 Hello there, it's Thursday at noon. I know it is. Do you remember our Arrangement Thursdays at noon on CFUV Are you ready to get started? What do you have in mind? What I want to do now is called first-person plural You make it sound excessively attractive That's what I have in mind The United Nations Commission on the Status of Women held its 47th session early in March The world was busy paying attention to the impending war and missed the irony that the Commission was unable to draft agreed conclusions on violence against women before closing its session on March 14th 2003 a week later The war on Iraq began putting women and children in further harm's way The Commission was established in 1946 to prepare recommendations and reports to the Council on promoting women's rights in political economic civil social and Educational fields the Commission also makes recommendations to the Council on urgent problems requiring immediate action in the field of women's rights women's health Violence towards women women's poverty and women's equality are all critical areas of concern The 47th session of the Commission on the Status of Women addressed an elimination of all forms of violence against women and girls as Defined in the Beijing platform for action The failure of the Commission to find agreement on conclusions on violence against women points out the difficulties of bringing together a great many cultures to come to agreement on most issues The tedious process is encumbered by the need to balance gender issues with cultural practices and economic realities in 1993 Karl wrote a paper called third world women and European American medicine historical trends future prospects and development options For a class he took called politics of developing areas Development in impoverished parts of the world is highly dependent upon raising the status of women consideration of indigenous practices must be included in planning and implementation or impasses will become impossibilities We wondered if the status of women had changed much since 1993 Did the 1995 Beijing declaration and platform for action do anything to make the world better for women? The sad truth is that many of the same problems identified in Karl's paper in 1993 Still exist and still remain on the international table while some things have changed for the better Women's issues continue to be put on the back burner We came to the conclusion that an oligopolistic view of health care was holding back progress in Promoting the health of women in developing countries This week Karl shares excerpts from his paper and we discussed the complexities of women's well-being in the developing world And in episode we call honey. Just buy two aspirin and call me in ten years Medical care in the so-called third world has been a source of considerable concern since the decline of the colonial system Former colonies of European nations and other developing areas have often suffered from their lack of adequate medical facilities and personnel to run them In areas of health care pertinent to women the inadequacy of existing networks has been especially pronounced Women have been relegated by the western models of medical care imposed on these nations to second-class status Moreover, the western medical model is assumed to supersede the knowledge already accumulated by the indigenous medical Professionals without any need for consideration of these professionals opinions or even research into the effectiveness of their methods As many of these indigenous professionals are women their exclusion from the future progress of medical care Constitutes further misogyny The treatment offered and medicines and health supplements marketed have established a pattern that is in opposition to the continuing development and equality of women in the third world It is both realistic and necessary to reconsider self-determination in health care as An alternative to that pattern with medicine considered a part of the political economy of an autonomous nation and a part of its culture as well As an indicator of general quality of health and environmental effect on health life expectancy is often used While quality of life is not always identical to quantity of life It is considered to be proportional and it is in any case more easily measured Women outlive men in most parts of the world However, there is a trend visible in areas where the life expectancy is lower without regard for gender Women outlive men by very little and in South Asia actually pre-deceased them Clearly the problem of women's health is proportionally greater in the third world than in the quote developed close quote countries The record of the Western medical industrial complex has not been exceptional in its interaction with developing areas The pattern has been condescending and even malignant at times with the principles often being simply unconcerned about the health of their female patients and customers of particular historical note is the infant formula controversy of the 1970s and 1980s several large multinational corporations chiefly Nestle and Borden began selling synthetic infant formula designed to take the place of breast milk to third world women infant formulas proved too expensive difficult to prepare sanitarily Addictive in the sense that mothers who began bottle feeding soon became unable to produce breast milk and Even unhealthy with additional malnutrition cases and deaths blamed on the formula Lactation provided a sort of check on population increase as well with breastfeeding mothers less likely to ovulate Formula sales tended to remove this benevolent side effect Additionally the marketing campaigns were deceptive Free samples were offered to mothers in the hope that their breast milk would dry up and leave them dependent on the product Women working for the formula companies would dress as nurses and go door-to-door giving quote advice closed quote Waited toward purchasing infant formula an international boycott with organizations such as the infant formula action coalition and the International baby food action network boycotting Nestle specifically proved successful Eventually the number of groups participating in the boycott grew to 300 