A incompetência da metáfora ou a metáfora da incompetência?

Esse livro de Sunsan Sontag, A Doença como Metáfora foi editado no Brasil em 1984. Emprestei para alguém, que não devolveu. Comprei depois a versão original. Caso esse exemplar encontre-se com você, amigo leitor desse blogue, por favor, envie ele diretamente, a Sua Excia. o Presidente da República, Sr Luiz Inácio Lula da Silva. O primeiro mandatário na Folha de S. Paulo " admitiu, 16 dias após o acidente com o Airbus da TAM, que estava mal informado sobre a extensão da crise aérea, iniciada há dez meses com o desastre do Boeing da Gol. Em reunião com ministros e líderes partidários, Lula comparou-se a um paciente que não soubesse a gravidade da doença e descobrisse que está 'com metástase no corpo todo'.

A sinopse do livro de Suzan Sontag pela editora foi o seguinte: utilizando as fantasias forjadas em torno do câncer, e também da tuberculose em tempos passados, Sontag realiza um severo exame da irreal e muitas vezes primitiva utilização da doença em nossa sociedade. O livro revela uma forma de protesto contra todas as formas de mistificação das enfermidades. As reflexões da autora muitas vezes se voltam sua vivência pessoal como portadora de câncer.

Virando a medicina de ponta cabeça

Se você tiver interesse em em entender como fatores de risco tornaram-se doenças e, como sintomas foram substituídos por números. O livro Prescribing by Numbers

Drugs and the Definition of Disease de Jeremy A Greene é obrigatório. Entenderá também a bizarra decisão do FDA no caso Avandia. Em outras palavras, o medicamento não reduz o risco de doença coronariana, aumenta o de insuficiência cardíaca, mas reduz o valor da glicemia no jejum. Entenderam?

JAMA: Direitos Humanos e Violência.

O Journal of the American Medical Association publicou uma edição dedicada a assuntos relacionados a violência e direitos humanos. A página inicial da revista pode ser vista clicando aqui com visualiação dos resumos. Abaixo, a relação de artigos.

Interventions for Depression Symptoms Among Adolescent Survivors of War and Displacement in Northern Uganda: A Randomized Controlled Trial

Child Maltreatment in Enlisted Soldiers' Families During Combat-Related DeploymentsDeborah

HIV Prevalence and Predictors of Infection in Sex-Trafficked Nepalese Girls and Women

Exposure to War Crimes and Implications for Peace Building in Northern Uganda

Association of Trauma and PTSD Symptoms With Openness to Reconciliation and Feelings of Revenge Among Former Ugandan and Congolese Child Soldiers

Improving Batterer Intervention Programs Through Theory-Based Research

Hunger Strikes, Force-feeding, and Physicians' Responsibilities

Editorials Children of War and Opportunities for Peace

Isto é SamPa

A foto ao lado de José Patrício da Agência Estado foi feita em São Paulo, hoje, para ilustrar o frio. Como o objetivo foi flagrar a compra de roupas, ele captou nessa amostra da população paulistana, um caleidoscópio racial e de cor de pele. Essa realidade é difícil de ser aceita pelos scholars americanos e os adeptos brasileiros que estão impondo o racialismo como política de estado. O falecido grupo Premeditando o Breque, já tinha cantado que a "japonesa loura, nordestina moura, só em São Paulo"

Quanto gastar em saúde?

Um questão antiga relaciona-se ao quanto gastar em saúde em um determinado país. Diz a lenda que um dia a Organização Mundial de Saúde estipulou em 5%. Valor mínimo ou maximo do Produto Nacional Bruto? Afinal, não depende da realidade demográfica e epidemiológica de cada país? Simplificando para a economia doméstica: um casal jovem com filhos irá ter gasto em educação e saúde diferente de seus pais já idosos e sem filhos em casa. Em Health Affairs , William Savedoff faz uma análise simples e elegante da questão do financiamento em saúde.

FDA: comissão considera que Avandia deve continuar no mercado.

