BiblioVault - Books about Medical care

Para-States and Medical Science

Making African Global Health

P. Wenzel Geissler, editor

Duke University Press, 2015

In Para-States and Medical Science, P. Wenzel Geissler and the contributors examine how medicine and public health in Africa have been transformed as a result of economic and political liberalization and globalization, intertwined with epidemiological and technological changes. The resulting fragmented medical science landscape is shaped and sustained by transnational flows of expertise and resources. NGOs, universities, pharmaceutical companies and other nonstate actors now play a significant role in medical research and treatment. But as the contributors to this volume argue, these groups have not supplanted the primacy of the nation-state in Africa. Although not necessarily stable or responsive, national governments remain crucial in medical care, both as employers of health care professionals and as sources of regulation, access, and – albeit sometimes counterintuitively - trust for their people. “The state” has morphed into the “para-state” — not a monolithic and predictable source of sovereignty and governance, but a shifting, and at times ephemeral, figure. Tracing the emergence of the “global health” paradigm in Africa in the treatment of HIV, malaria, and leprosy, this book challenges familiar notions of African statehood as weak or illegitimate by elaborating complex new frameworks of governmentality that can be simultaneously functioning and dysfunctional.

Contributors. Uli Beisel, Didier Fassin, P. Wenzel Geissler, Rene Gerrets, Ann Kelly, Guillaume Lachenal, John Manton, Lotte Meinert, Vinh-Kim Nguyen, Branwyn Poleykett, Susan Reynolds Whyte

[more]

Pedagogies of Woundedness

Illness, Memoir, and the Ends of the Model Minority

James Kyung-Jin Lee

Temple University Press, 2022

The pressures Asian Americans feel to be socially and economically exceptional include an unspoken mandate to always be healthy. Nowhere is this more evident than in the expectation for Asian Americans to enter the field of medicine, principally as providers of care rather than those who require care. Pedagogies of Woundedness explores what happens when those considered model minorities critically engage with illness and medicine whether as patients or physicians.

James Kyung-Jin Lee considers how popular culture often positions Asian Americans as medical authorities and what that racial characterization means. Addressing the recent trend of writing about sickness, disability, and death, Lee shows how this investment in Asian American health via the model minority is itself a response to older racial forms that characterize Asian American bodies as diseased. Moreover, he pays attention to what happens when academics get sick and how illness becomes both methodology and an archive for scholars.

Pedagogies of Woundedness also explores the limits of biomedical “care,” the rise of physician chaplaincy, and the impact of COVID. Throughout his book and these case studies, Lee shows the social, ethical, and political consequences of these common (mis)conceptions that often define Asian Americans in regard to health and illness.

[more]

Personal Memoirs of John H. Brinton

Civil War Surgeon, 1861-1865

John H. Brinton. Preface by John S. Haller, Jr. Foreword by John Y. Simon

Southern Illinois University Press, 1996

John Hill Brinton (1832–1907) met, observed, and commented on practically the entire hierarchy of the Union army; serving as medical director for Ulysses S. Grant, he came into contact with Philip H. Sheridan, John C. Frémont, Henry W. Halleck, William A. Hammond, D. C. Buell, John A. Rawlins, James Birdseye McPherson, C. F. Smith, John A. McClernand, William S. Rosecrans, and his first cousin George Brinton McClellan. John Y. Simon points out in his foreword that Brinton was one of the first to write about a relatively obscure Grant early in the war:

"Brinton found a quiet and unassuming man smoking a pipe—he could not yet afford cigars— and soon recognized a commander with mysterious strength of intellect and character."

Positioned perfectly to observe the luminaries of the military, Brinton also occupied a unique perspective from which to comment on the wretched state of health and medicine in the Union army and on the questionable quality of medical training he found among surgeons. With both A.B. and A.M. degrees from the University of Pennsylvania and postgraduate training in Paris and Vienna at a time when most medical schools required only a grammar school education, Brinton was exceptional among Civil War doctors. He found, as John S. Haller, Jr., notes in his preface, "the quality of candidates for surgeon’s appointments was meager at best." As president of the Medical Examining Board, Brinton had to lower his standards at the insistence of Secretary of War Edwin Stanton. Haller points out that one "self-educated candidate for an appointment as brigade surgeon explained to the board that he could do ‘almost anything, from scalping an Indian, up and down.’" Brinton assigned this singular candidate to duty in Kansas "where Brinton hoped he would do the least amount of damage." Throughout the war, the dearth of qualified surgeons created problems.

