Boinkie's Blog

Universalis

Tuesday, January 24, 2006

Inequality of income

Today we went to the new Waltermart...

Actually, we didn't have to go there, but I had some errands and our young driver suggested we go there...

Actually, what he wanted was a new teeshirt.

He's a farm boy from a distant pueblo...and was our gardner...and gradually we taught him to drive, and now he is able to drive even to Manila and even our large two ton truck that we use to transport fertilizer and rice to and from the farm...

But he is still very very poor...

And when we go to the new mall, he sees the motorcycles they have on exhibition there, and his eyes gleam..

Alas, the cheapest motorcycle is 36000 pesos...about 650 dollars...but his salary as a gardener was 1500 pesos a month (of course, he did get room and board also)...a dollar a day over room and board...

As a driver, he earns twice that...so 90 a month...but since he sometimes visits a girlfriend, and has to send his mother some money, you can see he will never afford the motorcycle...

I suspect when he is older, he will go to Saudi Arabia or another country. Our previous driver was looking into it...if he goes to Kuwait and drives US trucks he'd get 30 thousand a year...

Since that driver was fired after messing with a maid, a married lady we had in to help for a few days, I don't know if he will go there or not.

But it explains why there are so many OFW that leave from the philippines...

LINK
Called "third country nationals" (TCN) in contractor's parlance, they hail largely from impoverished Asian countries such as the Philippines, India, Pakistan, Sri Lanka, Nepal, and Pakistan, as well as from Turkey and countries in the Middle East. Once in Iraq, TCNs earn monthly salaries between $200 to $1,000 as truck drivers, construction workers, carpenters, warehousemen, laundry workers, cooks, accountants, beauticians, and similar blue-collar jobs.

LINK

"It is so obvious that I can get better pay in Iraq," said Joseph. "I don't want to settle for less and am willing to take the risk to do so." Joseph's friend, a driver who only wanted to be known as Ramon, agreed with him. "I can get $300 a month if I work in Iraq, compared to back home where I won't even get half of that," he said.

"It's hard to find jobs in the Philippines. I won't allow fear or risks to come in my way of earning money and providing my family with a decent meal every day," said Ramon. He said he knew there was a great demand for workers in Iraq. "One company is hiring around 25,000 people, including construction workers, secretaries, cooks, engineers and designers, for Iraq. My friends and I will definitely apply," he said.

LINK

I found there that it has become very common that some restaurants and hotels are using work agencies to get workers from Seri Lanka, India, Pakistan and the Philippines. Moreover, many families in Baghdad started to hire maids through work agencies; the family would pay 1300 $ for the agency to cover the travel cost of the maid who will get a monthly payment of 100 $ at least.

The question is why don’t these people hire Iraqis instead? And why do these people (workers) risk their lives in coming to work in such a “chaotic area”? I think the answer to the 1st question is that most Iraqis can easily find a job that pays more than 100 $ with less effort and commitments. For example a kid (in summer vacation)who help in cleaning the streets and river banks get paid about 120$ by the city hall a month for about 5 hours work.
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Left wing sites hit the ceiling against the injustice...but what is the alternative? I mean, my own ancestors migrated for money...of course, most stayed in the USA...but many Philippinos come back here and start businesses...my stepson's business is based entirely on my husband's money (he does work hard, but without that money, we'd have nothing)...

If Gloria got her act together, she has a skilled and eager workforce...alas, unless we get more good Baptist and IglesiodeCristo people into government, I suspect the corruption will continue...

I am catholic and socialist...but the reality is that it is the rule oriented hard working working class who are protestant who are the ones changing society...and the Catholics who are influenced by the increased morality of those churches...

So my stepson's religious stuff drives me nuts, but I see the point in it.

Brain death keeps changing


They keep changing the definition of "death"...

And note the comment in part three about "such patients include those in a persistent vegetative state"?