spanning 41 countries The boycott had measurable economic effect cutting Nestle sales and market share But its ultimate importance was informational increasing awareness of the situation and political pressure for its rectification Here's a quote from the 1992 edition of the new our bodies ourselves Authored by the Boston women's health book collective quote the greatest success of the boycott has been the consumer education impact Which has brought the whole issue to the international government agency level for serious debate and action as a result the world health Organization developed an international infant formula code of marketing behavior for the industry When the World Health Assembly voted on the code in May 1980 Every country voted in favor of it except the United States whose representatives stated that it infringed upon the free enterprise system Close quote Reproductive rights are an important health issue with women worldwide being hindered in their economic and social development By being unable to decide how many children they will have Despite numerous low-cost generally effective birth control methods being technologically available Third-world women are often left to have children at random with no regard for the desires of the women who want to stop Having additional children and concentrate on supporting the ones they have support for birth control programs has been politicized Under the rightist Reagan administration Finding for birth control dropped to 20 million dollars from 1985 to 1987 While there was some social pressure on women not to use birth control The general pattern was for birth control opportunities to be welcome Additionally readily available birth control made social mobility easier for women as a nation in which women who needed not worry about their quote purity close quote We're likely to continue in school for longer periods and in gender more equitable distribution of wealth Other examples of increased social mobility resulting from demystification of women would naturally follow as well as quote protective close quote attitudes on the part of male relatives would be less quote necessary close quote prenatal care is similarly unavailable and much of the developing world in 1971 report by the World Health Organization Concluded that over half of the pregnancies in the world are permitted to run their course without any medical attention before the birth at all The absence of cheap reliable or in some cases any birth control does not imply that Western involvement in third world reproductive issues is passive sterilization is increasingly common 98 million women and 35 million men are sterilized annually worldwide Some of these sterilizations are carried out as a result of pressure from European and American medical professionals who incredibly justify the action in terms of eugenics Social Darwinian I erasist and class biased belief in the early 20th century United States Created a new cult of forced sterilization promotion The idea was discredited in the United States But is frequently heard in connection with third world quote planning close quote as the quote only close quote Means I'm effective population control Incredibly the nation with the greatest need for population control may be the United States It uses 30% of the world's resources despite containing only 6% of its population It consumes one quarter of the world's energy each year and still produces less economic output than Japan or Germany There is some question as to whether the entire population control movement is just a shadow game to cover up for the industrialized nations inflicting of economic damage on the third world and failure to exercise quote consumption control close quote Here's another quote from the New Arbades ourselves Quote population control groups seriously downplay the principal causes of the environmental crisis Dominate economic systems that squander natural and human resources in the drive for short-term profits The displacement of peasant farmers and indigenous peoples by agribusiness timber mining and energy firms the policies of international lending institutions War and arms production and the wasteful consumption patterns of industrialized countries and wealthy elites in the world close quote For true development to occur in the third world women's medical situation There must be a general recognition that the purpose of population control is to improve the quality of life for the user The purpose of population control is not to allow the unnecessarily rich to become richer and less necessarily so Via elimination of people existing and anticipated whom they consider an obstacle to this goal Considering the per capita figures one is left with the notion that the real problem is not too many third world people But too many consumers in the most quote developed close quote nations on the globe birth control and forced birth control or eugenics are incompatible in their aims and methods and Women of all nations interested in their own well-being should be aware of the differences between these responses to quote Surplus population close quote the concern shown by moralistic developed nations for the third world has boundaries Measurable by fiscal considerations when the opportunity to maximize profit arises for a multinational corporation Rarely does anyone stand in the way for quote ethical close quote reasons despite the most dubious practices by the principles Here's a quote from imperial alibis by Stephen Shalom. This is from the 1993 edition of that book quote Pharmaceutical companies routinely sell products banned for use in the United States to third world buyers They omit warning label information that is required in the United States when it is not also required by the developing country In which it is being sold bribes to local health officials are common as well Close quote treatments for diseases that are serious threats to the populations of third world nations are not researched Seriously by the pharmaceutical companies Instead they simply market the drugs They have already developed for the diseases common in the quote civilized world close quote Pharmaceutical companies even go so far as to test