About Rachel Ceccarelli

I am a senior majoring in Human Biology and I hope to pursue an MD/MPH degree in the future. I enjoy traveling, any activities outside, and reading for leisure.

Epidemiology and Medical Anthropology

I chose to elaborate on epidemiology and medical anthropology because I am interested in pursuing a public health degree, and epidemiology is an important aspect of public health. It will apply to my future career because I hope to provide health care to underprivileged communities around the globe, and understanding epidemiology and the distribution of illnesses is a vital component of public health. Through epidemiology, risk factors for disease can be identified, allowing for preventive medicine to inhibit the development and spread of diseases in a given community.

An anthropological view on epidemiology, particularly the applied anthropological approach, would be useful because it focuses on research and analysis for a specific problem and client, which is the basis of epidemiology. It would also be helpful so preventive measures can be developed and applied in specific contexts within communities because these solutions may not translate to different populations. As an epidemiologist, it will be of value to incorporate the cultural values of anthropology into medical practices. Culture is a huge factor in how populations will respond to treatments and the Kleinman and Benson article emphasizes that culture is not static but rather dynamic and comprised of multiple variables.

The Youtube video from this weeks materials emphasizes the importance of taking an anthropological approach to medicine and how important culture is in the treatment of illnesses. The video describes how a woman tried to prevent the spread of E. Coli in water from cattle farming in Peru because it was causing intestinal problems such as dysentery and young children were dying of dehydration. She raised money to campaign for boiling water and went through villages to teach women how to boil water to kill the parasites causing the infections. It seemed as though the village was responsive to her efforts, but when she returned to follow up she found people weren’t boiling their water because they believed it held the spirit of the Earth, which would be destroyed when they boiled it. Because cultural context was not taken into consideration in this case, the effort failed. Another example occurred in Ecuador, where intrauterine devices were distributed to women who wanted less pregnancies. However in this culture, menstruating women are secluded and can’t handle food, leaving their children without care. The IUD’s increased the length and severity of menstrual bleeding, which was problematic for this village. These instances emphasize the importance of considering the anthropological approach while administering treatments, as they should be culturally defined within relevance to the context of a culture.

Sexual Health in India

Sexual health is considered a taboo topic among Indian culture. Sexual health implications are interlinked with social implications as well. Stigmas of sexual activity exist heavily in India, which can lead to further health issues for women due to reluctance to seek treatment resultant from fear of social ramifications.

Some social factors that facilitate the inhumane treatment of women include denial of human rights being evident in Indian populations and the allowance of the state to administer beatings and other forms of punishment to women by police officers. It is apparent the Indian government is not worried about the health of women or rate of infections because they enable women to be viewed in a negative light for sexuality, as it is something that is frowned upon in their culture. In addition, culturally, Indian women are expected to be submissive to their husbands, facilitating even more discrimination.

According to one article,  Tamil Nadu is dealing with an increased infection rate among married women in rural areas. Traditionally in this area, the rate of reproductive tract infections are high, however women often will not visit a clinic for treatment because these sexuality stigmas do exist. Unfortunately, as a result, a significant number of deaths among Indian women in these areas are due to cervical cancer. Another sexual health issue in Indian women is HIV, who are often deserted by their husbands upon contraction of the disease. There was a program implemented to prevent parent to child transmission of HIV by encouraging pregnant women to get tested and to receive antiretroviral therapy so the disease is not spread to their child during birth. However, the program has inadvertently resulted in further stigmatization and discrimination against women. If an Indian woman tests positive for HIV and convinces her husband to get tested, Indian men will more often than not reject the idea they have been the source of the virus and will instead question the wife’s fidelity (1).

Stephen Schensul is an anthropologist that has studied the prevention of HIV and STI’s in Mumbai among married women. He found that sexual health is not a chief concern among families with low incomes that have more dire concerns such as overcrowding in homes and unsanitary water. Since he has started his research, there has been a significant drop in sexually transmitted infections and the extramarital affairs of men through the treatment of clinical care and sustaining knowledge and resources to prevent these infections. Schensul’s project has helped established a women’s health clinic in Mumbai to provide health services to the varied gynecological needs of women (2).