Brinton’s memoirs reveal a remarkable Civil War surgeon, a witness to conditions in Cairo, the Battle of Belmont, and the Siege of Fort Donelson who encountered almost every Union military leader of note.

Brinton wrote his memoirs for the edification of his family, not for public consumption. Yet he was, as Haller notes, a "keen observer of character." And with the exception of Brinton’s acceptance of late nineteenth-century gossip favorable to his cousin General McClellan, Simon finds the memoirs "remarkable for accuracy and frankness." His portrait of Grant is vivid, and his comments on the state of medicine during the war help explain, in Haller’s terms, why the "Civil War was such a medical and human tragedy."

[more]

The Political Economy of Health in Africa

Mis Af#60

Toyin Falola

Ohio University Press, 1992

This book examines the major phases in the history of health services in Africa and treats health as an integral aspect of the deepening crisis in Africa’s underdevelopment. One important thesis is that Western delivery systems have made health care less accessible for most people. Contributors direct attention to problems engendered by food shortages, acute cases of infection, the market in fake drugs as well as the inequality of access to facilities, the violation of human rights, and the recent danger of the dumping of toxic wastes in several African countries. One major implication of this volume is that there can be no solution to the health crisis in Africa until the linkage between health and poverty is recognized. The authors consider questions that add to the contemporary discussion of the place that traditional African medicine and philosophy should take alongside modern Western medicine in Africa today.

[more]

Poor People's Medicine

Medicaid and American Charity Care since 1965

Jonathan Engel

Duke University Press, 2006

Poor People’s Medicine is a detailed history of Medicaid since its beginning in 1965. Federally aided and state-operated, Medicaid is the single most important source of medical care for the poorest citizens of the United States. From acute hospitalization to long-term nursing-home care, the nation’s Medicaid programs pay virtually the entire cost of physician treatment, medical equipment, and prescription pharmaceuticals for the millions of Americans who fall within government-mandated eligibility guidelines. The product of four decades of contention over the role of government in the provision of health care, some of today’s Medicaid programs are equal to private health plans in offering coordinated, high-quality medical care, while others offer little more than bare-bones coverage to their impoverished beneficiaries.

Starting with a brief overview of the history of charity medical care, Jonathan Engel presents the debates surrounding Medicaid’s creation and the compromises struck to allow federal funding of the nascent programs. He traces the development of Medicaid through the decades, as various states attempted to both enlarge the programs and more finely tailor them to their intended targets. At the same time, he describes how these new programs affected existing institutions and initiatives such as public hospitals, community clinics, and private pro bono clinical efforts. Along the way, Engel recounts the many political battles waged over Medicaid, particularly in relation to larger discussions about comprehensive health care and social welfare reform. Poor People’s Medicine is an invaluable resource for understanding the evolution and present state of programs to deliver health care to America’s poor.

[more]

Practicing Medicine in a Black Regiment

The Civil War Diary of Burt G. Wilder, 55th Massachusetts

Richard M. Reid

University of Massachusetts Press, 2010

In early 1863, in the aftermath of Abraham Lincoln's Emancipation Proclamation, Massachusetts began recruiting black soldiers to serve in the Civil War. Although the first regiment formed, the 54th Massachusetts, would become the best-known black regiment in the war, the second regiment raised, the 55th Massachusetts Volunteer Infantry, performed equally valuable service in the Union Army.

Burt Green Wilder, a Boston-born, Harvard-educated doctor-in-training, was among the first white officers commissioned to staff the 55th Massachusetts. Like other officers serving in the state's African American units, Wilder was selected for his military experience, his "firm Anti-Slavery principles," and his faith in the value of black troops. From the time he joined the 55th in May 1863 until the regiment was discharged in September 1865, Wilder recorded his experiences and observations. He described the day-to-day activities of a Civil War surgeon, the indignities suffered by black enlisted men at the hands of a War Department that denied them the same treatment offered to white troops, and the role of the regiment in the campaign around Charleston and in Florida.

Service in the southern states also allowed Wilder to indulge a passion for natural science and comparative anatomy, including the collection of unusual species, one of which—the spider known as Nephila wilderi—still bears his name. After the war he completed his medical studies at Harvard and joined the faculty of Cornell University, where he became a distinguished professor of zoology as well as an outspoken advocate of racial equality.

