Life as an Extreme Sport

Tag: stupid people continue to annoy me

No, American Doctors, You Don’t Need Tyvek In Case of Ebola

...and everything else, Bioethics

One of the more interesting aspects of the constant media coverage of the latest Ebola outbreak has been watching how developed nations like the United States, Britain, and Canada assume that the entire world is Just Like Them. The Seattle Times had a charming example of this yesterday, with American doctors questioning the CDC guidelines for how to care for an Ebola patient in America. An example of the ignorance on display comes from Tulsa, Oklahoma emergency physician Justin Fairless, who says that health care workers in West African nations

are wearing the highest level of protection, but the CDC recommendation lets us go down to the lowest level of protection.

Now, the CDC has repeatedly said that caring for patients in African nations is quite different than caring for patients in America, Canada, other developed nations, but apparently Dr. Fairless and others need a pictorial show-and-tell to understand that not everyone lives and works in a state-of-the-art world.

But first, a bit of description to set the stage for the pictures you are about to see. (Note: There are no sick or dead bodies in the following photographs.) This is from a Pulitzer Center on Crisis Reporting report on maternal/fetal care in Guinea, published in February of 2014, before the international community was aware of the Ebola outbreak:

“The biggest problems at Donka are no electricity, no water, no equipment, no sanitation and very high rates of infection,” said Bintu Cisse, adjunct midwife supervisor, who has worked at Donka National Hospital for 20 years … External support provides some operational assistance, but Donka lacks basic facilities due to the inefficiency of Guinea’s under-performing infrastructure … Inside the maternity ward operating room, Cisse pointed out that the equipment did not work and doctors used suspended basins of water and a mixture of chlorine to sanitize. The main light sources were open windows””outside garbage was burning.

Cisse is describing the largest medical center in Guniea, Donka Hospital, which is also the university teaching hospital for the country.

This is what their isolation unit looks like:

Donka Hospital Isolation Tents. Cellou Binani/AFP/Getty Images.
Donka Hospital Isolation Tents. Cellou Binani/AFP/Getty Images.

Those are tents. Here’s what those tents look like on the inside:
DonkaIsolationWard-Open

When patients are inside, they are lined up on cots, one after another. There is nothing separating the patients from anyone, or anything. There is no airflow system—isolation wards in regions where Ebola is active tend to work by setting up large barriers to prevent people from getting close enough to worry about contagion; this could be large plastic sheeting, it could be fences that indicate the line at which people should not pass.

This is what an isolation unit looks like at your average, developed world, fully-equipped hospital:

Isolation room at Wellington Hospital, New Zealand.
Isolation room at Wellington Hospital, New Zealand.

So, as you can see, Dr. Fairless, and others, things are just a little bit different in countries where the GDP is more than USD 6 billion a year.

A MSF worker suits up to care for Ebola patients.
A MSF worker suits up to care for Ebola patients.
The major difference in treatment, aside from already-discussed issues, is who is in isolation. More specifically, in places like Guinea, Liberia, and Sierra Leone, while patients are isolated from other people in order to curtail infection, the health care workers are the ones “in isolation”—they’re the ones who are kitted up in bunny suits, in full Tyvek, layers of gloves, and the whole nine yards. Because: see above. The effort here is to keep the HCW in a protective environment to limit transmission to the worker, because it’s impossible to keep the patients inside a protective environment, due to the economy, the lack of infrastructure, the lack of ability because there’s no technology, there’s no power.

Isolation units in America and other developed countries, on the other hand, function to keep the patient inside isolation; patients are isolated from others to curtail infection, and that includes being “in isolation”: that is, the protective bubble that bunny suits and Tyvek create for HCWs in Guinea, etc, is extended around the patient in the form of negative air pressure rooms and glass walls.

In that sort of environment, the basics of gloves, gown, and mask are more than sufficient to care for a patient with Ebola—or any other highly infective agent. Which is why that’s what the CDC recommendations are; because technology and care levels are different, and the basic approach to isolating and isolation can change.