Sources:

1. “Perception of Stigma and Discrimination.” South India AIDS Action Programme. N.p., 2009. Web. 10 Aug. 2012. <http://www.siaapindia.org/resources/publications/perception-of-stigma>.

http://www.siaapindia.org/resources/publications/perception-of-stigma

2. DeFrancesco, Chris. “UConn Today.” UConn Today. N.p., 31 July 2012. Web. 10 Aug. 2012. <http://today.uconn.edu/blog/2012/07/reducing-sexual-risk-in-india/>.

http://today.uconn.edu/blog/2012/07/reducing-sexual-risk-in-india/

Erectile Dysfunction in Society

Erectile Dysfunction is heavily biomedicalized in our culture because it deals with the enhancement of the body and behavior through medical intervention. According to the Mayo Clinic, erectile dysfunction or impotence occurs when a male is not able to maintain an erection. These problems can arise from chronic illness, poor blood flow, and heavy alcohol consumption. ED is further framed culturally as an ‘illness’ because treatments include lifestyle changes and medications. This comes with the social repercussions of society assuming that a male with ED has brought this illness upon himself. Economically, men with ED have medicine available to them to treat their ‘illness’ at a cost. Pharmaceutical companies are financially gaining through appealing to not only men exhibiting ED but also men occasionally experiencing impotence, who are embarrassed about their sexual performance and willing to go to great expenses to treat it.

On the other end of the spectrum, Conrad discusses medicalization, which is the control over bodies and behavior through medical interventions. Conrad defines medicalization as an extension of the medical boundaries. Conrad also points out how media claims can further identify a condition such as ED as an illness that requires medical attention. He describes how such medicalization can be associated with underperformance, which when applied to the context of ED can result in stress, strain on relationships, and a lowered self confidence. Medicalization can also focus on how nonmedical problems can be defined as medical problems.

I chose to elaborate on a Viagra commercial. In this advertisement, a man is driving through the desert and his car starts smoking so he pulls over to a gas station.  The background narration states, “You’re at the age where you don’t get thrown by curve balls, this is the age of knowing how to get things done.” The man is seen fixing the problem under the hood of his car without the help of the mechanic. This strategy not only portrays the man that seeks help for erectile dysfunction as masculine and strong, but implies the cultural ideologies that with old age comes impotence, which is something that can be cured as long as you take their medicine. Socially, the man is seen as self sufficient, as he is able to fix his car, which is a parallel to taking Viagra for his ED. The medical information is not presented until near the end of the ad, where the viewer is advised to talk to their doctor about Viagra, because 20 million men already have. This also plays into a social role that every one else has taken action against ED so it is now your responsibility. The side effects are also listed at the end. Interestingly enough, there are no doctor/patient interactions in the advertisement. Overall, this Viagra ad is effective in reeling in another Viagra consumer.

http://www.viagra.com/viagra-tv-commercial.aspx

(3rd video down, “gas station”)

Sources:

Staff, Mayo Clinic. “Definition.” Mayo Clinic. Mayo Foundation for Medical Education and Research, 10 Feb. 2012. Web. 03 Aug. 2012. <http://www.mayoclinic.com/health/erectile-dysfunction/DS00162/>.

“WebMD Erectile Dysfunction Health Center – Find Impotence Information and Latest News on ED Treatments.” WebMD. WebMD, n.d. Web. 03 Aug. 2012. <http://www.webmd.com/erectile-dysfunction/default.htm>.

http://www.mayoclinic.com/health/erectile-dysfunction/DS00162/

http://www.webmd.com/erectile-dysfunction/default.htm

Life/Death

Biomedicine plays a huge role in western culture and is considered the dominant form of medicine. It has become so important and influential because it is evidence based and explains health in the terms of biology. The culture of biomedicine is established by the culture studies of biomedicine including institutional history, language of biomedical facts, and the rituals of biomedicine such as in the clinic. In this context, social values are conceptualized as natural or scientific. Biomedicine is also culturally constructed because it is not objective but rather based on biology and fact. Our culture is socially bound through biomedicine because it determines if a person is mentally stable enough to be a contributing member of society or not.

