the spared I had the privilege of caring for.

William Giraldi is the author of the novels Busy Monsters and Hold the Dark (soon to be a feature film from Netflix), the memoir The Hero’s Body, and a collection of literary essays, American Audacity.

The post One Life at a Time: A Conversation with Dr. Daniel Baxter appeared first on Los Angeles Review of Books.

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newstfionline · 7 years

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How Utah Keeps the American Dream Alive

Megan McArdle, Bloomberg, March 28, 2017

There’s no getting around it: For a girl raised on the Upper West Side of Manhattan, Salt Lake City is a very weird place.

I went to Utah precisely because it’s weird. More specifically, because economic data suggest that modest Salt Lake City, population 192,672, does something that the rest of us seem to be struggling with: It helps people move upward from poverty. I went to Utah in search of the American Dream.

Columnists don’t talk as much as they used to about the American Dream. They’re more likely to talk about things like income mobility, income inequality, the Gini coefficient--sanitary, clinical terms. These are easier to quantify than a dream, but also less satisfying. We want money, yes, but we hunger even more deeply for something else: for possibility. It matters to Americans that someone born poor can retire rich. That possibility increasingly seems slimmer and slimmer in most of the nation, but in Utah, it’s still achievable.

If you were born to parents who were doing well, you are likely to be doing well yourself. If you were born to parents who were not doing well, then you are likely to repeat their fate. To take just one metric of many: In a society in which a college degree is almost required for entry into the upper middle class, 77 percent of people whose families are in the top quarter of the earnings distribution secure a bachelor’s degree by the time they are 24. For people in the lowest income bracket, that figure is 9 percent.

But things look a lot better in Salt Lake City, which economists Raj Chetty, Nathaniel Hendren, Patrick Kline and Emmanuel Saez identified as having the highest rates of absolute upward mobility in the nation. So I went to Utah to discover its secrets and assess whether they could be exported.

Once I got there, I found that it’s hard to even get a complete picture of how Utah combats poverty, because so much of the work is done by the Mormon Church, which does not compile neat stacks of government figures for the perusal of eager reporters.

The church did, however, give me a tour of its flagship social service operation, known as Welfare Square. It’s vast and inspiring and utterly foreign to anyone familiar with social services elsewhere in the country. This starts to offer some clue as to why Utah seems to be so good at generating mobility--and why that might be hard to replicate without the Latter-Day Saints.

UTAH-STYLE GOVERNMENT. There’s bad news and good news.

Bad news: The wide gulf between Utah and, say, North Carolina implies that we do, in fact, have a real problem on our hands. A child born in the bottom quintile of incomes in Charlotte has only a 4 percent chance of making it into the top quintile. A child in Salt Lake City, on the other hand, has more than a 10.8 percent chance--achingly close to the 11.7 percent found in Denmark and well on the way to the 20 percent chance you would expect in a perfectly just world.

“Big government” does not appear to have been key to Utah’s income mobility. From 1977 to 2005, when the kids in Chetty et al’s data were growing up, the Rockefeller Institute ranks it near the bottom in state “fiscal capacity.” The state has not invested a lot in fighting poverty, nor on schools; Utah is dead last in per-pupil education spending.

But “laissez faire” isn’t the answer either. Utah is a deep red state, but its conservatism is notably compassionate, thanks in part to the Mormon Church. Its politicians, like Senator Mike Lee, led the way in rejecting Donald Trump’s bid for the presidency. And the state is currently engaged in a major initiative on intergenerational poverty. The bill that kicked it off passed the state’s Republican legislature unanimously, and the lieutenant governor has been its public face.

This follows what you might call the state’s “war on homelessness”--a war that has been largely victorious, with most of the state’s homeless resettled in permanent housing through a focus on “Housing First.” That means getting people into permanent shelter before trying to diagnose and address the problems that contributed to their homelessness, like mental illness and substance abuse.

This approach can be cheaper than the previous regime, in which too many individuals ended up in emergency rooms or temporary shelter seeking expensive help for urgent crises. But Housing First runs into fierce emotional resistance in many quarters, because it smacks too much of rewarding people for self-destructive behaviors. Utah’s brand of conservatism overcame that, in part because the Mormon Church supported it.

