Tuesday, March 25, 2014

Tuberculosis and Healthcare Inequalities: It gets personal

I had tabled this particular blogpost because I felt it wasn't quite complete enough to tackle the controversy that I'm trying to expose. But as this blogs is merely a platform for an exercise in writing, I thought I'd post it in hopes for a lively discussion or searing critiques. 

I’ve always loved a good story, particularly when the subject matter revolves around my favorite celebrity—me.  To start with, I realize my fortune; I don’t have any serious medical conditions and I have health insurance. But sometimes, I want sympathy, I want shock value, and saying you’ve got a sore back when you just finished 5 rounds of disco-bowl doesn’t usually make friends and family come running with a heating pad, foot rubs, and chicken noodle soup. So imagine my incredulity when I tested positive for TB.

This Christmas, when I was in town, I visited my pediatrician, whom I still visit occasionally for inexplicable reasons (mostly because he wears a teddy bear bow-tie) due to a persistent cough and cold. My mother strongly suggested that I get a TB skin test as well, in the same way that she strongly suggested my sophomore year that I wear a helmet and hockey pads while riding in the car with my girlfriends. That being said, I brushed her off initially, but then, on a whim, decided to request it anyways.

Three days later, I came back in with an angry, red lump underneath the skin of my forearm. It was clear. I was positive for the TB bacteria. He called the public health department and ordered a blood test and a chest X-ray, looking wide-eyed. As one of the only positive results in his three decades of practice, I’m pretty sure my case was an exciting break from his routine of baby hernias and snotty noses. After all, most pediatric patients don’t run in high risk circles. Despite my questionable choices in friends, migrant laborers and Russian prison inmates have unfortunately heretofore not been a part of my immediate social network.

But I have sat on a bus so crowded that people clung to the sides, and children laid over rows of seats like plywood. I suppose in that circumstance, an uncovered cough could be problematic. As my skin reaction continued to swell, I thought about all the famous noteworthies who succumbed to TB. Emily Bronte, King Tut, Nicole Kidman’s character from Moulin Rouge, and Doc Holliday, the famous gunslinger from OK Corral. A sanitarium would be the perfect setting for a Gothic romance novel, I fantasized! They called it consumption at the time, which sounds a lot… wetter.

My X-ray, sputum test, and blood work all came back negative. I have the TB bacteria inside of me, but no active infection. I AM NOT CONTAGIOUS.

But, as the reality and scope of the disease sank home, my nonchalance over a potential 9 month round of antibiotics sickened me. I was ashamed. I was treating a potential TB infection as a joke, a ploy for attention and some well-placed references to Florence Nightingale.

But it’s not. It’s not a joke. It was only a joke to me because I’m a lucky one. Put simply, I’m healthy, I’m young, I’m well-fed, I am part of one of the most developed biomedical systems in the world. I’m rich, comparatively. I have health insurance. I’m the neatly pieced and presented Exhibit A of Market-based Medicine’s display at the science fair. I have no reason to be scared.

It’s a matter of access, haves and have nots. Consumption, as it was known in the olden days, did not discriminate back then. Egyptian mummies are buried with ancient curses and some bling, but their skeletons spell TB.  Emily Bronte, a high-born Victorian (although perhaps constitutionally delicate, as she would, no doubt want us to imagine her) died of it. 

So where are the posh patients now? All I see are poor patients. Because in 1,323 B.C. or in 1848 A.D. water was dirty, travel was hard, and black, graveyard themed 40th birthday parties were swiftly followed by an actual funeral. Doctors were quacks and antibiotics a thing of the future. Modern medicine hadn’t made its grand debut, with scrub-clad high kicks and latex-gloved jazz hands, a show performed only for those who can pay the price of admission.

But now, the 1.3 million people who die each year are concentrated in the poorest countries in the world, where all those hardships of the past are present realities—Nepal, Haiti, Malawi house the burden of disease. Treatable diseases, such as TB, HIV, and malaria, doggedly follow the poor, and if they don’t run fast enough, will snatch them by the ankle and bear them to the ground.  For many, TB is a death-sentence, or at least, another giant setback for those already fighting the long defeat of poverty and malnutrition.

So tell me, in a world where Twitter can start a revolution, a man can play putt-putt on the moon, you can take a satellite photo of your own garage, and medicine can reattach limbs, why can’t we prevent poor people from diseases we’ve had cures for since before that inaugural lunar golf game? Does this showcase the progress of humankind? I think not.

What it shows, in stark, dark relief, is that we haven’t gotten our priorities straight. It can’t be scientifically impossible to ensure that neither rich nor poor die from these diseases, we just… can’t be bothered with it. The rich aren't dying from it, so why are the poor? We must ask ourselves this question, and not be afraid to stare at the ugliness of the answer.   

But I’m lucky. I can take the possibility of a disease that kills 1.3 million people each year as a God-given gag gift. A trivial anecdote to pull out at during that summer camp ice-breaker. 


There, my friends, penned into every syllable of this text, is packaged privilege. 

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