their products on third-world women during the course of research and development experimentation You're listening to first-person plural on CFUV Victoria's Public Radio 101.9 FM 104.3 cable and on the internet CFUV.UVG.CA Giving sociology an edge Prior to the intervention of colonial powers in their affairs Many of the developing nations had established medical services Some of them were highly ritualized and even religiously based But most had measurable levels of effectiveness and knowledge about indigenous maladies that Western quote scientific close quote medicine did not A particular interest in light of the historical trend towards male domination is the observation that many of these services were dominated by female practitioners women practicing either traditional or Quote modern close quote medicine have historically had to face direct and indirect attempts to reduce their number and their Respectability in their communities The effect of the westernization of medicine in the name of quote science closed quote is to ignore the information possessed by these cultures in a practice that is effectively ethnocentric and to exclude arbitrarily from constructive employment a great many Women in a practice that is effectively sexist the disregard the quote scientific close quote medical model and its practitioners have shown for the welfare of the Third world people it is supposedly meant to serve amounts to a kind of disenfranchisement The local population is told in effect that it is not competent to participate in the development of medical care models and that its potential Contribution to matters of real consequence particularly in quote scientific close quote areas must be of negligible concern this preemptory attitude Manifests itself especially in its effects on women as patients and as career health professionals themselves in fact to call the model Scientific is inaccurate in light of the inconsistent use of rigorous investigation or testing of new concepts They're refusal to consider new hypotheses for into Western thought and the general regard for dogma over empirical data Women in the third world who want to become European style doctors are often hindered in pursuit of their work by being the focus of prejudice This prejudice can come from the intervention of more developed nations or from indigenous males May rotten by hockey of Sri Lanka found herself restricted to a women's hospital and midwifery duties upon graduation from medical school in 1916 Kamala Israel Vitellingham of India was frustrated in her attempts to apply to medical school when one of her family members Hit her credentials in accordance with family disapproval of education for women Safi Rafatia of Iran was a practicing physician in Tehran until forced by the Itinerant nature of her husband's career to take a quote leave of absence close quote in Safiya's words and this quotation is from Halstead's women physicians of the world quote in Tehran I carried on my practice from my home until my husband got another appointment And we had to leave for Iraq the same business of packing and moving was once more necessary After two years in Iraq my husband was recalled to Tehran But shortly after this he was appointed consul general in India where we lived for five years During all this time to my great sorrow my medical career had to be sacrificed I was a homemaker and all I could do was read the medical journals close quote Of course it was assumed that as a woman Rafatia would automatically put her life on hold whenever her husband's circumstances demanded it United States women who find it difficult to balance career demands and husband demands will no doubt be sympathetic to and perhaps even a little odd by this extreme example of having to put up with a loved one if female medical personnel Who are conventionally trained encounter difficulties then female medical personnel who practice indigenous healing methods are completely ignored What knowledge they have is usually ignored by scientific doctors whose egos will not permit them to learn anything from locals family medicine is Disregarded yet many cultures maintain indigenous healing methodologies the Sardar Guru of Ecuador have continued to prefer home treatment to available Quote professional clothes quote facilities relying on the women of each house to diagnose and treat the maladies of those within They have accumulated in their ignorance of quote scientific knowledge close quote a record that the modern doctors admit is exemplary Kiran Dara's are common throughout Central and South America Dismissed as faith healers by scientific medicine these women nonetheless acquire substantial experience and consequent knowledge in their specialties It is not uncommon for a Kiran Dara to collaborate at patient request with medical doctors and even to teach them the difference between Splendid trouble and heart trouble or how to tell if a baby ready to be born is anatomically complete Jamaican folk healing is called balm it embraces an extensive mythology of ghosts fallen angels and demons Nevertheless balm healers are more efficient and better liked in the process of being so and private doctors and government medical clinics on the island Boreeba women healers native to Benin are largely midwives and maternity consultants They deliver babies in the home calling in specialists only when the job proves especially difficult midwives are prevalent in other countries as well in Nigeria medicine is identified with magic to a great extent The traditions of each area developed together and they are intertwined now in a way that resists the separation of one from the other the mixing of religion with medicine is not necessary from a strictly logical viewpoint, but the medicine employed is effective in measurable quantities nonetheless and ought not to be dismissed without some assessment of the relative strengths and weaknesses of the accuracy of diagnoses and effectiveness of treatment Plus as is the case with all medical procedures the behavior of the healer ought to be regarded within the social context and more Arrays of the culture the religious machinations of indigenous Nigerian medical people may seem unnecessary from