People in Utah’s government casually talk about getting the community involved in their efforts, not as a rote genuflection to a political ideal, but as an actual expectation. “Government’s not going to solve all this, and that’s why you’re in the room,” Lieutenant Governor Spencer Cox said to attendees of a community meeting about the Intergenerational Poverty Initiative, and it wasn’t just an idle hope. Utah really does have an immense parallel structure that can be counted on to bolster anything the government does on poverty. Its front door is Welfare Square.

THE MORMON WELFARE NETWORK. Like most social service agencies, Welfare Square is in one of the less pretty parts of town, tucked just off the highway between industrial buildings and modest tract homes. The complex itself, incorporating public spaces where help is offered, and private spaces where the church manufactures many of the goods it gives away, is built of modest materials and is kept scrupulously clean. And it is vast.

Many charity operations offer a food pantry or a thrift shop. Few of them can boast, in addition, their own bakery, dairy operation and canning facilities, all staffed by volunteers. The food pantry itself looks like a well-run grocery store, except that it runs not on money, but on “Bishop’s Orders” spelling out an individualized list of food items authorized by the bishop handling each case. This grows out of two features of Mormon life: the practice of storing large amounts of food against emergencies (as well as giving food away, the church sells it to people for their home storage caches), and an unrivaled system of highly organized community volunteer work.

The volunteering starts in the church wards, where bishops keep a close eye on what’s going on in the congregation, and tap members as needed to help each other. If you’re out of work, they may reach out to small business people to find out who’s hiring. If your marriage is in trouble, they’ll find a couple who went through a hard time themselves to offer advice.

But it does not stop with informal networks. Mormon youth are encouraged to go on missions. Many of them evangelize, of course, but others end up doing work for the church, including at Welfare Square. Every Mormon is expected to skip two meals a month, and to donate at least the value of the food they would have bought (and preferably more) to help the needy. They’re also encouraged to volunteer for the church. A job center at Welfare Square harnesses the still-prodigious energies of retirees; when I was there, an immigration center, also staffed with volunteers, was just starting up. The assistance offered is not unique, but the sheer scale of it is; few other churches could muster a similar army of willing, helpful people, or deploy them so efficiently.

The Mormon Church has a particular philosophy of help. Don Johnson, division director for the Welfare Department of the Church, spoke of the Pharisees quizzing Jesus in the gospels: “They asked the savior what is the greatest commandment--love God, and love your neighbor.” For the Mormon Church, that means making sure that no one goes hungry.

But the church is quite clear that the help is a temporary waypoint on the road to self-sufficiency, not a way of life. People are asked to work in exchange for the help they get, and, as the bishop said, “We make a list of what will sustain human life, not lifestyle.” I sampled various of the food items, and all were perfectly tasty, but nothing was what you would call fancy. It’s a utilitarian stopgap, not a substitute for an income, and not meant to be; the help comes with a healthy push to get yourself back on your feet as quickly as possible. The two phrases I heard over and over were “individual” and “self-reliant.”

“It’s a failure on the part of many,” he said, “if this is going on for six months or a year and their condition hasn’t changed.”

This combination of financial help and the occasional verbal kick in the pants is something close to what the ideal of government help used to be. Social workers used to make individual judgments about what sort of help their clients needed or deserved. But such judgments always have an inherently subjective and arbitrary quality, which courts began to frown on in the middle of the 20th century, in part because they offered considerable discretion for racial discrimination.

THE RACE FACTOR. One astonishing feature of Utah is how little people talk about race. The state population is now about 13 percent Hispanic, but only 1 percent black. Part of the explanation is probably the Mormon Church’s century of institutional racism.

During the era of founder Joseph Smith, the church actually seems to have been relatively egalitarian for its time. But his successor, Brigham Young, who led the Latter-Day Saints to Utah, excluded black followers from the priesthood (which is generally open to every Mormon man), keeping them out of the center of ecclesiastical life. The doctrine did not change until 1978, and the church’s racist past still lingers.

Unsurprisingly, the Mormons did not attract many black converts during the century that the ban was in place. Given that Utah is primarily peopled by Mormons, its population skews white.

