sentences:  They urge that the DOTS protocol be constantly reformed in the context of local practices, forms of knowledge and everyday life.Erin Koch has used Paul Farmer's concept of "structural" violence as a perspective for understanding how "institutions, environment, poverty, and power reproduce, solidify, and naturalize the uneven distribution of disease and access to resources".She has also studied the effectiveness of the DOTS protocol in the widespread disease of tuberculosis in the Georgian prison system.