a rationalistic standpoint But when medical treatment is viewed as being part of a larger social package They become perceptible as courtesies and conventions of social meaning the meaning may be subtle or Imagistic, but it should not be considered impertinent to the process if it is of anthropological value American doctors who wear white coats despite not having been in a laboratory in 35 years are participating in the same sort of gesture of respect for and cultivation of the ideals of their culture medical sciences Thus not solely the province of western academic and scientific thought what is needed is a model that incorporates the traditions of each culture on A case basis medical self-determination is important for cultural and for scientific reasons with increased self-reliance Efficiency and societal contribution ultimately resulting James in a Moseley writing in the American Journal of Public Health proposed a revised methodology for approaching third-world health care among other changes they called for an integrated community-based approach to replace Institution-based care and a greater emphasis on prevention via health education and elevating the status of women these changes have not been adopted with Repetitive however and even if adopted they may be too late to convince third-world nations with a degree of medical self-determination of the good Intentions of medical tradespeople from the quote scientific close quote school the medical trades people themselves need to be convinced of the need for Integration else there are bound to be instances where they impose the old-fashioned scientific medicine out of impatience ignorance or simple apathy Convincing them may be enough of a chore in it of itself to wreck any last-minute reform attempts Robert Collis recounts firsthand the divergence of agendas between the British and Irish physicians and their patients in Nigeria immediately after Nigerian independence from Britain quote inside the university most of my colleagues were content as they were they were Surrounded by fascinating new disease syndromes and the diseases which they found presented different signs and symptoms in Nigeria than they did in Europe medicine here was wide open for research of the most interesting kind Why worry about health when disease was so exciting if Ibadon was just recovering from an epidemic of smallpox Because the people had not been vaccinated if thousands of children died of malaria and dysentery every year if thousands of cases of tetanus occurred It wasn't your fault if the authorities did nothing about it close quote The traditional disposition of European and American doctors towards pathology and not prevention was evident at Collis's University So was the quite natural but substantially socially irresponsible desire to pursue potentially glamorous and career-enriching research Opportunities instead of the more mundane public health concerns more pertinent to the immediate needs of the Nigerians It is possible that reasonable health care for women is not Realizable unless it has made a specific goal of the political and economic structure In fact Marxist communist systems with their emphasis on social issues are doing a better job in this area with less effort than the Capitalist influenced countries the sacrifices that residents of communist countries make are considerable But health care for women apparently need not be among them Socialist theoretical assessment is that the lack of medical services available to poor people of capitalist countries is a necessary Byproduct of capitalism medicine is a business like any other with no special considerations to be made on the basis of the type of business quoting from Cheryl Brown Travis's women and health psychology quote Profits are realized in the conduct of private practice and clinical care Pharmaceuticals and medical technology and the operation of nursing homes The health care industry is seen as simply another field where a surplus value is obtained through limiting the access of workers to the means of Production the class nature of health care is demonstrated by the domination of decision-making bodies by members of the elite and upper classes Close quote Travis goes on to state that medical systems are seen by Marxists as a means of social control The state and the medical industry offer and withdraw care according to the level of social unrest And they define health and health care in politically convenient ways The state also aids the medical industry in maintaining its profit base such observations are perhaps over Generalized but they are not inconsistent with the history of health care in the United States over the last century if there are in fact structural inadequacies in this capitalist model of health care Deliberately or inadvertently established on an extensive level a third world nation Prioritizing health would have to avoid it unless strict regulation of the industry could be established and maintained no mean trick when dealing with multinational corporations Cuba in an effort to subdue discrimination against women passed the maternity law and the family code in 1975 the maternity law allows in fact requires 18 weeks off work for the prospective mother one day off per month for the newborn babies medical care and an option at the end Of the first year for a full year off without pay or loss of job the family code requires that the father take Responsibility for 50% of the child care when the mother works similar legislation has not been enacted in the United States because of the Unfairness that would accrue to employers whose female employees refuse to choose job over family in the absolute the state planning in Cuba Clearly permitted this reasonable and appropriate response to the dilemma of working motherhood Precisely because there were no private employers to palliate Developing nations that want to achieve wealth first and equanimity second are advised to take note of this example Audrey Lord in a trip to the Soviet Union in 1976 discovered that free medical care was available to all Inevitably she was quizzed on the topic of health care coom capitalism. This quote is from sister outsider Quote I told Helen to tell