Many Patients Don’t Survive End-Stage Poverty by Dr. Lindsay Ryan is a great/upsetting piece about how the poverty many Americans are subjected to in America is killing them. Many people die here in the world’s richest country not because they are sick but because they are poor and our systems of government, justice, business, and health care don’t do enough to help them (or, more cynically and perhaps truthfully, actively work against helping them).
This is one of those pieces where I want to quote every single paragraph, but I’ll start with this one (bold mine):
Safety-net hospitals and clinics care for a population heavily skewed toward the poor, recent immigrants and people of color. The budgets of these places are forever tight. And anyone who works in them could tell you that illness in our patients isn’t just a biological phenomenon. It’s the manifestation of social inequality in people’s bodies.
I have not been able to stop thinking about this phrase since I read it: “Illness in our patients isn’t just a biological phenomenon. It’s the manifestation of social inequality in people’s bodies.”
Medical textbooks usually don’t discuss fixing your patient’s housing. They seldom include making sure your patient has enough food and some way to get to a clinic. But textbooks miss what my med students don’t: that people die for lack of these basics.
People struggle to keep wounds clean. Their medications get stolen. They sicken from poor diet, undervaccination and repeated psychological trauma. Forced to focus on short-term survival and often lacking cellphones, they miss appointments for everything from Pap smears to chemotherapy. They fall ill in myriad ways — and fall through the cracks in just as many.
You should read the whole thing yourself (NY Times gift link). Her argument about the need to expand/shift the definition of what healthcare is (e.g. housing is healthcare) reminds me of this more progressive idea of freedom.
Now this is a lede:
When I first read Virginia Woolf’s dictum that “A woman must have money and a room of her own if she is to write fiction,” I was homeless.
It follows through on that first punch:
I know half a dozen published authors who’ve had to rely on food stamps. The seedy poverty of the author has been a cliche for centuries. We find the figure of the poor writer already in the medieval era, in the form of poet-clerics called “goliards,” who begged and sang ribald songs in taverns as they wandered from monastery to monastery. Hundreds of years later, in the Beat Generation, the type survived with no essential change. Now a new generation of writers are confronting ever lower and less reliable payment for articles, stingier advances for books, fewer jobs, and smaller royalty checks. A host of new threats to writers’ livelihoods, from internet piracy to the slow-motion collapse of the academic job market, means ever fewer writers are making a middle-class wage.
So, full-disclosure time! I have been on food stamps, as recently as a couple of years ago. I am currently on Medicaid, and thank god for that, because the open market for health care is terrible, and Medicaid is great. (Freelancers, stop paying COBRA or Obamacare and get yourself on Medicaid if you can.)
I have been a professional writer for almost ten years and have only been employed at a full-time job with benefits for (counts fingers) let’s say three of them. The rest of the time, I’ve been on the 1099 economy, piecing together pieces of living from freelance gigs. I have been homeless, and I have lived with family who’ve been much more stable than I have been. My health has never been good, which has made it difficult for me to maintain full-time work when I’ve had it. I have been behind on my child support, but am currently (thank God) current.
I would not say I am devoted to writing, with my poverty a consequence of that devotion. This entire time, I have simply not known what else to do. I have been writing for my life.
There are a lot of us. We don’t always show it.
Most writers I know who’ve been really poor practice similar forms of self-censorship. Sometimes the reasons are obvious even to someone who’s never had money problems. One writer I know went through a patch where he had to report to a subway cleaning crew to keep getting his welfare checks. He talked about this openly to friends, but went through extreme contortions to hide it from a publisher who was considering hiring him. When I was first profiled for a women’s magazine, I had their photographer come to my apartment, only to have her look around and instantly suggest we go out to a park. After that, I had photographers meet me at a richer person’s apartment to save everyone time and embarrassment.
But often the decisions are less clear-cut. Social media, for instance, can be the ideal forum for openly discussing social class—but it’s also notoriously a place where going too far can damage your career. Most of us filter what we say. This affects how we talk about being broke. A post about student debt is safe, but one about living in your car risks losing face and professional standing. It can even come across as a passive-aggressive jab at more affluent people. One writer friend of mine commented: “On Twitter, we make jokes about being poor. We don’t talk about the fucking dread eating through us because we’ll never be stable. We don’t talk about what it means, that we’re on Twitter because we can’t afford therapy or social lives.”
I don’t know what to do about any of this. I can’t promise that I’ll be more forthcoming about this on Twitter, or here on Kottke.org, or anywhere else I write. I do know that my life is changing again, thanks in part to The Amazon Chronicles, and other opportunities coming into my life. I hope it continues to change. I hope it changes for all of us.
I can only testify, right here and now, that poverty and authorship coincide, including authorship that comes with a kind of modest fame. I can testify that there is nothing romantic about it, only the very real life of compromises that Sandra Newman documents so well in this essay. I can testify that talking about and not talking about it can both eat away at you. There is no cure; only doing better and doing worse, only new wounds and a moderate form of relief.
