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September 23, 2012 / katlen

The Next Pandemic?

The Next Pandemic?

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February 15, 2012 / katlen

Check this out

Here is what I did NOT do but probably should have:

http://www2.mdanderson.org/cancerwise/2012/01/letting-people-know.html

I just didn’t want a lot of people around, each with their own energy, clouding my journey through Stage 4 Cancerland.  It was between me and God. Finally told my mom that Stanford University could only offer me palliative care.  Had to google it.  Then I said, “that’s not me.”  And I kept saying it.

 

September 22, 2011 / katlen

Narco-Trauma, an Editorial

Narco-Trauma:  Mental Health and Young Adults in Ciudad  Juarez, an Editorial

 Recently, I (temporarily) stopped my subscription to the El  Paso Times, because I found that every morning with my coffee I would open the
newspaper and see yet more reports of the terrible violence taking place just  across the border in Ciudad Juarez.   “27
dead over the weekend”; “children’s birthday party shot up with machine guns”; “more  then 50 bodies unearthed in a narco-fosa
or mass grave”; “diplomatic personnel gunned down.”  I have El Diario de Juarez emailing me daily  reports with the key word “violence” and I eventually stopped reading that too.  (Temporarily.) It’s a coping  strategy:   I just needed a break.  It’s true that it’s part of my job to read
these reports:   I find myself unexpectedly working on the  mental health effects of what amounts to a complex humanitarian emergency, in
the language of conflict studies; characterized by political instability, armed conflict, social disruption, and population displacement[i]
.  This wasn’t what I planned to do  research on when I moved here in 2008 – but it feels like a responsibility to
our community to engage.

There is a numbing banality to this drumbeat of violence –  the “banality of evil,” a phrase coined by Hannah Arendt[ii]
to refer to evil acts during the Holocaust, perpetrated not by sociopaths but  by ordinary people going about their business or work duties in the
normalization of terror, violence and cruelty.   The armed conflict in Juarez illustrates with cold clarity Arendt’s
meaning, where the loss of human life is merely the cost of doing business.  It seems that as of 2008, narcobusiness
represented 63% of Mexico’s economy, second only to oil.[iii]  Globally, the the narcotics business is worth
more than oil and gas trade and is double the automotive trade[iv].   Narcotrafficking injects as much as $40
– 50 billion into the Mexican economy each year[v].  If the “war on drugs” should ever be  successful in eradicating narcotrafficking, Mexico’s economy would implode.[vi]  Along with a sizeable chunk of the US  economy.

So who are we kidding?   The market has spoken.  How often  have we heard the phrase, “Let the market decide” in the post-Citizens United
world of neoliberal, market-oriented political philosophy?  The drug trade is a successful, flourishing corporate  enterprise run by organized, savvy businessmen serving vigorous market demand and  accumulating vast amounts of capital with great success.  Is there a way to acknowledge this hard truth  and stop the violence?  Are we suffering  all these troubles because of the false consciousness of policymakers?  And research on terror and trauma contexts such  as the Shining Path in Peru, the ongoing Israeli-Palestinian conflict, and US inner
cities such as Baltimore has shown that those who suffer the most from the  destabilizing effects of trauma, violence and armed conflict are those with the  lowest social and economic capital:  the  poor, the powerless, women, children.

What concerns me profoundly are the mental health effects on  local communities.  I recently completed  a pilot study, funded by the Hispanic Health Disparities Research Center at  UTEP (Grant number 1 P20  MD002287-04 from the National Institutes of Health/National Center for Minority Health  and Health Disparities; Principal Investigator Elias Provencio-Vasquez), in  which I hired and trained interviewers based in Juarez – since we are not  allowed to go there ourselves to do research with public funds –  to test Spanish language versions of the
Harvard Trauma Questionnaire and the Hopkins Symptom Checklist.   With a team and a couple of focus groups,  we’d examined these mental heath survey instruments and revised the Spanish to  be locally appropriate.  Then we  conducted interviews with 40 university students on the effects of the ongoing  violence, as well as 40 low income female victims of domestic violence.

Results are wrenching.   Among the university students, 35%  meet DSM-IV criteria for PTSD; 37.5% for major  depression; and 37.5% for anxiety disorder.   By comparison, members of the military returning from Iraq and  Afghanistan report prevalence rates of PTSD as 19.1% and 11.3%, respectively[vii];  and prevalence rates for Latinos in the US for depression and anxiety are 15.4%  and 4.1%, respectively[viii].  One part of the Harvard Trauma Questionnaire  solicits qualitative narratives about traumatic events:  almost half of the students had had a family  member or friend seriously injured in the violence;  12 had suffered the death due to violence of  family or friends ; 12 had witnessed a shooting; almost 10% had had a family  member or friend kidnapped; 15 had witnessed violent events; 11 had witnessed  dead bodies; and almost half had been robbed at gunpoint.   Our participants are college-age:  between 18 and 24 years of age.  So young to suffer these traumas.