It’s also worth remembering that bunny suits and Tyvek weren’t always around when people were fighting Ebola. Here’s what Peter Piot was wearing in 1976, when Ebola was first recognized:

Peter Piot wearing protective gear in Yambuku, 1976.
Peter Piot wearing protective gear in Yambuku, 1976.

That’s how the outbreak was stopped in 1976. In conditions that in many ways were worse than in the pictures shown above.

The doctors and other health care workers in that Seattle Times piece should be ashamed of themselves, demanding bunny suits and Tyvek and full protective gear when not only is it unnecessary, it’s a waste of money. But more than that, and even more than the myopic view of the world that appears to assume everywhere is just like their tidy and neat and well-staffed and well-maintained medical center, it illustrates the continued “me me me” reaction people in the developed world have around Ebola.

…after all, you don’t hear anyone suggesting that full isolation suites be sent to Guinea, or Sierra Leone, or Liberia, so that those countries can revert to the simpler CDC recommendations, do you?

Childless: My Joy is Another’s Grief; Don’t Conflate the Two

...and everything else, life and living

This morning, CNN1 ran a piece on misunderstandings and stereotypes of childless women called “Check your ‘cat-lady’ preconceptions about childless women.” Naturally, it’s full of preconceptions, misunderstandings, and stereotypes of childless women. In particular, the women are still discussed by their relationship to/with children, and the voluntarily child-free are conflated with the involuntarily childless and uncertain.

Let’s take a quick walk through the women interviewed for this story:

  • Grell Yursik, 35: she and her husband have not decided whether they want to have children;
  • Laurie White, 43: refers to herself as “accidentally childless”;
  • Melanie Notkin, 45: says she has circumstantial infertility because she’s single and discusses “the pain and grief over not having children,” promotes maternal instincts of childless women;
  • Kitty Bradshaw, 35: heeded advice to wait to have children (portrayed as bad advice in the story), still dreams of having them and has moved to LA to find a husband;
  • Sheila Hoffman, 64: conscious choice to be child-free.

Women, still defined by the activity of their uteruses. Still defending their ability to be maternal,2 still looking for someone to create a child with,3 still using morally loaded language to justify their childless state as an accident of fate.

In fact, in an article ostensibly about the great life of childless women, four of the five women interviewed discuss wanting to have children and feeling that the circumstances of their lives simply don’t allow it. There are 33 paragraphs in the story, and three—the last three—talk to and about a woman, Sheila Hoffman, who actively made the choice to not have children. None of the paragraphs on Hoffman discuss her choice or how it makes her feel, only the need for role models for women that are not mothers. This, despite the fact that the DeVries Global white paper that at least in part prompted Wallace’s article showed that a full 36% of the 1000 women without children interviewed didn’t actually want children (and another 18% were on the fence).

So why did Wallace’s article spend absolutely zero time on this theoretically large segment of the American population?

Because it’s still not considered acceptable for women to not want children. Even the term being coined for these women, “Otherhood,”4 emphasizes the Otherness5 of women who have decided to skip having children.

What is acceptable is for a woman to want to have children, but to ruefully conclude that she cannot because she is single, cannot afford IVF treatments or being a single mother,6 or has lost her chance for reasons running the gamut from missed love to missing love. Women can and should be apologetic and sad about being childless; it is an accident, or a tragedy, rather than an empowered choice. And that’s reflected in Wallace’s article.

But beyond being infuriating for those of us—a third of the women sampled!—who are cheerful, happy, and decisive about our decision to not have children, the grouping of women who do not have children with women who do not want children is hurtful to the women who do feel that loss in their lives. These experiences—of feeling circumstantially infertile, of accidental childlessness, of deeply wanting a child—should not be lumped in with those of us who happily hug our IUDs, pills, and/or condoms whilst skipping gleefully down the Marvel toy aisle thinking “all for me, all for me.”7 Being infertile, circumstantially or medically, is a serious emotional wound that should not be conflated with a joyful and intentional life choice.

Write about the pain.

Write about the joy.

Don’t write about them at once, because that only does a disservice to both.

