Monthly Archives: October 2009

Afghanistan and the Hereafter

There’s an old joke about an elderly man who’s asked if he thinks about an afterlife.  “All the time,” he says.  “I’m always walking into a room and asking myself, ‘Now, what am I hereafter?'”

Va-da-boom.

The joke comes to mind with the debate over an Afghanistan troop surge and the recent resignation by foreign service official Matthew Hoh in protest over U.S. policy.  The full letter is worth reading.  But I was struck by one point in particular:  “I find specious the reasons we ask for bloodshed and sacrifice from our young men and women in Afghanistan. If honest, our stated strategy of securing Afghanistan to prevent al-Qaeda resurgence or regrouping would require us to additionally invade and occupy western Pakistan, Somalia, Sudan, Yemen, etc.”

Hoh frames the issue exactly the way it needs to be discussed.  What’s the point? It is upsetting to see in some of the media that much of the debate centers on tactics:  what’s the right level of troop strength? Will they be able to “pacify” the populace (to resort to a Vietnam-era term)? Where should they be sent? But the real issues are more fundamental, and go to the matters that Matthew Hoh raised. As President Obama stood at attention on the tarmac at Dover Air Force base yesterday and saluted what the Pentagon refers to as “transfer cases” — 18 coffins carrying the remains of U.S. military personnel killed in Afghanistan — the questions hanging over the somber event were echoes of the old joke, but not so funny:  What exactly is the mission?  Does the strategy make any sense? What are we here after?

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Medical Care and Poverty

Not all assignments turn out as planned.  When the NewsHour asked me to research and produce a story looking at what the Centers for Disease Control and Prevention (CDC), Dr. Peter Hotez at George Washington University and others describe as the “neglected infections of poverty” in the United States, I assumed that I would be able to easily find clinicians dealing with the diseases who could describe the experiences and introduce me to patients.  There are a handful of these infections, many of them parasitic, that show up in pockets of poverty around the United States — in inner cities, Indian reservations, rural areas, etc.  Based on national blood surveys, the CDC has determined that millions of people may have symptoms of these infections. They include Chagas disease, spread by bugs commonly found in Latin America; toxocariasis, transmitted by worms in the fecal matter of infected dogs; and trichomoniasis, a sexually-transmitted disease which is more than ten times likely to be found in African American women than in whites or Latinas.

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Chagas disease clinic in LA

In Los Angeles, I found Dr. Sheba Meymandi, a cardiologist with Olive View medical center, who has made a personal crusade of finding and treating patients with Chagas disease, which can cause death if the parasites invade the heart.  (The work she does has virtually no funding.  It’s a labor of love.)  But in calling around to find examples of some of the other infections, it was almost impossible to find clinicians who had come across cases.  Toxocariasis, for example, is estimated to show up in the blood work of some 14 percent of the U.S. population.  It can lead to blindness.  But only a handful of cases have been reported.  I didn’t understand why.  Were physicians simply missing these cases?

I traveled to Atlanta and rural Virginia, where I saw the work of the Remote Area Medical (RAM) organization. That’s the group that sets up weekend clinics in areas around the country.  People, generally those without insurance, line up by the hundreds to seek basic medical care — check ups, dental work, eye exams, etc.  RAM’s very existence represents a real indictment of the U.S. medical system.  There, I asked about the list of the “neglected infections of poverty” put out by the CDC,  and the larger issue of neglect became more apparent.  Scott Syverud, an emergency physician at the University of Virginia put the CDC list into context.  “When you have a tsunami of people with no health care at all,” he said, certain diseases, such as the ones on the CDC’s list “are just going to get lost in [treating] the regular health care needs.”  That morning he had diagnosed diabetes in two patients unaware they had it, and had seen one person who seemed to be having a heart attack.

The CDC and Dr.  Hotez at  are doing commendable work in calling attention to what they are describing as NIPs — the neglected infections of poverty — but the neglect and the need are vast, and their efforts, unfortunately, are barely scratching the surface.

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