This near-absence of racial diversity means that racism is largely left out of Utah’s conversations about economic inequality. That leads to some conversations around inequality that would be unbearably fraught elsewhere. When the poor people are, by and large, the same race as the richer ones, people find it easier to talk about them the way they might talk about, well, family members--as folks who may have made some mistakes and started with some disadvantages, but also as folks who could be self-sufficient after a little help from an uncle or a sister. It’s a very different conversation from “victim”/”oppressor” and “us”/”them”: a conversation that recognizes that poor people often make choices that keep them in poverty, but also that the constraints of poverty, including the social environment of poor neighborhoods, make it very difficult to make another choice.

Utah’s willingness to help, and its ability to help, may arise from its homogeneity--a trait that won’t be exported to the diverse nation at large.

THE SOURCE OF STABILITY. Utah is an aberration in many other ways. Look at alcohol and marriage.

The Mormon Church forbids drinking, and alcohol sales are far lower here than in other states. The incidence of problems associated with alcohol--like poverty, unemployment and crime--is also lower than in most other states.

On the other hand, the Mormon Church strongly encourages marriage, and the state is #1 in both married adults and in the percentage of children being raised by married parents.

Chetty et al suggest that having two married parents is a bedrock foundation of economic mobility--one that is rapidly eroding in modern America.

By encouraging members to marry, the Mormon Church is encouraging them to reduce their own likelihood of ending up poor. But it may also be creating spillover effects even for non-Mormons, because Chetty et al didn’t just find that married parents helped their own children to rise; they also influenced the lives of the children around them.

If you live in a neighborhood full of single mothers who had a hard time finishing school, that’s probably the future you’ll expect for yourself and your own kids. If you live in a neighborhood full of thriving two-parent families, that’s probably the future you’ll envision, even if your own father disappeared when you were 2. Marriage matters at the individual level, but it also matters at the community level, because the community can strongly shape individual behavior.

CAN UTAH’S MOBILITY BE REPLICATED? Utah’s incredible levels of integration, of community solidarity and support, of trust in government and in each other, enable it to build something unique in America, something a bit like Sweden might be, if it were run by the U.S. Chamber of Commerce. Where the best ideas of conservatives and liberals came together in one delicious package: business friendly, opportunity friendly, but also highly committed to caring for the needy and helping them get back on their feet.

No place is perfect. But with mobility seemingly stalled elsewhere, and our politics quickly becoming as bitter as a double Campari with no ice, I really, really wanted to find pieces of Utah’s model that could somehow be exported.

Price gave me some hope. The Mormon Church, he says, has created “scripts” for life, and you don’t need religious faith for those; you just need cultural agreement that they’re important. He said: “Imagine the American Medical Association said that if the mother is married when she’s pregnant, the child is likely to do better.” We have lots of secular authorities who could be encouraging marriage, and volunteering, and higher levels of community involvement of all kinds. Looking at the remarkable speed with which norms about gay marriage changed, thanks in part to an aggressive push on the topic from Hollywood icons, I have to believe that our norms about everyone else’s marriages could change too, if those same elites were courageous enough to recognize the evidence, and take a stand.

President George W. Bush talked a lot about compassionate conservatism 15 years ago, but Utah has made it a reality. Utahans seem strongly committed to charitable works, by government, alongside government or outside government. Whatever tools used are infused with an ethic of self-reliance that helps prevent dependency. And yet, when there’s a conflict between that ethic and mercy, Utah institutions err on the side of mercy.

America could use a politics more like that. And the values that make it work are not unique to Mormonism.

#Salt Lake City #Utah and the American Dream #American Dream #Mormons and American Dream

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ongames · 8 years

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Dr. Mary Bassett: We Must 'Name Racism' As A Cause of Poor Health

The following is excerpted from Dr. Mary Bassett’s October 2016 acceptance speech, ‘Public Health Meets the ‘Problem of the Color Line,’ for Columbia University’s Frank A. Calderone Prize in Public Health. Bassett is the commissioner of New York City’s department of health and mental hygiene.

Before Hillary secured the nomination, before many “felt the Bern,” and indeed, even before there was change we could believe in, there was a presidential candidate of several firsts running to represent a major party ticket who broke the mold in more ways than many could comprehend, let alone support. I am speaking of Shirley Chisholm.

There’s so much to learn from, but what I want to focus on today is her bold, unapologetic, and explicit commitment to naming racism. In her memoirs, she wrote: “Racism is so universal in this country, so widespread, and deep-seated, that it is invisible because it is so normal.” If you think the conversation on race in our country is just getting legs now, can you imagine a presidential candidate saying this in 1972? And still, nearly 45 years later, her analysis stands.