I feel that most dichotomies have unclear boundaries and many grey areas. I find the life/death dichotomy the most interesting from a social stand point because it seems as though life and death are two polar opposites that should be easy to distinguish, but under further evaluation this is not the case.  You would presume that someone is either dead or alive, however the cultural implications of life and death determine this. Life is measured in ways that are influence by culture, our legal system, and politics. There are many discrepancies on when life begins; at conception, in the womb, or during birth. Death is also just as uncertain. If you rely on a respirator to breath, use a feeding tube, or are brain dead, you may be legally alive, but for all intensive purposes considered dead by society. From my perspective, life begins after the first trimester of pregnancy, and death occurs when either someone’s heart stops beating or they take their last breath. I think my ideals about life and death have formed as a result of the media and politics. There is much debate between pro-life and pro-choice, but ultimately life to me is established by the second trimester. Society may consider someone unresponsive as dead, but when it is a member of your family, this does not necessarily correlate with your definition of death.

Dichotomy is accepted as natural, logical, and true in western society because so many discrepancies exist between them and the definitions of their components are socially and culturally defined. There are no direct translations of life and death or any dichotomy for that matter from person to person, and our views on dichotomies are culturally formed and dependent.

Fibromyalgia

Fibromyalgia is described as wide spread muscle pain and spasms and the symptoms can vary on which areas of the body they affect, which is virtually unlimited. The author of the article even stated that it feels like ‘someone is reaching in and ripping out my spine’. This intense pain is unpredictable and seemingly not unprovoked, making it hard to control. The pain ranges from dull pains, sharp pains, burning and itching sensations, needle pricks, and stiffness. People with this condition are plagued by a number of other medical ailments including insomnia, mood swings, irritable bladder, and anxiety and panic attacks. Because the symptoms of Fibromyalgia vary so greatly among those affected, it is considered only a syndrome and not an actual disease. This directly affects the management and treatment of this disease because the syndrome will be hard to diagnose with so many symptoms present and cannot be controlled by following a strict medical regimen. The patient also has to effectively convince a physician that they are in fact experiencing pain from this condition, and pain is difficult to describe without a point of reference to previous experiences of pain, which would differ from patient to patient.

The author also states that it is incredibly frustrating when people don’t understand how sick she can feel when she looks so ‘normal’. This cultural stigma affects the illness experience because people don’t understand that Fibromyalgia is a real illness. Characteristic of a chronic condition, Fibromyalgia may not be taken seriously if you cannot convince people that you are experiencing genuine pain from such a condition. Like the MadTV sketch mocking Restless Leg Syndrome in lecture this week, chronic conditions are often made fun of in American culture as the legitimacy of chronic diseases is hard to prove.

I feel that belief and healing are in fact connected and that if you have a positive outlook on the healing process, you will in fact get better. The placebo effect describes how if you believe and expect for something to work, it will. It is ultimately our minds that create the medicine and we are psychologically able to cure ourselves. I haven’t had any personal experience with placebos, but the video described two patients recovering from leg surgery and other medical conditions through placebos, which proves that even if placebos do not have any therapeutic value, it is our minds that allows us to heal if we believe we will.

True Life: I Have Diabetes

This episode followed three young people that are afflicted with Diabetes and how they are learning to accept the sick role that is associated with the condition. Kristyn is a 25 year old that has racked up debt due to medical expenses that weren’t covered by her insurance. Because her pancreas does not produce any insulin, she needs a new insulin pump that will cost her over two thousand dollars. This insulin pump is essential to her survival as it administers insulin to her body throughout the day. She has to move back home and work almost eighty hours a week to cover the expenses. Consequentially she isn’t getting enough sleep, which is detrimental to her health. Matt is a college student that doesn’t want to give up his lifestyle because he has Diabetes. When he drinks, his blood sugar sky-rockets, which can result in a coma, seizure, or even death. He has already experienced numerous diabetic seizures. His A1C test which is an average of his blood sugar for the past three months is beyond what it should be, as he consumes alcohol 4-5 days a week. Jen is pregnant and has Type II Diabetes, meaning her body produces insulin but not enough. She originally doesn’t need insulin injections but takes oral medication. As a result of her diet choices, which regularly includes fast food, she is put on insulin. Everything she is doing is affecting her unborn child, and a blood sugar that is too high can be fatal to babies.

