Sunday, June 3, 2007

Transmittable Airways

Tracy Kidder's Mountains Beyond Mountains is the U.-wide shared reading for the fall semester at Syracuse. Because I will be teaching freshmen in the fall, I picked up a complimentary copy from the Writing Program office about ten days ago, figuring I'd read it sooner rather than later to get some sense of how it might merge in with the teaching I'll be doing in late August. I haven't worked that part out yet because I haven't received my formal course assignment (slight chance that it will be a Wellness Learning Community section). Still, it's never too early to begin thinking about such things. Basically, the book is Kidder's journalistic portrait of the life-work of Dr. Paul Farmer, a physician specializing in TB who is also trained as an anthropologist and who has deep convictions about treating infectious disease where it hits hardest--among the poor. A NYT Bestseller, the book trails Farmer from his start-up work in Haiti, which grew into Partners In Health, to related efforts to treat MDR (multiple drug resistant) TB in a region of Peru (eventually the entire country) and also in the prison system in Russia. Farmer is depicted as ingenious and unshakably committed to his work; he responds to ceaseless demands with a conventions-be-damned attitude toward medical treatment and cost efficacy when it comes to TB treatments.

I had considered posting about the book earlier, noting the few check-marks I've put in the margins next to the bits I want to find again--bits about Farmer's language games (ending assertions about commonplace attitudes toward the poor with the word comma to imply the unspoken word to follow: asshole; personifying infections diseases and closing his rants with Love, ID.; or his neologisms and PIH-speak: "[t]o commit 'a seven-three' was to use seven words where three would, and a 'ninety-nine one hundred' was quitting on a nearly completed job" (217). Or the bit about "hermeneutics of generosity" (215), where ethos blends with the believing game.

The TB-infected passenger who hopped aboard a flight to Atlanta generated more noise than I would have expected in light of reading Kidder's book. I'm no TB expert (not even close), but Kidder's book gives a reasonably straight-forward account of the differences among the virus's drug resistances. In fact, Farmer is notable in the subject-of-a-book sort of way in part because he is credited with getting at the complexities of TB's multiply resistant manifestations. The breakthroughs in Peru involved his realization that certain first-line treatments of the disease were, in effect, teaching the virus to resist certain drugs. Treatment success rates were so low because the medical establishment hadn't yet figured out that their treatments were smartening up the virus. The treatments were proliferating strands of the virus that were less likely to be remedied through conventional and decades-old practices.

This week's news, however, involves a case of XDR TB or extensively drug resistant tuberculosis, for which there is only a 30-pecent cure-rate (so says CNN). I can't remember any discussion of XDR TB in Mountains Beyond Mountains (my biggest complaint about the book is that it doesn't have an index), but as these events play out, as passengers who held seats on the plane get tested, and as we watch the airlines scramble to resolve the medicalization of air space (not only for flying and border-crossing, but for breathing), I am thinking about this splash of news as a kind of mini-sequel to Kidder's book, an extra chapter in what is, for me, a new awareness of the complex set of issues knotted together where medical research, germ circulation, epidemiology, border-keeping, and health care privacy come together.

Posted by Derek Mueller at June 3, 2007 8:15 AM to Reading Notes