Congresswoman Chisholm has us consider how we lose sight of what’s right in front of us.

This is a consideration that has woven its way throughout my working life. A little over 30 years ago, Nancy Krieger and I published an article in the Monthly Review titled “The Health of Black Folk.” In it, we wrote about the normalization of poor health among black people – how the status quo of poorer health and shorter lives comes to pass as one the “facts of being black.” The following passage begins this essay:

What is it about being black that causes such miserable odds? One answer is the patently racist view that blacks are inherently more susceptible to disease, the genetic model. In contrast, environmental models depict blacks as victims of factors ranging from poor nutrition and germs to lack of education and crowded housing. Instead of blaming the victims’ genes, both liberals and conservatives blame black lifestyle choices as the source of the racial gap in health.

The “facts of being black” are not, as these models suggest, a genetically determined shade of skin color, or individual deprived living conditions, or ill-informed lifestyle choices. The facts of being black derive from the joint social relations of race and class: racism disproportionately concentrates blacks into the lower strata of the working class and further causes blacks in all class strata to be racially oppressed.

I believe we’ve come a long way since the 1980s, but I’m not sure that our analysis of racism and health, or social justice and health, has grown more sophisticated, drawn more practitioners, or explicitly influenced much policy. I can say that because I continue to find myself explaining the very same concepts I wrote about in the 80s in 2015 and 2016, most recently in an interview with Big Think and in a piece for the New England Journal of Medicine about the importance of #BlackLivesMatter.

All of this is true even when there has never been more attention given to concepts like the social determinants of health and health equity. Representative Chisholm’s insight becomes prescient in this respect, for today our analysis of equity and social determinants is ironically myopic, a limitation that keeps us from fully realizing their potential as frameworks.

Today, we can speak of health equity without invoking race at all. Those who do speak of race seldom explicitly name racism, and even in those few forays into racism, there is hardly mention of the history and the contemporary of racial oppression, or the staying power of white supremacy. This troubles me, because it doesn’t take much for invisibility – what we don’t see – to become blindness – what we can no longer see.

My goal is to convince you all that we must explicitly and unapologetically name racism in our work to protect and promote health – this requires seeing the ideology of neutral public health science for what it is and what it does. We must deepen our analysis of racial oppression, which means remembering some uncomfortable truths about our shared history. And we must act with solidarity to heal a national pathology from which none of us – not you and not me – is immune.

There are many well-meaning and well-trained public health practitioners who disagree from the outset that we must name racism. That argument will sometimes claim that the very essence of public health is about helping people, pointing to increased lifespans and decreased infectious disease outbreaks over time. Their argument will at other times claim that we don’t want to muddy the clear waters of public health with the messy politics of race, that this sort of a topic is best left to protesters, opinion editorials and campaign stump speeches. I have also heard the claim that identifying racism opens this Pandora’s Box of problems that our modest field cannot hope to address comprehensively – that identifying racism hoists too heavy a burden. Last, there are those who say that racism is not the core issue, but instead poverty. We cannot fix racism, but we can fix poverty.

Of these, I believe the most dangerous claim is the first, that our technical expertise is enough to meet the challenges of poor health, wherever they are. This mindset presumes a neutrality of public health that has never been true – it ignores the fact that public health both operates in a political context and is itself, like any science, permeated by ideology.

Much is conflated when medicine and public health attempt to fly below the radar of politics by donning the armor of scientific objectivity – guarding the faith by positing the cold logic of the scientific method. Let me start by saying that science is not all methodology – one simply cannot judge the prudence of a whole ecology of funders, research proposals, theory-building, conferences, journals, institutes, and applications by reducing all of that to the scientific method. Each of these facets is fully penetrated by the biases of human behavior, by the ideologies of our time.

Consider two examples: funding priorities of the National Institutes of Health (NIH) and the public health, medical, and criminal justice response to the current opioid crisis.

In the case of the NIH, see its most recent 2012-2013 biennial report to Congress: as my colleague Nancy Krieger has pointed out, not only did it allocate only 9 of its 441 pages to “Minority Health and Health Disparities,” but within these 441 pages, the terms “genome,” “genomic,” “genetic,” and “gene” appeared 457 times, whereas “social determinants of health” occurred only once, “discrimination” and “poverty” twice, “socioeconomic” 12 times, and “racism” not at all.