him it was more difficult for black people to find work and make any kind of living and that the percentage of unemployment among American black people was far higher than that of American white people then he asked Do black people have to pay for their doctors too? It's not only black people who have to pay for doctors and medical care all people in America have to if you don't have the money to pay Sometimes you died it displayed utter amazement that human beings could die from lack of medical care close quote Understandably this conversation carries a serious message for third-world women if you are a poor resident of a capitalist country It is advisable not to get sick for the rest of your life The capitalist model demands that consumers pay the price named by health professionals for their services or do without them A demand that might be beyond the realm of possibility for residents of nations where the GnP per capita is under $500 a year additionally one might argue how can health professionals so motivated be trusted to pursue adequately the preventative approach to disease Why would they want to reduce their own profits what good is an economic system whose purpose is to prevent satisfaction of basic needs dissatisfaction with the compatibility of capitalism and reliable medical care is even more evident in Eastern Europe Developments in Russia and the former Russian occupied areas of Eastern Europe indicate Awareness by the respective areas that a population that wants medical care and specifically prenatal and postnatal care provisions May have to ask for them by name and to the exclusion of all their goals Including capitalism why this should be true theoretically is not certain Intuitively however the percentage of people who prefer survival to ideological purity should be over 50% The credibility of capitalist nations must look poor to third-world countries in the wake of the third world infant formula birth control and Pharmaceutical fiascos they have started to neglect even their own citizens third world women may have to embrace communism with its image of universal health care And special consideration for women's health issues out of sheer self-preservation Health care so recently having become the dominant domestic issue in the United States has been an issue for third world women Indefinitely it has not always been easy or cost-effective to obtain women who have attempted to bridge the gap by themselves treating others health problems Have faced discrimination the impact of the developed countries both in colonialist days and afterward may have been more harmful than good displacing existing resource networks and Substituting ill-considered one-size-fits-all models for health care practice of extreme political significance in the post-communist World is that the communists are taking better care of women and the poor in medical terms than many capitalist nations Including the United States to dismiss the entire issue of how best to research and treat conditions identified with women as an uninteresting throwback to the 19th century is to misunderstand that the standards of the 19th century in Europe would be a dream come true To many third-world women to consign feminism to the 1970s or communism to the 1980s is to overlook the real impact on economics and political development that these forces continue to have despite the incredible amounts of negative publicity They have received in the quote free world close quote as the United States grapples with the inequities and inefficiencies of its own health care system the failures of the capitalistic model of medicine may become obvious even to those who now Export it some changes in the system are imminent They're not necessarily for the best as these domestic changes take place It may still be possible that Europe and the United States will begin to collaborate with individual developing countries in the establishment of integrated models that comprise local accumulated knowledge cultural sensitivity and helpful pertinent European American medical techniques without that collaboration There is little that can be concluded other than third-world women and third-world nations in general are their own best hope for appropriate safe and inexpensive medical care You're listening to first-person plural on CFUV 101.9 FM Victoria 10 years later not a lot has changed. I Have in front of me a Press release from the Commission on the status of women a United Nations Commission Regarding its March 5th and 6th meetings for this year 2003 The title the press release is women's social economic inequality leads to trafficking domestic violence exploitation say speakers and women's commission Subtitle note women represent staggering 70% of those in poverty staggering in single quotes Why is most dangerous place for a woman her own home delegate asks? This was mostly about economic issues, but as you might Have gleaned from my reading of the paper. I wrote 10 years ago. There's a very large overlap with the health issues That face women worldwide Let me hit some highlights from the press release The 70% figure was Taken from remarks by the representative of Nigeria on the Commission The representative from Nigeria said that the basic needs of women had yet to be adequately addressed by local national and international policies The representative from Tanzania said that unequal power relations and unfair ownership of property and assets caused women to be more prone to poverty than men In that country women were according to her remarks the main Workers and producers in agriculture, but the distribution of the little wealth generated was still not equal between men and women as to administration as Distinct from ownership the director general of children and family affairs of Norway Said that even though her country had been referred to as a quote Haven for gender equality close quote by the committee on the elimination of discrimination against women There still had not been improvement in the gender wage gap Really really that's an interesting one She mumbled something about the lack of women and decision-making positions in the corporate world The number of women on boards and in top management