Violence in Russian Prisons

Chapter 9 of Farmer’s book, Pathologies of Power, brings up the issue of tuberculosis in Russian prisons and how that relates to violations in civil, social, and human rights. He says that these prisoners are subjected to very long pre-trial incarceration times, leading to a susceptibility to getting TB, which flourishes in the overcrowded conditions of the prisons. He points out that most of the objections to this terrible situation are made through a human rights lens and therefore most human rights groups interested in this issue try to get the incarceration time lowered while people are waiting for their trial. Farmer points out that some inmates have died from TB before their case has even gone to trial, an egregious violation of the prisoner’s rights on multiple levels. However, Farmer also mentions that these human rights violations are tied into the right to medical care, because most TB patients aren’t given an adequate amount of medicine in order to cure it, which is worse than not giving any medicine at all because it can result in the spread of drug-resistant strains. These human rights issues can also be tied to violence in Russian prisons, as I will address further.

In 2010, penitentiary reforms were enacted to lower prison overcrowding in Russian prisons. However, overcrowding is not the only problem, as there is an astounding amount of violence in these prisons, and it is frequently perpetuated or at least accepted by the guards and administrative representatives at the prisons. As this article explains, there is a great need for further prison reform, including the reduction in violence. The high mortality rate in Russian prisons is the result of a multifaceted system of dysfunction. Overcrowding, TB, and violence are among a few of the problems that makes the Russian prison system so problematic. As described here, there is a very high mortality rate in these prisons. Paul Farmer makes the case that TB has a lot to do with that, but violence plays a role as well in not only the mortality rate, but also the overall environment of despair.

As Farmer describes later in the chapter, the way to solving these health crises and to facing other human rights violations is through “the rapid deployment of our tools and resources to improve the health and well-being of those who suffer this violence.” A multifaceted and pragmatic is the best approach to these issues of structural violence.

The following video shows the issues that were being discussed about Russian prisons leading up to the prison reform in 2010. It reports on how graphic videos that showed violence against prisoners were part of the arguments in favor of reform and that it helped push the legislation into existence.

[youtube http://www.youtube.com/watch?v=8-BqksjUNg0]
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Food, Violence, and Health

As Kalofonos’s article points out, there is a wide range of interventions that are necessary in the treatment of HIV/AIDS in Central Mozambique. This concept can be extended to most diseases throughout the world. Treatment in the form of drug therapy is not enough; people need adequate access to food, clean water, sanitary conditions, among other treatment components in order to combat their illness most effectively. As this article points out, in the case of HIV/AIDS, the side-effect of hunger presents a problem due to the food shortage and widespread poverty in Mozambique. While people with HIV/AIDS may have access to ARVs to combat their disease, if they lack access to proper nutrition, their treatment will likely not be as effective.

As Paul Farmer has pointed out in the case of treatment for HIV/AIDS and tuberculosis in Haiti, it has been shown that drug therapy is more effective when combined with other lifestyle treatments such as a food allowance and periodic health visits to ensure proper medication. As this U.S. News article explains, in Farmer’s comprehensive plan, “patients receive not only lifesaving medicines and surgical care but also food, clean water, housing, education, and other social services, all delivered by locals trained in nursing skills and paid as community health workers.”

Much in the spirit of Farmer’s view of our interconnected world, violence and food also intersect in a global health context. For example, violence in Nigeria has led to an increase in the desperation of the food situation there. As the frequency of attacks by militant groups increase, the people in Nigeria living in poverty who already struggle with access to food are brought to an even more desperate situation. As the food crisis becomes even more severe, the health status of Nigerians will decline as well. In order to improve the food situation in Nigeria, the widespread violence needs to be quelled in order to prevent the ongoing “cycle of crises”, as this article highlights.

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An Oath Betrayed?

Chapter 8 in Paul Farmer’s Book Pathologies of Power examines the role that medical ethics plays in the global health care situation as well as the responsibilities that the medical community has to provide the basic human right of health care amidst the fundamental challenges of inequity. Farmer poses what are, in his opinion, the most important questions for the future of medical ethics in global health care. One of these questions includes the role and responsibility of physicians in living up to and fulfilling “the sacred contract between physician and patient”. He presents the disturbing concept of physician facilitation of harmful practices in the name of research or the betterment of society. One of these examples is the “participation of U.S. physicians in state-sponsored executions” despite the contradictory nature of being actively involved in ending someone’s life and the moral code and ethical model inherent in being a doctor.