Or, with regard to the current opioid crisis – and its appropriate reframing as a public health and not criminal justice issue – how differently it would have been had the same framing been used when Nixon declared his “War on Drugs!” But of course he did not. Today, the opioid crisis is perceived as primarily affecting white populations, people who need help. No such frame of deserving victims was used, however, by Nixon. Instead, as shown in Ava DuVernay’s extraordinary new film “13th” that was a “war” that aimed to criminalize the black population and reverse the gains of the Civil Rights Movement and the War on Poverty.

We must remember that objectivity is not a synonym for neutrality. Objectivity refers to the idea that independent researchers can independently seek to test the same hypothesis and, if the hypothesized causal processes are indeed going on, they should come up with the same results if they use the same methods. However, what researchers choose to study and how they frame hypotheses determines the context in which objectivity is deployed. I urge you to consider, for example, that a great deal of unacceptable actions have taken place when objective methodology is utilized without regard for the role of science in oppression: eugenics, forced sterilization, the Tuskegee study. Often these are dismissed as bad science, or unethical science, when they too, in fact, are science.

Knowing this, we must name racism in our research proposals, in our theories, in our oral presentations and conference tracks, and even in our hypotheses. The essence of naming racism is this – how we frame a problem is inextricable from how we solve it.

We must remember that objectivity is not a synonym for neutrality. Dr. Mary T. Bassett, NYC commissioner of health and mental hygiene

The first solution to the inadequate colonial workforce was found in Irish bond labor, and so Irishmen worked the plantations until the English desired more labor to maximize the gains of more land. This is where the Atlantic Slave Trade was born. For an early period, some workers of African descent also worked as bond laborers, freed just like the Irish following the period of their indenture.

This period came to an end when the settlers decided they were releasing too many bond servants into freedom to make full use of their land. At the same time, a growing lower class of peasants would occasionally rise up in rebellion against large plantation owners, light-skinned and dark-skinned fighting side by side against the tyrannies of the wealthy.

The elite and lawmakers in Virginia found the most effective answer to this problem, an answer that is still with us today. In the 1680s, Virginia created a new category of people: whites. White people were afforded rights that were subsequently denied to non-whites. By the 1700s, whites could not be held in slavery into perpetuity and black slaves could not gain their freedom through work. Poor whites were instructed that God made non-whites inferior, in much the same way that the propertied were superior to the poor. What’s crucial here is that poor whites were not given the right to vote, and they certainly weren’t given a way out of poverty. What they were given were financial incentives to turn on their former allies – bounties for runaway enslaved Africans and plantation jobs for policing enslaved laborers.

But superiority was enough – the Virginia solution forever created a fissure between poor whites and blacks that the wealthy and powerful have taken full advantage of ever since. The rest of the story, I think, many of you know.

Knowing the origin of whiteness, and seeing whiteness as a social construct with a particular history – these are crucial to racial justice. The creation of white peoples and the data collected since demonstrate roundly that white supremacy without a doubt privileges whites in relation to people of color, but it still limits the potential gains of our collective liberation, whites included.

One the most telling studies in this respect – I turn again to my colleague Nancy Krieger – looks at the relationship between Jim Crow laws and infant death rates. The graph she assembled compares infant mortality for whites and blacks who lived under Jim Crow to those who did not, before and after the Civil Rights Act of 1965. You might guess that the disparity between blacks living under Jim Crow and blacks not living under Jim Crow was erased. But what is striking to me is that whites living under Jim Crow had higher infant death rates before the Civil Rights Act compared to whites not living under Jim Crow. This disparity too was wiped out following the passage of civil rights legislation.

Yet, dog-whistle politics have harmed whites by racializing the safety nets of our social contract. Since the 1970s, as with Nixon’s “Southern Strategy,” conservative elites in power have linked nearly every public institution to unworthy people of color, hoping that poor whites would take the hint that they’re the better, hard-working race. By tying government institutions to an undeserving non-white underclass, we saw growing populist support to defund the War on Poverty, the Great Society, public schools, public hospitals, all while increasing penalties on drug possession and use. Today – particularly the last several years in which whites have been railing against the War on Drugs – all of these shortchanges have served to harm both non-elite whites and all blacks. The President of Demos, Heather McGhee, talks about the harms of racism on white people like this: “we prefer to drain the public swimming pool of economic opportunity rather than let people of color swim, too.”