SciAm Doesn’t Think Sexism in Science is “An Issue”—Will They Think Boycotts Are?

...and everything else

There has been a lot of talk this year about supporting women in science and related tech fields, about how it’s not okay to sexually harass a graduate student or colleague, about how rape jokes aren’t okay, and in general, how hostile academia, science, and technology can still be for women.

Yesterday, a Biology Online editor gave a pretty stunning example of this: he called biologist DNLee an urban whore for refusing to write for the Biology Online for free. We know about this because she blogged about it over at her Scientific American blogs column, Urban Scientist. And this was important for several reasons. First, many other biologists had casually agreed to work with Biology Online without being aware of the sexism of at least one of their editors (and many have now pulled posts due to it). Secondly, and perhaps more importantly, DNLee’s experience is a data point that shows why the on-going discussion of sexism and harassment of women in science needs to happen. It’s an insight into what women in science face—and why science has a woman problem.

Naturally, Scientific American was proud to be a part of the on-going conversation about how women in science are treated, and the importance of shining a light on the ways women are harassed in science, in order to help prevent such a thing from happening again, right?

Oh. No. Instead, Scientific American pulled DNLee’s blog post without comment. Other people stayed calm, saying it must be a technical error, and I admire them for their ability to give the benefit of the doubt.

sciam-responseMy cynicism was rewarded this morning. Mariette DiChristina, the EIC and Senior VP of Scientific American, confirmed that DNLee’s post was removed on purpose. For apparently not being “about science.” Even though that was not the Scientific American blogs editor’s position (as seen here). In fact, Bora (said blog editor) and I have actually had some very specific arguments about the role of the Scientific American blogs, recounted by Nicholas over here. In short, Bora has explained that his view of the blogs is that people can and should write what they are interested in and about, even if they are not experts in the topic, and that it’s okay if they’re wrong, because the commenters can come in and correct them. As you can probably imagine, I don’t agree with this, and in fact had a several hours–long Twitter argument with Bora about it. I do think that if you are blogging under the Scientific American banner, you are being extended authority and thus should write responsibly about what you know.

But in this case, I am 100% convinced that DNLee knows about the sexism women face in science, just as I am 100% positive that this is an important—necessary—conversation to be having. And I would like to think that even were she wrong, Bora’s policy, as outlined in his argument with me and his comments about Christie Wilcox’s blog being “her space,” would support an on-going discussion in her blog rather than outright removal.

Right now, to paraphrase what Crip Dyke so eloquently noted on Dr. Isis’s blog, DiChristina has made it very clear, through her actions, that Scientific American finds “fighting racism & sexism is unscientific.” Especially if it involves someone in their partner network. As such, and until such a time that DiChristina and the rest of those involved with this decision at Scientific American apologize to DNLee for their actions, as well as to those fighting to end sexism in academia, I will be joining Dr. Isis in her boycott of Scientific American.

You can read DNLee’s account of what happened at many blogs, at this point; Rebecca Watson reposted the blog, with permission, at Skepchick.

edited to add
DiChristina released a statement to Buzzfeed after they picked up the story, saying

I’d like to elaborate on the original brief statement on Twitter that this blog fell outside Scientific American’s mission to communicate science. While we interpret that mission with a lot of latitude, Dr. Lee’s post went beyond and verged into the personal, and that’s why it was taken down. Dr. Lee’s post is out extensively in the blogosphere, which is appropriate. Dr. Lee is a valued member of the Scientific American blog network. In a related matter, Biology Online has an ad network relationship, and not an editorial one. Obviously, Scientific American does not want to be associated with activities that are detrimental to the productive communication of science. We are pursuing next steps.

Of course, as Kate Clancy, Janet D. Stemwedel, Christie Wilcox and Melanie Tannenbaum note, science and science blogging is personal. People–women–discuss their bodies, their rapes, sexual assaults, and miscarriages, all topics I have seen covered on the SciAm Blogs.