The death penalty example brings to mind the participation of medical professionals in torture. This article from The New England Journal of Medicine offers a disturbing look at abuse and torture in a military context in Iraq, Afghanistan, and Guantanamo Bay. It brings up an interesting point about the “potential moral conflict between between commitment to the healing of individual people, on the one hand, and responsibility to the military hierarchy and the command structure, on the other”. I think this seemingly incompatible relationship between medical ethics and the military connects to this chapter from Farmer’s book. He points out the opposition of motives, goals, and intentions of the medical community when it comes to prevention, treatment, and access to health care around the globe. Medical ethics is a multifaceted and complicated issue that seems to pose a lot of problems when it comes to the state of health care today. However, as Farmer alludes to, there is hope in the application of ethical principles in order to confront the important issues we face today.

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If you click on the picture above, it will take you to an article that describes how doctors hid evidence of torture at Guantanamo Bay.

The Worst Form of Violence

Klienenberg’s description of the Chicago heat wave of 1995 as “a structurally determined catastrophe” is an important one because it offers a deeper explanation of the correlation between inequality and poverty as well as the “institutional and social mechanisms” that contribute to suffering. Much like other natural disasters and epidemics, the heat wave did not affect all people equally. Some were more susceptible to death not simply because of demographic factors such as age (although those did contribute), but also because their social position led to a lack of access to adequate care.

A similar correlation between poverty and violence exists and has been demonstrated in various studies across a variety of situations. This article from The Economist is an enlightening look at the relationship between conflict and poverty and how these forces contribute to the cyclical nature of this association. Not only is poverty itself a form of violence, but violence is exacerbated by the circumstances of poverty. This relationship has been demonstrated in many environments across different nations, and it has been recently been brought to the spotlight regarding Nigeria. Former U.S. President Bill Clinton said that the income gap and overwhelming poverty of the country has contributed to the violence and despair. Poverty is the fuel to the fire that creates a breeding ground for violence.

The Invisibility of Darfur

I found this article very interesting in the way it examined the role the media plays in shaping narratives and rhetoric regarding genocide, rape, and other atrocities. It reminded me of the interview our group recently did for our upcoming podcast with activists doing work in Darfur. One of them talked about how the story about the genocide in Darfur, and specifically the plight of Darfuri refugees, has been ignored recently because the story is no longer “sexy”. It was in the news for a while, but it soon got lost amidst other tragic stories about human rights violations and violence in other parts of the world.

Chiwengo offers Rwanda as an example of the “international community’s disinterest in Africa,” which is now being manifested in the Darfur genocide. The ways in which these stories are presented through the Westernized media are usually not conducive to eliciting a response capable of significant change. In our interview, the activists talked about how the refugees are aware of their basic human rights and they know they are being denied many of them. They wonder why the world hasn’t intervened to help them and they are losing hope because they think they are considered second-class human beings. This article explains how people in Darfur wonder why President Obama intervened in Libya, but he has not helped Darfur. This newspaper article wonders if President Obama has forgotten about Darfur. And the following movie gives an look at President Obama’s view on Darfur before he was elected by saying he did not want to “abandon people or turn a blind eye to slaughter”. Despite his original ambitions, however, the violence continues and people are still dying.

PTSD and Violent Tendencies

PTSD is a widespread consequence of mild traumatic brain injury, as described in the research study on soldiers returning from Iraq. Depression and other symptoms are also more common in those who experience a head injury such as a concussion. The study highlights the dangerous effects of mild traumatic brain injury on the lives of soldiers after they return home from combat. These scars are not usually visible, but their far-reaching consequences are very real and can be extremely harmful on the health and social relationships of veterans.

Mild traumatic brain injury can lead to changes in personality, as this page describes. The effects of PTSD can also lead to an increase in violent tendencies. This change in behavior is frequently seen in domestic violence, and studies have shown that PTSD in veterans and higher incidences of domestic violence are closely correlated. This is becoming a widespread problem, as veterans return home with invisible wounds that may not be recognized and treated. This enlightening ethnography shows the individual experience of one woman dealing with her veteran husband’s domestic violence. The following video offers some interesting facts about the long term consequences of mild traumatic brain injury as well.

Income Inequality Leads to Violence?

As described in Chapter 6 of Paul Farmer’s book, Pathologies of Power, healthcare inequality in the United States has been justified in many ways, including under the guise of “freedom of choice.” The fact that capitalism “does not impose a moral duty to help” is evidenced by the healthcare system of the United States. Individual people and certain groups are prone to being left out of having access to adequate care. Their social positions and economic statuses are reinforced by institutionalized mechanisms of inequality as described in the chapter. Income inequality has risen as the gap between the very rich and the very poor continue to widen. Now, even the disparity between the moderately wealthy and those on the cusp of the poverty line has become more noticeable in these economic times. Despite the political rhetoric of “class warfare” that has been raised recently, income inequality is a very real issue in society today that has tangible consequences. Healthcare is one of the facets in which this issue plays a significant role and there are devastating repercussions for those who do not have access to healthcare in this country.

