Laurie Garrett "Betrayal of Trust: The Collapse of Global Public Health"

Amelia Jordan's picture

Chapter One: In September of 1994 people in India were found to have a disease that was once called the Bubonic Plague in the 1400s. In the end fifty-six people died, but before it was all over, panic and fear spread throughout the nation rapidly, and then it hit the world. This panic caused the economic and political decline of the country. Stocks went down, tourists stopped coming, and trade with surrounding countries ceased almost completely. Indian doctors and citizens fled the country as well. Basically, all the necessary components of functioning cities were not in place, thus the country lost its ability to maintain an economic infrastructure. The Indian government had been negligent and had not paid enough attention to issues concerning the country's public health; their priorities had not been in order. As Garrett suggets, the government did not need new technology to defeat the plague, but proper implementation of basic health measures. There is a certain amount of trust between government officials and citizens that is necessary for maintenance of public health programs; this trust was violated globally and nationally during the plague outbreak. Garrett proposed that if the Indian citizens trusted their government they would, "respond swiftly to a disease crisis, reach sound scientific conclusions, and act rapidly in a manner that both staunched the outbreak and quelled panic."

Chapter Two: Zaire is yet another example of how an epidemic could have been stopped if a strong public health system had been in place. The pattern here is similar to that in chapter one: fear breaks out after several cases of the Ebola virus have developed, due to unclean conditions the virus spreads rapidly, and the government is blamed. In Kikwit, the Ebola outbreak was nosocomial and spread through a hospital that was completely lacking in basic hygiene. Doctors Without Borders finally stepped in and brought basic equipment, such as latex gloves, soap, and clean water. High-end technology was not needed, but these supplies and a plan for putting them to good use were. Similarly, India only needed cheap antibiotics and an adequate system for dispensing them to get rid of the pneumonic plague.
Chapter Three: One of the first Soviet public health campaigns was created by Stalin. A massive network of sanitation and epidemiology reached out to most Russian villages. The Sanitation and Epidemiology Service (SanEp) was made in the 1920s and its goal was to eradicate all of the infectious diseases of the Soviet Union. At this point, Russia had a strong public health infrastructure; however, this was before the collapse of the Soviet Union. Barely a year after the downfall of the USSR, epidemics exploded all over the fifteen former Soviet states. Outbreaks of Diphtheria, polio, hepatitis, typhoid, AIDS, cholera, and dysentery devastated the country. The collapse of this public health system also failed to contain "manmade" diseases such as alcoholism, drug abuse, tuberculosis, and cardiovascular mortality. One thing Russia's public health system needed the most was centralization. All of its individual sections had tools against disease, such as vaccines, scientists, sterile medical equipment, pharmaceuticals, and databases, but in order to be effective, all these tools needed to be combined. Alcoholism became a huge epidemic of its own. Garrett brings up statistics that demonstrate the drinking rates of Russians compared to other industrialized countries, and they are absolutely ridiculous. The rampant alcoholism led to a great deal of domestic abuse, which included severe numbers of abandoned, homeless children. Many were drinking on the job, including health care workers, which was acceptable because there were no alcohol policies. When Mikhail Gorbachev implemented one it was quickly brought down by a presidential hopeful, who wanted to win people over with his own brand of vodka. The issue of pollution also infiltrated the lives of those in Russia. At one point there had been a radiation accident (called Chernobyl, in 1986), which changed the ecology of the area forever. In the 1990s, the Russian government created a "dirty cities" policy program that included funds to help cleanup the "dirtiest" areas, most of which were considered unfit for living. AIDS was another source of distress for the public health system in Russia. Although Russian leaders agreed that something must be done to curb the epidemic, they ultimately did nothing other than give written support to programs like UNAIDS.
Chapter four: This chapter addresses the fact that the U.S. government does not fund public health sufficiently, which in turn caused public health infrastructures to erode. At the end of the twentieth century the idea that community health had rights and was important took second place to the concept that all public health responsibilities and rights belonged to individuals. Another important issue America faced was nosocomial infections. These infections were acquired when a patient was in the hospital, and by 1997, ten percent of all patients spending more than one night in a hospital had this non-viral infection. An additional example of an issue public health officials had to deal with was the transfer of drug-resistant "superbugs" to antibiotics.
Chapter five: Garrett emphasizes the importance of a strong public health infrastructure. The need for a well-built infrastructure arose from the threat of biowarfare. In biowarfare, viruses and/or germs are used as weapons. Examples of these weapons are smallpox, anthrax, and salmonella. Select U.S. citizens also published books on how to concoct various mixtures of chemicals that were thought to be lethal one prepared. These dangers initiated laws against bioterrorists. Public health protected communities by monitoring disease trends. The role of public health in bioterrorism was generally in concordance with defense and law enforcement

This book relates to what was learned in Biology: Basic Concepts, beginning with the idea of a viral or bacterial outbreak. Viruses and bacteria are highly improbable assemblies. They are not only energy-dependent, for they feed off the organism they are inhabiting, but also semi-autonomous. Bacteria must reproduce with some variation because there are different strains of the same kind of disease (e.g. the common cold).
Government-enforced infrastructures, that have gone wrong, pertain to the idea that if you do not take care of yourself, your body will not take care of you. The human body is energy-dependent, and if it does not maintain a source of energy, it will fail. Similarly, people are the "energy" units of public health systems and when the health system does not care for them, they will disperse or fail, thus causing the entire system to fail on account of death or the fact that there are no energy units left.


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