All that said, my hope is that white supremacy does not make you anxious or uncomfortable. It should make you mad. Understand that anti-racism is not a witch hunt, but a collective healing, without which our nation will remain painfully and inequitably divided, corroding opportunity, spirits, and bodies alike.

Over time, the explicit bias of white supremacy has turned into an implicit bias, something measured deftly by the Harvard Implicit Association Test – I encourage you all to go online and take it. What it has shown is that implicit bias against blacks, as well as other identities, is pervasive, including among people of color. The socialization we all go through in this country, because it is so thoroughly imbued with anti-black messaging and imagery, creates a bias most of us most exact active effort to counterbalance. So you can see the power of explicitly naming racism and taking stock of white supremacy.

The question arises – how do we act in solidarity? What does this all mean for our practice?

Naming racism, keeping it at the forefront of our consciousness and in our dialogues, is really important. Talking about racism, I hope, will encourage you to read and study more about some of the topics I’ve discussed, and the many more that I have not. If your study leads to critical self-reflection, I say that’s a good thing if you truly believe that racism hurts everybody. I do caution you, if you are a white person, to avoid placing too much of a burden on people of color to explain their racial oppression to you.

If acknowledging racism and white supremacy is the minimum, there’s room for much more. I wrote in the New England Journal of Medicine that we must use our tools in public health to carry out more critical research on racism to help us identify and act on longstanding barriers to health equity. This is why, in part, we are emphasizing the revitalized Neighborhood Health Action Centers I described at the beginning of this talk, and are placing them in neighborhoods long deprived of societal resources that should be theirs.

Further still, we can look inward toward the makeup and conduct of our own institutions. When I started as Commissioner almost three years ago, I put resources toward a group of staff to lead what we call “internal reform” at the health department. With the goal of becoming an anti-racist institution, the agency is acting on recommendations made by staff to reform our budgeting and contracting practices, our recruitment and hiring procedures, our community engagement behaviors, our training protocols, and our communications frameworks. It takes a sustained commitment to realize the full promise of these reforms, but we are laying the groundwork with urgency.

Last, I think one of the most important things we can do to stand in solidarity is lend our voice to advocacy for racial justice, unto itself and fully cognizant of the many other struggles for justice in which the work for racial justice is entwined. Those of us who work in public health have been afforded great privileges, tremendous credibility. The best use of that is to be a voice for the voiceless – and to amplify the voices of those who are speaking up, especially those of the youth who have the energy to drive us forward.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

Dr. Mary Bassett: We Must 'Name Racism' As A Cause of Poor Health published first on http://ift.tt/2lnpciY

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yes-dal456 · 8 years

Text

Dr. Mary Bassett: We Must 'Name Racism' As A Cause of Poor Health

Congresswoman Chisholm has us consider how we lose sight of what’s right in front of us.

Consider two examples: funding priorities of the National Institutes of Health (NIH) and the public health, medical, and criminal justice response to the current opioid crisis.

We must remember that objectivity is not a synonym for neutrality. Dr. Mary T. Bassett, NYC commissioner of health and mental hygiene

The question arises – how do we act in solidarity? What does this all mean for our practice?

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from http://ift.tt/2k47gOn from Blogger http://ift.tt/2kJdksz

#http://www.topwaytohappy.tk/2017/02/dr-mary-bassett-we-must-name-racism-as.html

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imreviewblog · 8 years

Text

Dr. Mary Bassett: We Must 'Name Racism' As A Cause of Poor Health

Congresswoman Chisholm has us consider how we lose sight of what’s right in front of us.

Consider two examples: funding priorities of the National Institutes of Health (NIH) and the public health, medical, and criminal justice response to the current opioid crisis.

We must remember that objectivity is not a synonym for neutrality. Dr. Mary T. Bassett, NYC commissioner of health and mental hygiene

The question arises – how do we act in solidarity? What does this all mean for our practice?

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from Healthy Living - The Huffington Post http://huff.to/2lprD4L

#Healthy Living - The Huffington Post

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