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Unequal access to healthcare is not the only potentially dangerous effect of the disparity of wealth that has continued to rise rapidly. Income inequality and violence are strongly correlated. Countries with more income inequality have higher rates of homicide as well as other violent crimes. This article describes this relationship that has been proven in countries around the world and “persist despite cultural variations.”

Water Danger

Most of us take water for granted. We experience no hardship in the process of accessing this life-sustaining natural resource and it is hard to envision a life where water is more than just a turn of the faucet away. Zlolinski’s article features the inequity of water distribution in the San Quintín Valley by looking at the consequences for the agriculture industry in the area. The issues that arise in this article are based upon social, political, and economic mechanisms that maintain the unequal allocation of water in the area. This is a global problem, with many people facing individual hardships due to lack of access to water. And for many people around the world, getting water can be a dangerous endeavor.

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In the poorer, developing countries of the world, it is frequently the women’s job to have to go far away to get water. This endeavor is time-consuming, exhausting, and potentially dangerous. Throughout the world, women and girls spend “40 billion hours every year fetching and carrying water“. They walk for miles, but when they get there the water is often unclean and contains disease. Then they must haul heavy containers on the long walk back. This backbreaking labor is compounded by the risk of violence, frequently sexual violence, along the way. The vulnerability of the long trek to fetch water leads to men sexually assaulting or raping women along the way. Women fear for their lives on the way to get a necessary resource whose access is grossly unequal. This article shows how a water project has helped reduce sexual violence in Darfur.

Disease Compounds Disaster

The readings for this Thursday’s class explored the inequalities in health care and appalling lack of access to basic resources throughout the world. Millen’s introduction shows that despite the apparent improvement in statistics, the widening gap between developed and less developed countries has devastating consequences for billions of people around the world. It shows how statistics can be misleading, because while the world’s wealth has continued to increase, the disparity of wealth has created a global health crisis. And the most tragic part is that most of the diseases that kill people in developing countries are preventable. The lack of access to basic health care and adequate living conditions tends to be hidden underneath the faulty logic of improvement that lets developed countries “off the hook”. A good example of this is what happened in Haiti after the earthquake in 2010.

After the devastation of the earthquake, there was an outpouring of financial support from across the globe. However, much of the aid that has been pledged has yet to be distributed. And of the money that has made its way to Haiti, most of it has not improved the lives of the Haitian people in a noticeable way. In fact, a health crisis in the form of a cholera epidemic has thrust Haiti into a state of despair once again. The systemic poverty and lack of access to resources has been exacerbated by the earthquake, and the aid has not made a difference. As the poorest country in the Western Hemisphere suffers from a cholera epidemic, Haiti’s plight has all but been forgotten by the rest of the world that sent in billions of dollars in donations when the earthquake struck. As the readings for this week illuminated, health care is one of the areas that is most problematic for poorer countries. The statistics seem to convey that the world health situation is improving. However, as the article here describes, the devastation of cholera that has compounded the already inconceivable tragedy of the earthquake is an example of how less developed countries bear the burden of the world’s health care problem. This relates to our topic of violence because the same displacement camps with awful living conditions that became the breeding ground for the cholera epidemic created the conditions for violence, specifically sexual violence against women. The camps lacked basic health care and sanitary conditions, but they also lacked security, which gave opportunities for violence such as rape. This article gives one such tragic story.

[youtube http://www.youtube.com/watch?v=RstxNOjo9m8&feature=fvst]

The Tragic Toll of Diabetes

The New York Times article, “Diabetes and Its Awful Toll Quietly Emerge as a Crisis,” showed the frightening magnitude of social, economic, physical, and emotional effects of diabetes. By focusing on the ravaging path of the disease in a particular state, community, and even a single hospital, it gives the reader a more personalized account of the disease rather than meaningless statistics. I think it is more powerful and relatable by offering personal stories combined with the concerned opinions of professionals calling diabetes in this country an “epidemic”. It is clear that diabetes is negatively impacting many aspects of society, including the health care system and the economy as a whole, on top of the hardships individuals with the disease face on a daily basis. However, considering the toll this disease is taking, it is remarkable how few resources have been devoted to prevention, research, and treatment.

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In addition to the negative consequences set forth in the article, research has shown that diabetes can contribute to violent behavior. When blood sugar is low or there are problems with the metabolism of glucose, the brain is less able to control aggressive impulses. As the co-author of a study described in this article says, “this is the first study to find that boosting glucose levels can reduce actual aggressive behavior,” and that “there is a real correlation between diabetes and violence.” In a previous study, it was shown that states with higher diabetes rates have higher crime rates. While this is an example of correlation, and not necessarily causation, it is an interesting finding, and one that may make more sense in the context of this new study linking blood sugar to aggressive behavior.

This is another interesting article about the connection between diabetes and violence that shows how children who suffer from abuse are more likely to get Type 2 Diabetes in adulthood.