showed no progress the representative from Japan Mentioned that Children and the relationship between women and children Was a factor It increased the vulnerability out of proportion to the increased poverty for poor women I mentioned Trafficking and the sexual exploitation of women and children There were a few other remarks as well by other members I've taken the liberty of not mentioning them here because they're not as pertinent to our subject in case you're curious about who spoke at this When the answer is quite a few people there were representatives of Australia, Lithuania, Croatia, Germany, Malaysia, Gabon If I'm pronouncing that correctly Guatemala, Senegal, Mexico, Israel, the United States, Peru Argentina, South Africa, Denmark, Burkina Faso, Kenya, Tunisia, Iran, Canada, Azerbaijan If I'm pronouncing that correctly Cuba, Botswana on behalf of the Southern African Development Community It says here Indonesia, Morocco, Guyana, Iceland, Turkey, Egypt New Zealand, Thailand, Mali, and Spain and the Philippines The observer for Palestine, I take it that's the non-voting member from the PLO or equivalent I also address the Commission. Palestine is not considered a nation But they do participate in a lot of UN. In addition, there are representatives of the following organizations The international migration organization, the UN Regional Commissions The Food and Agriculture Organization, the World Health Organization, they would have to be there The International Labor Organization, the World Bank, and the Inter-Parliamentary Union The following non-governmental organizations also contributed the conference of non-governmental organizations And the coalition against trafficking in women, I said in women A couple of these people tied the health issues to the economic issues And that seems to be the general perception worldwide about the status of women That life hasn't gotten a lot better for them Never mind that discussion of, quote, women's issues, close quote, has been going on what seems like forever Well, never mind that, we're what, eight years out now from the Beijing initiative I mean Beijing was supposed to be the beginning of a whole new world for women It was this extremely positive experience And yet, while some strides have been made There, it's been very, very small increments It has not been what I would call radical at all And in parts of the world it's gotten worse, not better And the reason that I see here in this press release, the one that keeps coming up, is that Women haven't made any great strides in terms of gaining ownership Women haven't made any great strides in terms of gaining access to administrative positions And that under, dare we use the word capitalism, the rich get richer and the poor get squat And since women are the poor And inevitably there is an interaction effect Yeah, and there's another interaction effect going on here that you address somewhat in your paper That struck me because it's probably a topic that's near and dear to my heart And that is the cultural interaction It isn't just a gender issue and it isn't just a poverty issue There are a lot of cultural backgrounds that come to the table In fact, this conference failed in putting together And passing its resolution on violence against women In part because of cultural discussions In part because there was wording that some people felt needed to be there And other people felt was distracting And those differences can be traced to a difference in the view of gender A difference in the view of among genders And I say among instead of between on purpose And also just religious backgrounds, ethnic backgrounds, and so forth I mean, there is an incredible amount of cultural baggage That comes with the discussion of the equality of women The United Nations is a culturally sensitive institution It's not going to be easy within that institution To merely point out that this is right Without listening to more than one point of view on it In other words, it's not going to impose a western view of what equality of women means The reason I bring up this press release now Is to add an element of currency to this And because in my paper the overlap between economic and health issues was considerable That the economic status of women in a particular place in the globe Was bound to be closely tied to the health status of women in that place There was an obvious relationship It hasn't changed much since you wrote your paper in 93, has it? If what I'm reading here is correct, if this UN commission has its facts straight It hasn't So Carl, let's ask ourselves, are there other factors that are going unmarked? Okay, in the paper I stopped just short when I wrote it 10 years ago Of saying that oligopoly was incompatible with women's health I think there's some theoretical reasons for it Okay For one thing within an oligopoly health gets defined on the basis of what gets delivered as a commodity And we live in a world right now, I mean especially if we look at pharmaceuticals I mean you brought out the Nestle infant formula fiasco in your paper And that's just one example of large corporations owning Products that supposedly either help or do in fact help health And one of two things happened, they either promote products That among developing nations that turn out to be not so health promoting Or they promote products and then ask for too high of a price tag for things that would be helpful One of the reasons that the epidemic of AIDS in Africa right now is so pervasive Is because the medications that are available to Europeans and North Americans Cost so much money that they are not available in Africa They're not slowing down the progress of the disease They're not helping in terms of identifying who is and who is not infected with the disease I mean all of the things that we kind of take for granted in North America regarding AIDS And the treatment of AIDS and the containment of the spread of AIDS is practically non-existent in Africa And that is purely purely economic has nothing to do with education It has nothing to do with anything other than These medications are not getting where they should be going Because the money does not exist to make it go there And