That is actually not true...PVS is merely lacking cortical function, and even then it is overdiagnosed 40 percent of the time...but YOU CAN"T DIAGNOSE IT until the patient has been comatose for six months...(The P means persistant...that means it's been there for awhile)...and many people with some coritical damage have seizures, or may only be alert part of the time...

I KNOW this because of my work with the retarded when I was younger...some of our patients were diagnosed as "PVS" when WE knew they responded and were alert...

But THAT doesn't really matter, because there is a trend that will soon make it "Higher brain death" then into those who don't meet the criteria for personhood...

A 1995 article gives the Catholic take on all this...or, if you prefer, here is an article from The New Yorker magazine...and here is a discussion from a medical ethics journal ....

Actually, I've had enough patients whose lives were saved by donated kidneys to believe in organ donation...and I don't mind if my family signs my organs away, as long as I am brain dead...the classic definition, that is...

Unless, of course, they will get money for the organs, then I say no way Jose...Of course, in the Philippines, that might mean my organs will go to a rich Japanese instead of a poor philippino...and of course we still have the Hippocratic oath here...

And as for the Hippocratic oath, well, Cornell is trying to change it...again...Guess what parts they left out? Yup...the parts about abortion, killing patients, and God...

Thanks for the heads up from Bioethicsblog

Thursday, January 19, 2006

Euthanasia rare in the UK

This is a surprise, because it is being touted as "common" and the numbers are confusing because of the way we treat people.

If we inject someone with a deliberate overdose until he dies, that is euthanasia...if we do it with the patient asking for it, it is assisted suicide.

BUt somepeople mix this up with pain medicine needed to relieve pain..

If a person is in severe pain, and we keep giving slow frequent morphine shots to relieve his pain, and slow the morphine drip when he is pain free, this is treatment not killing...I once argued with a nurse when the dose to relieve a patient's pain caused his respiration to slow...she wouldn't give any more, but he still kept waking and moaning in pain...so I gave three more doses, and he went to sleep....and died a few hours later without furthur pain medicine..
However, I should observe I have had similar scenerios where the result was that after a few hours, the patient woke up and recovered and was pain free with the adjusted dosage...the highest dose of Morphine I have given is 300 mg an HOUR by iv drip...the patient lived on that dose for several weeks...

Ditto for pain patches. I had a 95 year old who broke her femur but it was held in place by an earlier hip replacement...so we treated her with bedrest...a special bed to prevent bedsores...and since she refused IV's, we used patches...she ended up on Fentanyl 250 mg patches...a huge dose...and later we weaned her off it...she finally died two years later...

Extraordinary treatment is optional...open heart surgery in 80 year olds is optional (although my mother had it and lived 9 more years, driving her car until a year before her death)...Dialysis is optional. Respirators are optional. Even ICU for heart attacks are optional...and I've had older patients refuse all these things and some lived, and some died...

Feeding is more delicate.

However, if a person is dying of cancer, and the IV is uncomfortable, stopping it is optional.
Ditto for antibiotics if they have pneumonia...

If a person has terminal Alzheimer's and won't eat, the treatment is either to feed them slowly with a spoon or a feeding tube...

If a person has terminal Alzheimer's, or PVS, or severe degenerative neurological disease, and they are so bad they are unable to eat when fed correctly, then they can't swallow saliva and are essentially dying...a feeding tube does not significantly prolong their life over spoon feeding...again optional. Morally and ethically you can remove it...

If a person has severe brain damage and can swallow, but the feeding tube is placed for the convenience of the family , and then you remove it, it is essentially murder. But if the person says, as one patient said to me: Look, I want to eat normally with my family, and not be kept alive with tubes, then again this is an option that even Catholics argue about...and he died of pneumonia three days later...

So when you hear of "withdrawing treatment" or "medication" and euthanasia, remember: it is not simple...

And in this day and age, with the dehumanizing hospitals and overuse of technology, many elderly people want the option to end it...while ignoring that there are alternatives...

