Judgment

Talking with Poo about how other people wonder why she’s an ID (HIV) doc. A lot of other docs (or people in general will say), "those ppl did it to themselves; why should you help them?". She says she’s sorry for the stay-at-home housewives who never did anything wrong and got infected from their husbands. She is not sorry for the men who got it by sleeping around/going to sex workers. I tried to express that it shouldn’t really be a matter of whose fault it is or assigning blame to people, but I understand about the women issue. Like should people be treated differently because they are thought to deserve something? Smokers and lung cancer? IV drug users and HIV? Although I agree people should take responsibility for their lives, I also think it’s necessary for us to think about humans as humans and maybe not be so focused on assigning blame. Who should be allowed to receive treatment when there are limited resources? It used to be Thai policy that active drug users could not receive ARV from the government...is that fair? Who decides how much people's lives are worth? Unfortunately we do make these judgments everyday. Drug companies make these judgments, American foreign policy makes these judgments, and we, as physicians, will make these judgments. I think that's been a hard thing for me to come to terms with. People with crappy insurance don't deserve crappy care but sometimes that's all you can give them because that's what they can afford.

I remember a conversation I had with my mom about assigning blame when I originally started working with HIV+ people. She held the belief that people must have done something to get it (and they shouldn’t be doing that stuff anyway, so they ‘deserve’ it). What about the women who get it from their husbands? (well, she replied, someone is doing something wrong in any case - he shouldn't be cheating on his wife). Not so black and white though. Even when thinking about my own life, it's hard for me to think that anyone deserves to be infected just because they have sex, esp. since I’ve engaged in a lot of risky behaviorin the past and was just lucky that I wasn’t exposed since I grew up in a low prevalence area. If you're going to assign blame and talk about victimization and fault, exactly how are you going to break all these people in to groups of no culpability (victim?), kinda responsible for getting infected, responsible for infecting others, etc? What do you tell the girl who slept with her fiancee who was infected and then became positive herself? (She found out when her fiancee, 22, died). How much blame do you assign an iv drug user who grew up in the slums and originally started using drugs to escape poverty, the miserable reality of life? What about the sex worker who is trying to raise money to send back to her family? Are all of us who engaged in premarital sex wrong? Do we all deserve std’s and a death sentence if we don’t get access to drugs? Do you personally still know any virgins? What if you were infected by your first partner and ended up infecting others, not getting sick until 10 years later? How many of you have been tested in the past?

I've been more aware of lots of subtle kinds of judgment, discrimination, stigma, lately. I'm taking private Thai lessons, and during my last lesson, my teacher brought this book called ‘ a day in a life’, which is collection of short stories about different people in thai society. Yesterday I read a story about this kid who lived with his alcoholic father. He had this piggy bank that he talked to everyday and put money in because he was saving money for new shoes. All the kids at school made fun of him because he was poor and had crappy shoes and his teacher was like, you should tell your dad to buy you new shoes, but he knew that his dad wasn’t going to buy him anything so he just kept saving. He also did really good things like donate money to his friend whose house burned down and he also found 200 baht but returned it to the owner (and got a 50 baht prize). At the end of the story, the kid’s dad broke his piggy bank when he was drunk and took all his money to buy alcohol. The kid bought a new piggy bank and then the whole story started over.

After reading the story, my teacher will ask me questions to see if I understood what I read (usually about the characters in the story). What kind of person do you think the narrator is? What about his father? She wanted to me to say his father was a bad person (and he didn’t really sound like a good father) but I didn’t want to get into the ‘all alcoholics are bad people.’ She was like, there are a lot of Thai people (mostly men) who are alcoholics…people should help themselves…why cant people just quit? My teacher talked about how there wasn't AA in Thailand, how she had a friend who quit once, and had respect for people who quit, but she really believed it was just a choice to drink a lot of alcohol (and then become alcoholic). I tried to bring the shades of gray into the conversation and brought up things like genetics, family, support, circumstances….I think that's a big thing I've learned over the years working with the underserved both at home and abroad...everything is some shade of gray, and I'm totally wary of people who just want to judge people in a black/white fashion. I'm wary of it in myself as well.

Finally, I never fail to be surprised at racist comments that my own (extended) family make (“I hate when the Burmese beg for money in the street.” “I refused to learn Spanish because I hate the Mexicans.”) What’s up with that? I try not to listen because arguing is futile (and disrespectful over here). Interesting to think about Race vs nationality – people are more into hating on other nationalites here (no 'Asian' bond exists). Why do people always have to look down on others/pass judgment? Are they making themselves feel better in some way?