In his introduction to the volume, Richard M. Reid analyzes Burt Wilder's diary and places it within the context of the war, the experience of African American troops, and Wilder's life and career.

[more]

Primary Medical Care in Chile

Accessibility under Military Rule

Joseph L. Scarpaci

University of Pittsburgh Press, 1988

Since Pinochet's regime assumed power in 1973, the Chilean public medical system has been incrementally disassembled in favor of private enterprise, modeled after U.S. HMOs. Scarpaci assembles data ranging from interviews with patients to income statements and balance sheets from the National Health Service System, National Health Fund, and National Statistics Institute to view the financial and cultural impediments imposed by the Pinochet system that have compromised and effectively limited health care accessibility for Chile's adult population.

[more]

Principles of Green Bioethics

Sustainability in Health Care

Cristina Richie

Michigan State University Press, 2019

Health care is ubiquitous in the industrialized world. Yet, every medical development, technique, and procedure impacts the environment. Green bioethics synthesizes environmental ethics and biomedical ethics, thus creating an interdisciplinary approach to sustainable health care. Notably, green bioethics addresses not the structure of environmental sustainability in health-care institutions but the sustainability of individual health-care offerings. It parallels traditional biomedical ethics by providing four principles for ethical guidance: distributive justice, resource conservation, simplicity, and ethical economics. Through these four principles, green bioethics presents a coherent framework for evaluating the sustainability of medical developments, techniques, and procedures. The future of our world may very well depend on how effectively we halt ecological destruction and conserve our resources in all areas of life. The principles of green bioethics, outlined in this book, will advance sustainability in health care.

[more]

Private Bodies, Public Texts

Race, Gender, and a Cultural Bioethics

Karla FC Holloway

Duke University Press, 2011

In Private Bodies, Public Texts, Karla FC Holloway examines instances where medical issues and information that would usually be seen as intimate, private matters are forced into the public sphere. As she demonstrates, the resulting social dramas often play out on the bodies of women and African Americans. Holloway discusses the spectacle of the Terri Schiavo right-to-die case and the injustice of medical researchers’ use of Henrietta Lacks’s cell line without her or her family’s knowledge or permission. She offers a provocative reading of the Tuskegee syphilis study and a haunting account of the ethical dilemmas that confronted physicians, patients, and families when a hospital became a space for dying rather than healing during Hurricane Katrina; even at that dire moment, race mattered. Private Bodies, Public Texts is a compelling call for a cultural bioethics that attends to the historical and social factors that render some populations more vulnerable than others in medical and legal contexts. Holloway proposes literature as a conceptual anchor for discussions of race, gender, bioethics, and the right to privacy. Literary narratives can accommodate thick description, multiple subjectivities, contradiction, and complexity.

[more]

Privatizing Health Services in Africa

Turshen, Meredeth

Rutgers University Press, 1998

Privatizing Health Services in Africa analyzes the disappearance of public health in the form of state services in Africa, and the growth of a private market in health care that will serve primarily an urban elite. Meredeth Turshen considers the implications of introducing private insurance in countries with growing unemployment, a shrinking formal job sector, and a lack of social security programs or other safety nets. She debates the pros and cons of shifting the delivery of health services to the nongovernmental sector in the context of new concepts of the role of the state. Many of the schemes to privatize the purchase and sale of pharmaceuticals reverse decades of United Nations work challenging the power of the multinational drug industry. Turshen weighs these policy changes in light of the World Bank’s eclipse of the World Health Organization as the premier UN health policy agency. Until now, no book has disputed the World Bank’s plans to privatize health care in Africa. This is the first book-length analysis of policy changes in light of monetarism and globalization.

Throughout the book, Turshen examines the implications of privatization for gender equity. She also provides a case study of Zimbabwe and comparative material from Malawi, Mozambique, and Zambia. Her study makes a contribution to current debates on the impact of structural adjustment policies on health and the design of health services in the Third World.

[more]

The Profit Motive and Patient Care

The Changing Accountability of Doctors and Hospitals

Bradford Gray

Harvard University Press, 1991

In this penetrating analysis, Bradford Gray tackles the thorny issues surrounding the question of to whom and for what our physicians and hospitals are accountable. This book provides a careful evaluation of the mechanisms of accountability that have developed along with a growing profit orientation of health care, and it alerts us to keep a sharp eye focused on who is looking out for the interests of the patient.

[more]