20 x 3 foi o resultado. Leia no The New York Times. Interessante, o maior problema do diabetes é aumentar o risco de doença cardiovascular, mas o Avandia, não aumenta, nem reduz o risco de doença coronariana, diz o FDA. Então, por que prescrevê-lo?

A migração do médico da "rica" África para o "pobre" Canadá

A saída de pessoal médico da África para Europa, Estados Unidos e Canadá é motivo de preocupação cada vez maior. Há duas publicações recentes analisando o tema.

The Brain Drain of Health Professionals from Sub-Saharan Africa to Canada

Ronald Labonte, Corinne Packer, Nathan Klassen, Arminee Kazanjian, Lars Apland, Justina Adalikwu,Jonathan Crush, Tom McIntosh,Ted Schrecker, Joelle Walker, David ZakusSeries Editor: Prof. Jonathan CrushAfrican Migration and Development Series No. 2, 2006Southern African Migration Project (SAMP) ISBN 1-920118-38-1 Produced by Idasa PublishingAva ilable online PDF [92p.]

Significant numbers of African-trained health workers migrate every year to developed countries developed countries including Canada. They leave severely crippled health systems in a region where life expectancy is only 50 years of age, 16 per cent of children die before their fifth birthday and the HIV/AIDS crisis continues to burgeon.1 The population of Sub-Saharan Africa (SSA) totals over 660 million, with a ratio of fewer than 13 physicians per 100,000.2 SSA has seen a resurgence of various diseases that were thought to be receding, while public health systems remain inadequately staffed. Migration and Developmente in Africa: an overview Richard Black, Jonathan Crush, Sally Peberdy with Savina Ammassari, Lyndsay McLean Hilker, Shannon Mouillesseaux, Claire Pooley, Radha Rajkotia African Migration and Development Series No. 1, 2006PDF [169p.] at:

"....The aim of this study is to synthesise existing research on migration in Africa, and its relationship to development policy. The report focuses on the relationship between migration, poverty and pro-poor development policy. Propoor policy is taken here to mean policies that are context-specific, listen and react to poor people’s voices, and/or seek to assist poor people to become less vulnerable and build up their income and assets. Government health and education policies might not be considered intrinsically pro-poor, but become so where they are targeted at widening access to health and education services, and especially basic health and education services (e.g. primary care, vaccination campaigns, primary schooling), or at responding to the specific needs of the poor. ..."

Dica de livro: Globalization and Health

Um livro que merece tradução é Globalization and Health de Ichiro Kawachi e Sarah Wamala, da Oxford University Press. Ele apresenta uma visão diferenciada da saúde pública abordando temas relevantes pouco discutidos como a dominação do automóvel nos dias atuais.

O grande pecado desse livro, para variar, é considerar a globalização como um fenômeno atual, contemporâneo. Essa é a grande negação da história que muitos pesquisadores - involuntariamente - cometem.

Eu particularmente aprecio muito a visão de Charles M. Boxer, expressa na obra O Império Marítimo Português - 1415 - 1825, edição da Companhia das Letras. Ele apontou que a expansão portuguesa e holandesa se chocaram naquilo que ele descreveu como sendo a Primeira Guerra Mundial que envolveu Pernambuco, Angola e a Indonésia. Em outros termos, a globalização se inicia muito antes com impacto no desenvolvimento da humanidade, vide a transferência de ouro, a migração de alimentos e de doenças entre os continentes.

NYT: uma análise da aids na Líbia

The New York Times (ver abaixo) apresenta uma análise da situação da aids na Líbia, após a libertação das enfermeiras búlgaras e do médico palestino. Revela que racismo, predomínio dos clãs na região de Bengazi e, o total descontrole sobre a hemoterapia estão na base do ocorrido. A Organização Mundial da Sáude considera os dados oficiais sobre a doença como "subnotificados". Foram-se os injustiçados profissionais da saúde, ficaram as vítimas de um sistema infame, cruel e incompetente.

