Consumed In The City

Consumed In The City: Observing Tuberculosis At Century'S End

Paul Draus
Copyright Date: 2004
Published by: Temple University Press
Pages: 344
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  • Book Info
    Consumed In The City
    Book Description:

    As a public health field worker assigned to control tuberculosis in New York and Chicago in the 1990s, Paul Draus encountered the horrible effects of tuberculosis resurgence in urban areas, and the intersections of disease, blight, and poverty.Consumed in the Citygrows out of his experiences and offers a persuasive case for thinking about-and treating-tuberculosis as an inseparable component of the scourges of poverty, homelessness, AIDS, and drug abuse. It is impossible, Draus argues, to treat and eliminate tuberculosis without also treating the social ills that underlie the new epidemic. Paul Draus begins by describing his own on-the-job training as a field worker, then places the resurgence of tuberculosis into historical and sociological perspective. He vividly describes his experiences in hospital rooms, clinics, jails, housing projects, urban streets, and other social settings where tuberculosis is often encountered and treated. Using case studies, he demonstrates how social problems affect the success or failure of actual treatment. Finally, Draus suggests how a reformed public health agenda could help institute the changes required to defeat a deadly new epidemic. At once a personal account and a concrete plan for rethinking the role of public health,Consumed in the Citymarks a significant intervention in the way we think about the entangled crises of urban dislocation, poverty, and disease.

    eISBN: 978-1-59213-770-1
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Acknowledgments
    (pp. vii-viii)
  4. Prologue: A Day in the Life, Chicago, 1998
    (pp. ix-xiv)

    The first question to answer: What am I doing here?

    It is the last day of September, two years before the end of the twentieth century. I am sitting on a milk crate cushioned by a dirty old jacket, under a tree in an empty lot at the corner of First Street and Jefferson Avenue on the West Side of Chicago (these are disguised names, so don’t try to find them). I have been stopping by here every morning lately, usually between 8 and 8:30. This morning there are four guys out here, not including myself and Hank, who sits...

  5. Introduction: TB and Sociology
    (pp. 1-12)

    The man was 54 years old, short and slight of build, a heavy smoker, and a habitual drinker. One day in early winter, while working in the detached garage outside his small home, he slipped and smashed his chest against the side of the car. When the pain in his chest did not go away, he went to the doctor. He was told that he had a tumor, that it was most likely cancer, and that he needed surgery. It was almost Christmas, so they told him to wait until after the holidays. The impending event hung over the family....

  6. 1 Bugs in the Big Apple: Chasing TB in NYC
    (pp. 13-32)

    I remember several works of popular culture distinctly influencing my decision to move from Laramie, Wyoming to New York City in the summer of 1992. First was the 1991 Terry Gilliam filmThe Fisher King, a surreal story about a radio disc jockey who is suddenly plunged from the heights to the depths of life in 1990s Manhattan, where the streets were haunted by living specters of AIDS, homelessness, and mental illness. That film captured the growing chasm between the privileged and the disenfranchised, even in an environment where they could reach out and touch each other at any moment....

  7. 2 Slow Motion Disaster: Postindustrial Poverty and the Return of TB
    (pp. 33-56)

    Tuberculosis in the 1990s was like a fire burning in the wrong part of town, a flood in Bangladesh, a famine in Sudan. It was something to be driven past, to be seen on TV or perhaps in a movie. For the average American, it was somewhat exotic because it was so segregated, so walled off from the mainstream middle-class majority. It was a Third World disease, and in the United States of the 1990s the Third World existed on the South and West Sides of Chicago, on the Lower East and Upper West Sides of New York, in the...

  8. 3 The Public Hospital: Battles on the TB Frontier
    (pp. 57-86)

    No matter how noble their intentions, medical institutions are not immune to social prejudice. Just as muscular, skeletal, and nervous systems are intimately bound within the same human body, so is the medical system embedded in a larger social body, and it is afflicted by the same problems that perplex the society as a whole (Freund 283). Among these are the everpresent maladies of poverty, race, and gender discrimination. Eli Ginzberg has written that: “… every nation’s health care system is embedded in its cultural, political, economic, ideological and social institutions, and … these must serve as points of departure...