the companies that have this information and product Refuse to give it up without economic compensation But pharmaceuticals i'm becoming more and more convinced are more evil than practitioners practitioners Are a mixed bag There are a number of practitioners in the world who who are not in it for the money Who are beginning to take their expertise into places And they also are beginning to be more sensitive to the indigenous knowledge That exists in the places that they go to The pharmaceuticals however as near as I can tell Are doing very little they're as bad as drug dealers They'll show up with a few free samples and give a little bit of hope and then the The real money starts being the issue And the reason they can get away with this is frighteningly simple It is that when you're selling somebody a necessity and you are a monopolistic provider You can charge whatever you want. It's just that simple the money becomes a dangling signifier at that point And there I mean it's a very complex world too because in a whole lot of The research and development that occurs that creates Pharmaceutical products Are funded through governments They're evil in two accounts On account one They profiteer off of people's suffering and on account two they often don't take their the risk That other companies take in order to get that profit So they kind of feed off of societies from both ends They take money for research And they do some pure research and then they fund some pure research But they also get matching grants frequently And then they turn around they create products that they won't sell for reasonable prices First person plural Your source The police state is using its phallocentric organ the corporate media To control ordinary people like you And me It's worth pointing out at this point that some oligopolies do not get quote government closed quote subsidies and some oligopolies do Yeah, and this is one that does It gets subsidies at the very least to get subsidies in terms of knowledge and access to knowledge And at the very most it gets out and outright money So you'd say it really has reached the point where they can play the public health card when they're hitting up the government for money And then turn around and deny that they have anything to do with public health when it comes to actually selling their product You would say that it's really reached the point where they can say to government Oh, you have to fund us because if we come up with a cure that will help people Right and that's a public issue and then turn around once they have well a treatment or a product And say this is a private product that belongs to us exactly And so they turn to other organizations and say you have to pay for this And I would be sympathetic. I mean, you know, you have to pay for things and it's true that The development of pharmaceuticals takes a lot of money and so forth But the truth of the matter is that's not where the biggest part of their budget goes The biggest part of their budget goes to promotion. I mean, I was it was incredible when I was doing my dissertation research and interviewing nurses This was sort of a side issue. So I didn't pursue it a whole lot during my dissertation research But I would love to go back and do a study someday of this Every nurse I talked to that worked in a doctor's office Told me about the things that they received from Pharmaceutical companies. I'm not talking about pens and pads with the pharmaceutical company name on it We're talking and and I'm not talking just about free samples either which Physicians generally use for good, you know, they generally give away free samples to people who need That kind of supplementation and free samples are a very nice idea But I'm talking about meals and I don't mean sandwiches or bringing by donuts I mean pharmaceutical reps who go into physicians offices all over the united states. I haven't found out yet about canada I've asked around but I think they're starting to do this in canada as well And they show up with catered meals hot catered meals and we're not talking about every once in a while One nurse told me that she hadn't cooked in months Because every day she goes to work and a different pharmaceutical company comes in with a buffet with so much food That she piles it up in Tupperware and takes it home to feed her family And it affects the judgments of physicians the latest pharmaceutical guy comes in He gives a great big meal to the staff when he comes in And then he tells the physician all about the the properties of the new drug that they're promoting And this is the freshest thing in the physician's mind The physician can't keep up with all of the new pharmaceuticals that are coming out And so he doesn't read the journals about these drugs He reads the propaganda that walks into his office every day with the free food Now multiply that I mean I'm talking that I talked to like 20 some odd nurses in one county And Among them I would say 10 or 15 of them mentioned this Happening in their offices. So it seemed pretty pervasive and that's one county in the united states So we're talking hundreds of not thousands if not tens of thousands of physicians offices That get this free food and we're not talking about like New york city or los angeles. We're talking about A fairly sparsely populated area Certainly not what I would call a Metropolis so they're going out into Small cities and countryside to do this as well I mean, it's just it's mind-boggling when you think about it how much money they're spending to promote Pharmacy pharmaceutical products It's not being based on science It's being based on advertising Well, as long as we're railing physicians here, um, well, I was railing pharmaceutical companies Yeah, well they go hand in hand Yeah, I take exception with one of your earlier remarks where you placed physicians and pharmaceutical companies in opposition Physicians like to create the impression that they are in opposition to pharmaceutical companies and hmo's Which is an american expression meaning a healthcare prevention organization But I don't think that the opposition is as great as they would like you to believe I think it's a mixed bag. I I've looked at The