THE safe landing of five Bulgarian nurses and a Palestinian doctor in Sofia last week, freed of a death sentence after eight years in Libyan prisons, was an apparent victory of diplomacy at long last. But the drawn-out drama over Libyan accusations that the medical workers had infected children with H.I.V. also reflects how difficult Libya’s own internal politics made it to reach an obvious solution far earlier, experts in the case said. And it calls attention to a sad epilogue that will play out in Libya: an AIDS epidemic that has never been fully acknowledged and that continues to spread, even as the 426 children who figured in this case depend on treatment in a system ill prepared for the task. Officially, two visits to Libya by Cécilia Sarkozy, the wife of the president of France, Nicolas Sarkozy, precipitated the release of the medical workers, who had been found guilty — not once, but twice — of infecting the children as part of a purported plot by the Israeli secret service. But hers were only the latest in countless series of pilgrimages by diplomats and scientists to plead with Libya’s leader, Col. Muammar el-Qaddafi. “It was completely clear scientifically since 2002 that they were not guilty,” said Vittorio Colizzi, an AIDS expert whom the Qaddafi family invited in 2000 to study the hospital in Benghazi where the infections took place. “But the nurses suffered for years from the incapacity of diplomacy and politics to free them in a timely manner.” He and another expert, Dr. Luc Montagnier, concluded that the AIDS virus was present in the hospital before the nurses arrived, probably carried to Libya by guest workers from countries in sub-Saharan Africa. In many of those nations more than 10 percent of the adult population is infected. Mr. Colizzi concluded that the virus had been spread by the infusion of unscreened blood and blood products, as well as by unsterilized equipment, pervasive problems that have only been partly solved. A home-grown AIDS outbreak caused by lax practices at a government hospital was not an explanation the government could acknowledge, medical and other experts say, especially when there were convenient foreign scapegoats. Bulgarians have long provided medical care in Libyan hospitals, and “are very unpopular because of racism,” said George Joffe, an expert on Libya at Cambridge University’s Center of International Studies. Palestinians are unpopular, too, he said, “so this group provided an obvious target.” Once the doctor and nurses had been blamed, the families of the children had to be placated, which took time. Colonel Qaddafi is unpopular in Benghazi, which is Libya’s second-largest city and was the home of Libya’s former regime, Dr. Joffe said. Also, Benghazi is a city of extended clans, so each sick child could be related to many residents, if distantly. “Qaddafi needed to pacify the community there, while satisfying the international community,” Dr. Joffe said. “Of course, he exploited the issue for political and economic gain internationally. But basically, a domestic issue delayed international resolution.” (....) Libya reported 10,450 cases of H.I.V./AIDS to the World Health Organization by the end of 2006, but outside experts consider that figure low. “There may be a lot out there that’s not detected or reported, as is true in many countries in the region,” said Gabriele Riedner, regional adviser to the World Health Organization in Cairo. “There is evidence of increasing H.I.V. infections in Libya, especially among the younger age groups,” with many cases, if not most, among users of injection drugs, the W.H.O.’s annual report says. Early on, European negotiators recognized that winning over the families would be crucial in freeing the doctor and nurses. Once the death sentences had been handed down, the negotiators felt the best hope for the jailed medical workers would be to invoke Islamic law and custom, under which injured parties accept compensation and express forgiveness, allowing the sentences to be reduced or overturned. “We were constantly working around two axes: to give signs of attention to the families to show them the world cared, vis-à-vis things like equipping hospitals and providing medical care,” the E.U. diplomat said. “And to see how far we could go in helping with compensation. But in many ways this was less important.” In the end, the families received $1 million apiece, almost all of that paid by the Libyan state, Dr. Joffe said, and agreed to the death sentences’ being dropped. The European Union and its member states have sent tens if not hundreds of million of dollars in aid to Libya, to create “a positive psychological and political environment” for the families. Furthermore, the children have been treated in hospitals in Italy, France and Britain. Still, said Dr. Colizzi, who has seen the children during visits to Benghazi and in Europe, some are “really sick” and are not getting good treatment at home. More than 50 have died. “The tragedy for the nurses is finished; now starts the tragedy for the children,” he said.