KOLAHUN

The "Others"

    

 

Map of San Francisco neighborhoods on local real estate company's website and a map of the City's African American neighborhoods.

 

 

Every now and then, living in San Francisco, something comes up that reminds of what W.E.B Du Bois wrote…

"BETWEEN me and the other world there is ever an unasked question: unasked by some through feelings of delicacy; by others through the difficulty of rightly framing it. All, nevertheless, flutter round it. They approach me in a half-hesitant sort of way, eye me curiously or compassionately, and then, instead of saying directly, How does it feel to be a problem? they say, I know an excellent colored man in my town; or, I fought at Mechanicsville; or, Do not these Southern outrages make your blood boil? At these I smile, or am interested, or reduce the boiling to a simmer, as the occasion may require. To the real question, How does it feel to be a problem? I answer seldom a word."

A Homeless Geography

 

Chicagoans have their neighborhoods, New Yorkers their boroughs, San Franciscans their districts, Tokyoites their wards and Parisians their arrondissements; but what do the homeless have? 

Just as Humboldt Park is no Lincoln Park, Queens is not Manhattan and non messieurs-dames le 14^e n’est pas le 16^e, the homeless population of a city may also live in neighborhoods distinctly defined by who lives there, how they live, what they do and how they do it different from everyone else.

Whereas some agencies are dedicated to specific homeless communities and do get a chance to cross homeless neighborhood lines, the staff and volunteer providers on a mobile homeless clinic have long appreciated the fact that the homeless community that they visit on one day can be very different from one they visit the next day in a different part of the same, relatively small town of San Francisco, California:

 

Let's get on van and go for a ride....

MONDAY HOMELESS VAN ROUTE – The Castro/The Haight   (Map: D 4-5)

The Castro/ The Haight

Demographics: White, Adolescent

Housing: Parks, Vacant Lots

Drugs: Heroin, Amphetamines

Street Economy: Panhandling, Drug Sales, Recycling

New Diagnostic Testing for Tb

My initial reading of the accompanying editorial of this NEJM study, which shows a simplified pcr based testing for Tb, was that the editorial was too ambitious.  Here's the takeaway from the editorial:

Fortunately, in the past few years, several improved tuberculosis tests have received WHO endorsement for widespread use.6,7 In this issue of the Journal, Boehme and colleagues8 describe a new automated nucleic acid–amplification test that may allow a relatively unskilled health care worker to diagnose tuberculosis and detect resistance to a key antibiotic within 90 minutes. This test and others that are likely to follow have the potential to revolutionize the diagnosis of tuberculosis. Thus, in the coming years, rapid diagnosis and targeted treatment will provide the greatest opportunity for stopping the tuberculosis epidemic.

The part I missed was the last sentence...'in coming years'.  And that's absolutely correct.  The general trend of these technologies is that they initially come in a big box (think early cell phones) and through copy-cat research and advances, become simultaneously cheaper, smaller and more powerful. 

Right now, the only way to test for Tb in remote areas is to use a microscope (perhaps even this novel $240 microscope which uses an LED light source, produced by a student at Rice University) to check for the organisms in sputum.  It needs a trained laboratory technician and the appropriate chemicals.  And can take, at minimum, many hours. 

The new PCR technology, meanwhile, can give the right answers (by specificity and sensitivity and all that) within 2 hours - all done by minimally trained non-laboratory personnel.  And in the near future, when the machines can fit in the palm of a nurse in a remote location - it will become truly clinically useful.