This episode identified with the chaos narrative, as they will live with Diabetes the rest of their lives and diabetes to them is a permanent state. Jen even commented in the episode that this was something that she would always have to deal with. Within this narrative, all three are frustrated with their condition and do not want to sacrifice their lifestyle for it. There is a stigma associated with Diabetes, particularly strong for Matt. His roommates are concerned about his lifestyle choices and his alcohol intake leading to a seizure, while some of his other friends are constantly pressuring him to drink. Kristyn also experiences a stigma when she and her mother go to eat and her mom taunts her by eating sweets in front of her. The three regularly need to seek medical attention for diabetes, and Matt is constantly reprimanded for his drinking habits and Jen for her eating habits harming her baby. They also are experiencing a common struggle with accepting the sick role, mainly in acknowledging their health is abnormal. Kristyn seems to have a pretty good hold on this while Matt and Jen don’t seem to grasp that unfortunately they are affected by this condition that comes with limitations, which to them can be socially isolating.

Illness narratives are useful in that they provide patients with culturally acceptable explanations for their actions within the context of their ailment. They also help the patient adjust to their disability and feel empowered, while the listeners or family help patients feel less isolated and help them live with their illness.For the people in this episode, there is not really a resolution in terms of their recovery, but they are working towards the acceptance of having Diabetes.

Running Amok in Malaysia

Running Amok is a rare culture bound syndrome most prevalent in Malaysia, Puerto Rico, and the Philippines although there are traces of it in modernized cultures. Running Amok refers to a condition in which an individual becomes erratic and irrational and causes havoc along with the homicidal and subsequent suicidal actions of such individuals, which often result in the fatalities and injuries of other individuals. An individual on an Amok spree is usually killed by bystanders during an attack if they do not commit suicide first.  Running Amok is considered to be a psychiatric condition. This CBS was discovered about two centuries ago among primitive island populations and interestingly, culture was considered a predominant factor in the development of the condition. This was thought to be a result of the geographic isolation of the tribes and their spiritual practices. The characterization of Amok does not recognize that some of the behaviors of the CBS have been observed in western cultures with no geographic isolation and although it is considered a rare disease, displays of Amok’s characteristic violent behavior have become common not in the indigenous societies they are thought to have originated, but among modernized cultures. Mythology considered Running Amok to be an involuntary ailment caused by an evil spirit entering the body, resulting in violent behavior the afflicted individual was unaware of.

Culture is the most important factor in evaluating the manifestation of Running Amok. A strong belief among cultures with frequent cases of Running Amok is that the condition is culturally induced, with there being cultural factors only observed among these primitive tribes that caused Amok. Culture also heavily determines behaviors that individuals will manifest. Characteristic of a CBS, Running Amok occurs in many unrelated cultures. Biologically, Running Amok is considered the result of a mental disorder, personality pathology, and psychosocial stressors. Certain individuals may also be predisposed to the characteristic behaviors of Amok. Individually, patients are assessed for risk factors known to be affiliated with violent behavior. After an episode, the attacker often experiences amnesia.

In these cultures, Running Amok is presently being evaluated as an outcome of an undiagnosed psychiatric condition. Prevention is considered the only way to avoid the consequences of Running Amok because it is virtually impossible to stop an Amok attack without being at risk of losing one’s life. Prevention is only possible with prompt recognition and treatment of the Amok. In the professional sector, individuals displaying this erratic behavior often seek the help of medical practitioners before homicidal and suicidal behavior manifests. Patients even prefer seeing physicians instead of psychiatrists because of the stigma associated with mental disorders. Additionally, there is no medication proven to treat specifically violent behavior, although antidepressants can be used for individuals experiencing depressive disorders. In the popular sector, the patient’s family and social support network are enlisted in psychotherapy, a technique often used to prevent violent behavior.