Certain factors put people at greater risk in a situation  like ours.  One of the characteristics in  the complex humanitarian emergency that is Juarez is that no single person  knows everything[ix];  information about perpetrators, circumstances, victims, is delivered in tiny  fragments, in the language of gossip and reported speech where it gets  embellished and expanded until it’s never clear where the truth is; reported in  the news one day, then not another word.   Victims are glossed over as being somehow  involved, and thus somehow deserving of their fates, but no – those kids at the  birthday party were honor students, athletes.   This disinformation and lack of information adds to feelings of  helplessness among victims and witnesses – and everyone is a witness.   The  sense that there is impunity for perpetrators increases risk for long term  mental health issues in victims[x].  There is no one to turn to for justice and no  trust in the justice system; reports of collusion with narcotraffickers on the
part of police, military and government up to the highest levels[xi],  rumor or not, has curtailed any sense of protection or justice from the state
for victims.  The inability to mourn  losses because it’s just not safe to identify a body or to bury one’s dead  leads to incomplete closure, unfinished business, lifelong longing – never  knowing what happened to levantados,  the disappeared, because they simply never reappear.  Narcotactics have been deliberately modeled  on those of terrorist organizations like Al Qaeda to create the most intense  climate of narcoterror among the civilian population, including sophisticated  use of electronic media such as YouTube videos of executions.

The point is, the availability of mental health services is  abysmal.  This is a global problem that  sorely needs to be addressed on all levels and in all communities and societies.  Mental health should be equal in importance  to physical health, and in fact the two are inextricable.  Locally, we need increased services because  of the climate of uncertainty, trauma and terror.  Mental health care takes a back seat in any  health care scheme, but this is a tragic mistake for us to make, as mental health  issues cause so much suffering and lost productivity, lost hopes, lost lives.

We continue our research with a new study working with UTEP  students that is underway, funded by the Hogg Foundation for Mental  Health.  Four months in, we’ve already  found too many students who have had thoughts of ending their lives, or feel  hopeless about the future because of the situation across the border.  As a community, we need to help each other  and look out for each other.   We may not  be able to stop the violence, we may never stop the drug trade, but we can ease  the suffering.

Dr. O’Connor holds a PhD from Harvard University in Anthropology.  She has been working in the area of Latino
mental health and health disparities for 17 years.  She spent 11 years working on Brazil.  Since 2005 she has been working on Latino  health disparities in the US.


[i] Brennan
and Nandy 2001

[ii]
Arendt 1963

[iii]
Poppa 2010

[iv]
Bowden 2002, quoting a 1998 UN report by Thalif Deen, http://ipsnews.net/news.asp?idnews=75692;
downloaded 9/22/11

[v]
Celaya Pacheco 2009;  globalvision.org (http://www.globalenvision.org/2008/09/08/mexicos-war-drugs-war-economy,
downloaded 9/17/11; The Independent
6/4/08, http://www.independent.co.uk/news/world/americas/mexicorsquos-war-on-drugs-journey-into-a-lawless-land-839465.html,
downloaded 9/17/11:  citing a leaked 2001
study by Mexico’s internal security agency CISEN.

[vi] Campbell 2009

[vii] Hoge et al 2006.

[viii] Alegria et al 2009 (NLAAS data)

[ix]
Campbell 2009, Bowden 2002, 2010

[x]
Basoglu et al 2005

[xi]
Bowden 2002, 2010a, 2010b, Campbell 2009

June 25, 2010 / katlen

Everything’s marked as private!

I *think* I just put all my posts in the “private” section so no one can see them.  This blog will reappear as a medical anthropology book; something about bone marrow transplants from the patient perspective.  I had a strange vibe about being so open and unguarded!  Can’t elaborate!

For anyone following, things are great.  I’m all better, in remission, just I get fatigued and my eyes get inflamed from work rather easily, I can tolerate the heat for 15 minutes before I get kind of dangerously overheated, and i need to be in control of my schedule in case I need to go to bed at 4:30 in the afternoon!  So still requesting ADA accommodations to protect myself legally and to ensure that I don’t get overworked and REALLY tired, then REALLY sick.  (then REALLY dead…)

I am off all my meds except tacrolimus, except I always forget to take it so I am effectively off that too.  Hooray, success!

I am almost finished with my book on Candomble and hope to announce its publication in the not too distant future!

I found a GREAT support group:  BMTsupport.org.  Really great people on that site and they have helped me so much already.  It’s lonely – I look fine especially because I wear a wig but I am still not that strong and the heat is intolerable because the radiation left me without the ability to cool myself through sweating and such.  VERY interesting, if inconvenient.  But people don’t understand.

Post a comment if you want to talk.