  9. 4 Cavities of Contagion: Networks and Nodes of TB in Chicago
    (pp. 87-115)

    In New York, my buddy Spanner and I used to joke about “jacking into the matrix” every morning when we hit the streets of the city looking for lost TB cases. We had taken the phrase from William Gibson’s cyberpunk novelNeuromancer, where it referred to the process of entering the virtual world, a world that was dependent on the “real” world, existing in parallel to it, subordinate and separate, but nonetheless real. For me, what the term also evoked was the sense of the city as a living grid, composed of countless interrelated parts, tied together by the entangled...

  10. 5 Welcome to the West Side: Hanging Out in TB Alley
    (pp. 116-149)

    One day I was eating at a soul food kitchen located beneath the “L” tracks on the West Side. It looked like a shack that had been swept up by a tornado in Mississippi and plopped down in between two brick tenements. There were a couple small windows facing the street, and in the winter these were always steamed over and only dimly translucent. Inside, the peeling walls were adorned with paper plates on which menu items had been scrawled in black ink. A single black man, in his sixties and wearing a chef’s hat, prepared everything from pancakes and...

  11. 6 Hard Case Histories: Narratives of Tuberculosis, Homelessness, and Addiction
    (pp. 150-187)

    A familiar phrase among black Chicagoans is: “I’m going through changes.” Its implications are nearly always negative. When we heard this statement from a patient in the clinic, we knew that a litany of woes was coming. If things were changing, it usually meant they were getting worse. Martha, my supervisor, would laugh and recite the line from the old blues song, “Born under a Bad Sign”: “If it wasn’t for bad luck, I wouldn’t have no luck at all.”

    Time in the ghetto tends to be cyclical. For many people, the only markers of importance are the beginning and...

  12. 7 Difficult Negotiations: Coercion, Care, and Compliance in TB Therapy
    (pp. 188-232)

    In the winter of 2000 I attended a citywide meeting of tuberculosis care providers, in honor of “World TB Day.”¹ The Chicago Health Department was celebrating some of its success in controlling tuberculosis, and deservedly so, as disease rates had once again been reduced to record low levels. Most interesting to me, however, was a skit performed by the staff of a public health clinic. It was based on the then-popular game show,Who Wants to Be a Millionaire? and as contestants it featured four characters: an alcoholic woman, a homeless mentally ill woman, a Latina woman who claimed that...

  13. 8 Sheep’s Clothing: Lessons Learned from TB in the Field
    (pp. 233-254)

    In October 2002, I visited New York City. Exactly one decade had passed since my TB training first began. Clearly, much had changed since then. But the autumn sky was blue and clear, and the city felt the same as I remembered it from ten years before, in spite of the gaping hole in the downtown skyline. The streets were full of life, and people of every possible derivation and affiliation mingled there, en route to offices, restaurants, hotels, boutiques, factory floors, flower shops, sweatshops, liquor stores, hospitals, and prisons. On the corners across from where the World Trade Center...

  14. Conclusion: Implications of a Marginal Epidemic
    (pp. 255-262)

    Though much smaller than a flea, the tuberculosis bacterium has wreaked more havoc on the human race throughout history than any white whale, hurricane, earthquake, flood or war. Tuberculosis has cut down millions of people in the prime of life, and continues to do so. The story of this illness, therefore, encompasses many great themes: suffering, struggle, perseverance against great odds, and also real death, real loss, real tragedy. This tragedy is twofold. On one level, tuberculosis, like all other manners of natural illness and disease, forces us to recognize our mortality and confronts us with existential dilemmas of meaning....

  15. Epilogue: Back on the Corner, Chicago, 2002
    (pp. 263-266)

    Back in Chicago on academic business, I set out to see two guys whom I knew from my TB days. Rick was now living in a secure building on the South Side, and Isaiah was in a nursing home somewhere, the last I heard.

    Rick was a tough, aging thug with one eye and an attitude. When I first met him he was homeless, and I used to find him every morning, sitting on a bench in front of a low-rise housing project on the West Side. But we hit it off, and after he finished his TB treatment, he...

  16. Notes
    (pp. 267-272)
  17. Works Cited
    (pp. 273-283)
  18. Index
    (pp. 284-290)