Sources:

Saint Martin M.D. J.D., Manuel L. “Running Amok: A Modern Perspective on a Culture-Bound Syndrome.” Prim Care Companion J Clin Psychiatry, June 1999. Web. 20 July 2012. <Running Amok: A Modern Perspective on a Culture-Bound Syndrome>.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181064/

Clown Doctors: Shaman Healers of Western Medicine

The Clown Doctors of New York City shine a light on the unique process of healing among children. The Big Apple Circus Clown Care Unit are a group of clowns that work in New York City hospitals that help not only patients deal with their illness but also effectively work to cheer up their parents as well.

The healers are a group of professional clowns working with the Circus Clown Unit in pediatric units. The CCU is now active in seven New York City medical centers and has been active in hospitals for almost thirty years. A clown in the CCU typically works three days a week in groups of two or three entertaining patients and their families. Many of the clowns are actually prominent and experienced, with training in fields such as mime, physical comedy, and children’s theater. Some even hold degrees in fields such as directing. In the hospitals the clown doctors are highly respected and the physicians and nurses often play along with them to improve the stamina and social conditions of the patients. The clowns don outrageous costumes and have doctors bags on hand full of instruments, balls, and tricks. They enter the pediatric cardiology unit playing music, blowing bubbles, and handing out gifts. Some clowns prefer to use puppets and each patient gets an individual visit from a clown doctor. The clowns also visit pediatric oncology and perform tricks for parents in the waiting rooms. They don’t only work with children, but are also known to console outwardly upset parents and do this through a variety of techniques including singing and dancing. The clown doctors spread joy in an environment not designed for children.

I feel the clown doctors operate heavily in the folk sector within the professional sector of the actual physicians in the hospitals biologically treating the children. The folk sector involves the use of healers that treat patients using holistic methods that extend beyond physiological symptoms, which allows children to become more comfortable during their hospital stay. Because health care is only accessible to those who can afford it, clown doctors are only enjoyed by a select audience in New York City pediatric units. The body symptoms are understood and treated in a biomedical fashion through the professional sector. Some body injuries are considered to be more serious and emotionally draining than others, one being the intensive burn unit in which the clown doctors have to put on sterile caps and gowns for each room and children are not allowed to touch their props. Many of the children are seriously disfigured, which proves something very distressing to the clown doctors. Although the clown doctors do not perform any biological medical treatments per say, they are remarkably able to distract and console their patients and families from procedures and disease through the powerful use of humor and laughter.

Collateral Damage

I scored a 5 out of 10 on the Health Equity quiz, which was lower than I expected. I was incredibly surprised to find out that the US life expectancy is only  29th in the world. I assumed that because we have had so many medical advancements and have vast access to health care and resources compared to many other countries that this ranking would be closer to the top ten or so. What I also found interesting was that the greatest difference in life expectancy between counties in the US was 15 years. I find this to be a better indicator of life expectancy because it is not as general and takes into account environmental and lifestyle factors. This statistic also played into wealth being the number one predictor of some ones health as there are many suburbs in America in which wealth is concentrated and other urban cities that are poverty stricken.

I chose to elaborate on the ‘Collateral Damage’ video. I find it ironic that we usually think of urbanization and globalization as indicators of wealth and prosperity, while in the Marshall Islands, disease and poverty are a direct result of these developments. In this nation of islands, Tuberculosis is 23 times more prevalent than in the US. This rampant disease, which spreads easily in densely populated areas, is the result of the overcrowding of the island of Ebon, which at one mile long is home to ten thousand people. Ebon is the perfect environment for tuberculosis to spread because with up to twenty people living in one house, if one person is sick more often than not everyone in the home will become sick. These conditions of poverty lower compromise the immune system, and the stress of poverty can contribute directly to this malnutrition.