structure of hmo's and I've looked at The ways in which physicians are divided up and what a lot of people don't realize Is that there is a definite hierarchy among physicians And some of the younger physicians some of the family physicians are in fact getting screwed by the new hmo's But there are a lot of other physicians who are actually owners of hmo's Who are making a pretty profit at their peer's Expense one of the things that I liked about your paper probably One of the reasons why I brought up culture Is that you talked about the lack of respect for indigenous knowledge The very fact that we're talking about pharmaceuticals is one indication of that lack of respect Pharmaceutical companies are based upon what is called the magic pill solution after The germ theory of disease became a popular idea I guess in the mid 19th century Allopathic medicine, you know physicians regular physicians What we think of is westernized medicine or whatever Started really hunting for this magic bullet This one thing that was going to Make health happen There are lots of culturally different ways to think about health Health is not easily defined In western allopathic medicine, especially with the emphasis on pharmaceuticals Health is defined as the absence of disease You have a germ it makes you sick you take a pill you get rid of the germ you're well That's a really poor view of health And one that probably isn't Very conducive To good health among developing countries. It doesn't serve these women very well But it does serve oligopoly very well And oligopoly view of that is we own the pill We make the money So if we convince you that you have good health because you buy the pill You know, and I don't mean the birth control pill. I mean any pill that makes you healthy I mean the pill in question. Yeah the pill in question And I own the the rights to sell the pill in question Then I make money and that's the theoretical basis I think for the problem that you've pointed out empirically that Women's health is not going to get better as long as multinational corporations are allowed to be in charge of Development And it all springs from this notion that all systems can be modeled oligopolistically. Well, yes, they can But there are implications Patient health becomes immaterial The only things that remain material once you are committed to this oligopolistic system are going through some rituals that may or may not have anything to do with patient health Such as filling out forms and seeing patients I mean literally seeing them not doing anything to help them but turning your gaze upon them if you're a practitioner And assessing every new issue that arises with the question What's in it for me Doing anything substantive becomes immaterial what becomes material what becomes the manifest function of the system is Making those who own or manage or control it richer than they already are more powerful than they already are more In control of Their patients than they already are and this is I think to sum it up and probably to suggest a solution Is the way that you combat this is you do away with the top-down model if you stop thinking in terms of Women being helped by Developed nations who are coming in and serving development to the developing country And especially to the women and start asking the women What do they need? What do they want and empowering them to create it? I'm reminded of A thing that happened at a conference a few years ago And I think this is probably the best analogy that I can think of I went to a conference and was having to use a cane to get around at the time and The banquet at the conference was scheduled in a restaurant on the second floor And this restaurant had Two ways to get to the second floor You could go up a steep flight of stairs that at the time caused me considerable pain Or you could have the wait staff carry you up And that was their accessibility and not wanting to be embarrassed I walked up the steps and was in such pain at the end of it That I didn't make it through the evening. I had to leave before the speaker spoke Before I left I asked one of the planners of this Why after so many years after the American Disabilities Act They would plan a banquet at a place that was inaccessible for anybody with a disability The response I was given was quote. We can't think of everything close quote And that sums it up in a nutshell They didn't have to think of this if they had included disabled women in their planning And in their power structure the disabled women would have thought of this for them But all too often the way that development gets done Is the wealthier countries and much the same as the oligopoly Model come in and try to do development for them Women's health is being done By someone else and imposing in upon the women in these countries And I think you hit this in your paper quite well. That's why indigenous knowledge gets dismissed We need to start with the indigenous knowledge We need to go and say who are the health practitioners here? Who are the people who are providing? for Whatever health these people have Most of the time it's women And most of the time it's women with indigenous knowledge And there's no better example of a problem that would be served by this than The assessment of what the problem is in the first place Why it is that 10 years later nothing much has changed? Yes, it would change radically if it began at the bottom and worked its way up With the support of things like the united nations But that's not the way it's being done The way it's being done is imposed from the top And that is not going to work. So yes in the end oligopoly and women's health are incompatible You have been listening to first person plural because how people get along with each other still matters First person plural is a show created for community radio by carl wilkerson and dr. patty tomas to examine social and organizational issues Music for first person plural is performed composed and produced by carl wilkerson Except where noted for more information about first person plural dr. patty tomas or carl wilkerson Visit our website www.culturalconstructioncompany.com or email us at fpp at culturalconstructioncompany.com