Consumption of the Poor

The Consumption of the Poor is about the prevalence of tuberculosis late in the twentieth century. The chapter opens by challenging the claim that the high prevalence of tuberculosis in the late twentieth century was a “return” of the disease—this claim implies that tuberculosis prevalence had gone down over the years, an assertion the author of the chapter disagrees with. According to the chapter, not only was 1995/6 the deadliest year of TB deaths than any other year in history, but TB has also been around throughout the century, contrary to the belief in some discourse that it had abated or had been eradicated. According to the chapter, tuberculosis has continued to affect poor communities and communities of color in the United States, and poor people in the global South. Poverty, racism, and lack of social justice have all played a role in many incidences of TB, as has the HIV Aids pandemic. 

 
The chapter illustrates the experiences of three different TB patients: Jean Dubuisson, a black man from Haiti; Calvin Loach, a black resident of New York City and a veteran from the United States; and Corina Bayona, a poor working woman from Peru. When he becomes sick with TB, Jean avoids going to the hospital because it costs too much and his family is poor. In fact, he prioritizes his children’s tuition and education over his health. When he does seek medical care, he is given multi-vitamins and the ironic advice that he should “eat well, drink clean water, sleep in an open room and away from others, and go to a hospital.”  This advice is especially ironic because Jean’s family would have to spend all their resources in order to comply with this advice. When his health worsens, Jean is admitted to a hospital, even though poverty makes him check himself out before the treatment is done—and it also limits his prescription, which he could not afford to complete. By the time he was cured, the prolonged illness had affected his health so much that he was unable to function properly or even work.

Corina contracts TB after moving from a rural area to a poor neighborhood close to Lima. Again, the poverty and lack of proper sanitation in poor neighborhoods no doubt plays a role in her contraction of the disease. Repeated visits to medical centers and hospitals yield little relief for Corina and her family. In fact, Corina becomes very disappointed in medical staff after she suffers poor medical care and harassment at the hands of doctors and other health technicians. Corina’s experiences with medical staff discourages her son Jaime from seeking medical attention, and in the end he succumbs to TB and dies. These stressors plunge Corina’s husband into alcoholism, especially after his loss of employment. Corina eventually dies from the disease.

Calvin’s narrative is a little different from the other two, if only because he is from the United States. But racism plays a role in the way Calvin experiences medical care. For instance, his heroin use seemed to have made medical workers judge him harshly—as opposed to alcoholic veterans, most of whom are white. Medical staff also repeatedly complained that Calvin was “non-compliant” and that he was responsible for the worsening of his disease. Being poor had a role to play in both Calvin’s contraction of the disease and in the poor treatment he received, which led his TB to become drug resistant.

In all three instances, there are commonalities. These three people were all poor, regardless of their different locations. One was a woman—there seems reason to believe that Corina received bad care in part because of sexism, not just her poor economic status. Poor care for the patients also led to drug resistance, even as the medical establishment sought to blame the patients by labeling them as non-compliant or faulting them for not being able to afford the full regimen of TB medicine. Economic factors also played a role in all the cases: Jean suffered the poverty of rural Haitians, while Calvin and Corina suffered poverty as a result of neoliberal which brought cuts in social spending, especially in areas such as healthcare.

The chapter concludes that TB is a problem bigger than just a public health crisis. It is not an individual disease, but rather a disease caused by the broader forces of poverty, racism, and injustice. These forces operate and bear upon lives both here in the United States and in other countries. A comprehensive effort (“pragmatic solidarity”) that addresses the disease from all the angles of its causes (medical; economic; social justice; racism; structural adjustment policies) is necessary to combat the prevalence of the disease.