To make room for nuclear testing during World War II, the US military resettled thousands of people on different islands, tearing apart their culture. The Marshallese community structure broke down and there were significant impacts on health through the stress of not being able to grow food, becoming diabetic through a western diet, and contaminated land. The Marshallese were not an urban group of people but we forced them to urbanize and infectious diseases such as tuberculosis took off with overcrowding. In order to eradicate tuberculosis, the Marshall islands need improved living conditions, alleviated crowding, and improved nutrition, which are all factors we imposed on them through US development and urbanization of the islands.

Politics: The island with the military base is home to many affluent white contractors that live there with access to medicine and grocery stores while Marshallese workers have to take a ferry home everyday to their dense, overpopulated living conditions.

Economics: The Marshallese cannot afford care for tuberculosis at hospitals and they have to rely on public health officials to provide them with medicine for the treatment of tuberculosis.

Culture: Many of the homes on Ebon do not have inside toilets so inhabitants have to travel to public restrooms that do not have sinks and are unable to wash their hands until they return home, which allows for the spreading of disease.

Biology: The treatment of tuberculosis involves a strict drug regimen and if not completed the disease can come back in a deadly drug resistant form that is very dangerous.

Individual choice: People of the Marshall Islands are ashamed to admit they have the disease and will not seek treatment for it, which in turn will further spread tuberculosis.

Cystic Fibrosis Among White Americans

Cystic Fibrosis is not only the most common, but the most deadly inherited disease that affects Caucasian Americans. Cystic fibrosis is a disease in which a mutated gene causes a thick and sticky mucus to be produced, resulting in mucus build up in the lungs and digestive tract. This is turn causes life threatening lung infections and serious digestive problems.

There are approximately 30,000 Americans that have CF with about 1,000 new cases per year. The disease is most common in Caucasians of Northern European descent. It has been found that Cystic Fibrosis is much more common in White Americans than African Americans, Hispanics, and Asian Americans. Millions of Americans are carriers of this mutated Cystic Fibrosis gene, but an affected person must inherit two of these genes in order to display symptoms of the disease. Studies suggest that at least one in 29 White Americans carry the cystic fibrosis gene.

This specific gene mutation is thought to have arisen during the Stone Age in Europe and spread through hunters and gatherers across the continent and eventually to the US during migration. The gene is though to be 52,000 years old. Recent studies also show that even though Cystic Fibrosis is lethal when you inherit two of these mutated genes, there may be some evolutionary benefit to the carriers of this gene because if there were no selective advantage to the gene, it would have disappeared thousands of years ago. Because this mutated gene has persisted all these years is the reason why Cystic Fibrosis is so common today. It is not entirely clear to researchers what this specific advantage is, although they have come up with theories that the cystic fibrosis gene offered Cholera resistance and protection against diarrhea and dehydration. This is thought to be because CF disrupts salt and water balance in the body, which is the cause of the thick mucus build up.

I think that for genetic factors, this gene has become so prevalent because cholera and even diarrheal diseases were considered fatal to inhabitants of Western Europe when this mutated gene evolved, so there would have been a huge selective advantage to this gene. There are not so much social determinants to account for the occurrence of Cystic Fibrosis, but an early diagnosis scan improve survival. Antibiotics, inhalers, and other therapeutic medications can help quality of life for those wealthy enough to afford them.

Race, genetics, and health are three factors that are all intertwined in determining the occurrence of diseases among populations. Certain mutated genes are definitely more prevalent in specific races than other, which can lead to health or illness, depending if the mutation is positive or negative. Like the lecture stated, biologically discrete races do not exist. So even though there may be genes that are more common to certain cultural races, this does not mean only these races experience these diseases. For example, the lecture talked about Pima Indians and the occurrence of Type II diabetes. These altered genes that allowed for the quick processing of sugar and efficient fat storage got passed through genetic drift because these populations lived very near one another and rarely married outside their culture, which is why the mutation survived. However, this is not to say this mutation would not be passed to someone outside this culture through reproduction.

Sources:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001167/

http://www.lung.org/assets/documents/publications/solddc-chapters/cf.pdf

http://www.nytimes.com/1994/06/01/us/cause-of-cystic-fibrosis-is-traced-to-the-stone-age.html?pagewanted=all&src=pm