Indeed, one reason we came back to the Philippines is because my husband has had one stroke, and recovered...but if he has another, he wants to stay here...where family and maids can care for him...

As for me: well, I agree, but have kept my health insurance...because sometimes there ARE reasons to have extraordinary treatment..

Thursday, January 12, 2006

"..Although IVF is used routinely for the treatment of unexplained infertility, there is limited evidence to show that it is more effective than expectant management, and there is insufficient evidence to recommend it as an alternative to other therapies such as clomiphene citrate (Serophene), intrauterine insemination, or gamete intrafallopian transfer.

1 Risks of IVF include psychological stress, multiple gestations, operative risks, and ovarian hyperstimulation syndrome.

Another issue is its high cost. More research is needed to clearly establish the efficacy of IVF compared with other therapies... "

As a doctor, I know nothing is more desperate than a couple who can't get pregnant...in vitro fertilization is a nice "technical" answer to the problem...

When the tubes are blocked, either from an earlier tubal ligation or from scar tissue from infection or endometriosis, the only way to get pregnant is to bypass the tubes with IVF...

However, what is more disturbing is that some doctors are using IVF for any infertile woman...

And, of course, there is nothing happier than when it results in a child...But there is a question: Are we essentially selling snake oil? I mean, using IVF makes everyone happy because it is like a placebo for the parents and makes money for the clinic and gives the doctor a feeling of doing a good deed...

Because of this, few question if it is wise to do...I once read a history of the early research...essentially, because of Catholic objections, the government didn't fund these clinics, so the "research" was essentially funded by desperate parents...yes, they "Understood" the risks...but ethically, their own desperation made the decision less free, and ethically the doctors should not have exploited this anxiety (not to mention taking the money) of the parents when the "success rate" was very very low (it is now a bit better...30%, which is about as high as "expectant" treatment)...

And, of course, there is that nasty side effect of left over embryos...Again, no one wants to talk about it, partly because of the "abortion wars", but partly because the parents didn't think about the problem of "left over" embryos....and most of them think of these embryos as "children"...

So it's easier to ignore the problem than to confront the ethical dilemma...what should we do with aging embryos? WIth time, the chance of going to term even if implanted gets lower...

SHould a woman, who is often getting old to carry a child, risk trying to carry another baby (or sometimes six or ten more babies at various times)...

Some Evangelical groups are calling for adopting these children...but as "old" embryos, the rate of birth is low...and with half a million (?) left over, where would you find people to adopt them?

The Catholics frown on IVF because it is artificial and debases the sexual union between husband and wife...and have no answer...one priest said that the fetuses should not be destroyed, but left in storage so that their "death" would at least be natural...

Indeed, one suspects part of the overhyping/hysteria about embryonic stem cells is partly the abortion wars, but partly to justify seeing such embryos as non humans...so there would be less guilt to either destroy or use them to experiment on...

Ironically, few IVF parents have "released" their embryos to the stem cell experimenters, which is why the previously mentioned Korean scientist was first accused of an ethical lapse, because he pressured his female collegues into donating eggs for his experiments...

Wednesday, January 11, 2006

Actually, I am wasting far too much time on my blogs...

I should be praying...but am dry at prayer as usual...
I am trying to meditate on I am the vine you are the branches...the trouble is that as an independnt american, I am more enlightenment than christian...
I do my own thing, try to do my best, and offer it to God.
I need to be silent and listen to him, and let him work thru me.

One thing about being here is that I no longer have deeds to give...yet I don't pray any more than when I was busy working...

On the other hand, I am not as anxious and pressured as before...and despite the fact that I loved being a doctor, I still have no desire to take up that responsibility any more...I am still worn out and burned out...when it comes to doing work, that is...

But cheerful and not depressed about doing nothing...

more construction...the weather is beautiful, but the dust is so bad I stay indoors so I don't wheeze...

Ruby's dog was stolen or ran away.

Ruby is back in school.

Lolo is coughing almost as bad as I am...