By supporting, via their lack of removal, these personal blog posts (for example, Drs Clancy and Stemwedel both highlight several of their own “non-discovering science” blog posts within the SciAm blogs network) by other women and men, DiChristina is making it hard to excuse SciAm from the single thing that it seemed they had going for them that Biology Online didn’t: racism. Because what seems to separate Dr. Lee from the other bloggers, in the “verging in to the personal”, is that Dr. Lee is a woman of colour.

The implications here are incredibly ugly, and bear examination by everyone who write for or reads anything within the Scientific American publication sphere. (Personally, I have a digital membership which I will be canceling posthaste.) It’s not a significant sum of money, but it’s money I don’t want supporting sexism or racism.

Rape Kit vs Abortion – Educating Jodie Laubenberg

...and everything else, Bioethics, Politics

One of the first things I saw when I got off the plane in Philadelphia Sunday night, after a trans-Pacific flight, was this statement from Rep. Jodie Laubenberg:

In the emergency room they have what’s called rape kits where a woman can get cleaned out. The woman had five months to make that decision, at this point we are looking at a baby that is very far along in its development.

This is Laubenberg’s justification for why Texas SB5, which seeks to limit abortion services even further in Texas, including banning abortion after 20 weeks (and currently being filibustered by the amazing Wendy Davis), does not have an exception for rape or incest victims.

I’ve seen a lot of statements that Laubenberg is clearly confused, and a lot of very pointed comments about her lack of knowledge on a subject she seeks to legislate – all of which are true. But what I haven’t seen is the very simple differentiation between a rape kit and an abortion. So here, let me make a tiny contribution to the growing body of evidence that Rep. Laubenberg is in no way qualified to sponsor bills on or otherwise discuss rape kits, abortions, or women’s health issues.

Continue reading

Shame, Stigma and Angelina Jolie’s Breasts

...and everything else, Bioethics, Pop Culture

As reactions continue to race around the internet about Angelina Jolie’s double mastectomy and reconstructive surgery – the actual discussions, not the Monday-morning quarterbacking of her decision or the utterly vile “but what about her boobies” reaction from that particular subgroup of men who manage to amaze me by their continued ability to manage basic functions like breathing – I’ve been sent links. And more links. And then a few more. Most are relatively easy to dismiss because they’re quarterbacking a personal decision or they’re vile, but then you get the ones that tiptoe closer to decent – and they still have problems.

One that’s been flying around the internets today is the Maria Konnikova piece on Salon. I’m actually not terribly fond of this piece, or other pieces that hinge their complaint on the cost of testing and Jolie’s supposed privilege by virtue of her wealth. For one, let’s put the cost of testing squarely where it belongs: on the fact that Myriad owns the patent for the test (something that is being challenged in front of SCOTUS this June).

Secondly, almost no one remembers that the Affordable Care Act considers BRCA1 and BRCA2 tests to be part of preventive care, and that by January 2014, it must be covered for everyone, period. Yes, the pre-existing condition limitations and grandfathered insurance clause limitations means some women won’t have coverage for the test between now and January, but it’s not the doom and gloom exclusionary process that seemingly everyone wants to focus on when it comes to cost.

Finally, and most importantly, the notion of reducing stigma and shame by simply talking about these things – and in Jolie’s case, taking ownership of a body that has been extremely sexualized in media and popular culture – is incredibly important. In particular, even though we’ve moved society to a point where people talk about breasts and cancer together, it’s still in a “race for the cure” dialog, rather than in mastectomies and surgeries and things that shame. For example, within a day of Jolie going public about her mastectomies, Zoraida Sambolin (CNN) announced her own breast cancer and the mastectomies she’ll be having in June – and she credits Jolie for her decision to go public with her own health concerns.

This is dialog that’s important. It continues to de-stigmatize and remove shame from very basic aspects of women’s biology, and doing so is only a good thing: we need people to be able to talk openly and honestly about medical issues, illnesses, and diseases that affect women, not just men, and the sooner we can normalize aspects of the dialog that include frank discussions of biology and body parts in non-sexualized terms, the sooner we can embrace the idea that a woman – and her sexuality – is more than her breasts.