I disagree with Newman on one point. I think there is no real market for stories about poverty, first-person or otherwise. Not really. Maybe in fiction, maybe as a one-off. But one cannot be a writer about poverty in the same way that one can become a writer about technology; and in most cases, being a writer about technology is extremely difficult when one is poor. (You can track my poverty level through my writing subjects: when I’ve done better, I write about gadgets and the business of technology. When I’ve done worse, I write about memoir or pop culture: music, movies, television, comics, the internet. Things accessible from my memory or on my computer for free or cheap.)
People may want to read about what it’s like to be poor, but they don’t want to pay for it. Paying for things is a rich person’s privilege, and people pay for access to material wealth and things that get them closer to it. And in the free economy, people like the lingua franca of pop culture. Simple stories about heroes and villains, that when you scratch them open, tell them bigger stories about themselves and the worlds they live in.
That’s not to say that people can’t be brought to hear a different kind of story, but they do have to be brought there. How to bring them there? That’s what we’re all trying to figure out.
In case you missed it, the President of the United States called Haiti, El Salvador, and African countries “shitholes,” then pretended like he didn’t say it, but basically said it all over again.
This matters not just because it’s racist (the President is racist, in fact, he is professionally racist), because it’s vulgar (“shithole,” one of the all-time great swear words, is forever sullied by this), and because it’s catastrophically bad for foreign and domestic relations. It matters in part because of the history of Haiti, and the history of racist discourse about Haiti.
Ebony Elizabeth Thomas, a professor of education and scholar who’s closely studied these narratives, writes:
The reason why White nationalists like 45 always name Haiti because the Haitian nation & people are unique. Haiti defeated Napoleon, threw off the chains of slavery, and exposed the lie of White supremacy & European imperialism. So there’s no end to their hatred for Haiti.
Jonathan Katz, a journalist and former AP correspondent in Haiti who wrote The Big Truck That Went By about Haiti’s 2010 earthquake and the cholera epidemic that followed, has a longer thread spelling out how these narratives about Haiti were generated and how they work. Here’s a thick excerpt:
In order to do a victory lap around the GDP difference between, say, Norway and Haiti, you have to know nothing about the history of the world. That includes, especially, knowing nothing real about the history of the United States… You’d have to not know that the French colony that became Haiti provided the wealth that fueled the French Empire — and 2/3 of the sugar and 3/4 of the coffee that Europe consumed…
You’d have to not realize that Haiti was founded in a revolution against that system, and that European countries and the United States punished them for their temerity by refusing to recognize or trade with them for decades. You’d have to not know that Haiti got recognition by agreeing to pay 150 million gold francs to French landowners in compensation for their own freedom. You’d have to not know that Haiti paid it, and that it took them almost all of the 19th century to do so.
You’d then have to not know that Haiti was forced to borrow some money to pay back that ridiculous debt, some of it from banks in the United States. And you’d have to not know that in 1914 those banks got President Wilson to send the US Marines to empty the Haitian gold reserve… [You’d] have to not know about the rest of the 20th century either—the systematic theft and oppression, US support for dictators and coups, the US invasions of Haiti in 1994-95 and 2004…
In short, you’d have to know nothing about WHY Haiti is poor (or El Salvador in kind), and WHY the United States (and Norway) are wealthy. But far worse than that, you’d have to not even be interested in asking the question. And that’s where they really tell on themselves… Because what they are showing is that they ASSUME that Haiti is just naturally poor, that it’s an inherent state borne of the corruption of the people there, in all senses of the word.
And let’s just say out loud why that is: It’s because Haitians are black.
Racists have needed Haiti to be poor since it was founded. They pushed for its poverty. They have celebrated its poverty. They have tried to profit from its poverty. They wanted it to be a shithole. And they still do.
If Haiti is a shithole, then they can say that black freedom and sovereignty are bad. They can hold it up as proof that white countries—and what’s whiter than Norway—are better, because white people are better. They wanted that in 1804, and in 1915, and they want it now.
The history of Haiti is weird because it is absurdly well-documented, yet totally poorly known. It’s hard not to attribute that to ideology. We don’t teach the Haitian Revolution the way we teach the American, or the French, or the Mexican, because it’s a complicated story. Kids are more likely to hear variations of “Haiti formed a pact with the devil to defeat Napoleon” (this is real thing, I swear) than Toussaint Louverture’s or Jean-Jacques Dessalines’s names.
Also, while Haiti’s revolution was an early, signature event in world history-the first time a European power would be overthrown by an indigenous army (but not the last)-the causes of Haiti’s poverty are basically identical with those of almost every poor nation around the world: a history of exploitation, bad debt, bad geopolitics, and bad people profiting off of that poverty (almost all of them living elsewhere). And this is basically true about poverty in American cities as well (with all the same attendant racist myths).
Some recommended reading:
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