Global Health and Medical Anthropology

I chose this intersection of applied medical anthropology because I find it kind of interesting.  As far as future careers go, I want to be a doctor. There are programs like Global Health Service Corps physicians go to Africa, or anywhere really, and provide primary care for people the there that are dealing with various illnesses.  Specifically, Texas Children’s Global Health Service Corps is trying to set up programs dealing with conditions like HIV/AIDS, tuberculosis, malaria, malnutrition, and sickle cell anemia that heavily impact child morbidity and mortality all over the world.  This is something I’d consider signing up for, for a few years.

Taking an anthropological view of things is obviously important in this area.  This past spring break I went on a global medical brigade trip to Honduras.  We went into a community for a few days with a few doctors and dentists and a lot medications and vitamins and tried to provide whatever help we could with the resources we had.  One of the major things they really needed though was education.  Some of the people did not understand why their toddler’s teeth were all rotting out, and it was because the kids were drinking 7-UP and Coke.  We could explain the cause to them, and we taught the kids how to brush their teeth, but in the end that might not be enough because they do not have a lot of money, and soda is very cheap.  Anthropologists would know these people better and might be able to figure out some sort of solution.  A different example is from the video on YouTube that was provided for this week.  The guy talks about someone who taught people in a community to boil water to help kill parasites and the people in the community seemed to accept it, but really the entire time they knew that they were not actually going to do it because you cannot boil water without killing the spirit of the earth that is in the water.  So the NGOs ,or whoever else, knows what needs to be done technically to help these communities, but you have to have the anthropologist’s point of view to try and figure out how to actually go about helping these different communities with different cultures and beliefs.

http://www.bcm.edu/news/item.cfm?newsID=2634

HIV in Malawi

The first confirmed case of HIV/AIDS in Malawi was in 1985.  In 1999 it had a prevalence rate of approximately 16% in adults that has dropped to 11% as of 2009.  A study done by the National AIDS Control Programme (NACP) determined a major reason that HIV is so prevalent in Malawi is that “Malawians continue to uphold cultural values, beliefs and practices which entail the risk of HIV infection.”  They found that sex serves a role in many of their vital rituals including initiation rites, death rites and various magical rituals.  Traditional medicine and witchcraft can also cause issues.  In some communities they believe that HIV/AIDS can result from magic, and can be treated by herbal medicines.  Where as in other cases, they confuse AIDS with traditional diseases, “tsempho” and “kanyera” which all have similar symptoms, but the last two are treated by traditional healers providing herbal medicines.  There are quite a few institutions trying to help deal with this problem, and more are trying to take into account the cultural aspect of it.  Some organizations are utilizing things like traditional dances and cultural festivals to try to deliver their messages on HIV/AIDS, or getting the community leaders to help influence the people to accept the messages.

One anthropologist working in Malawi is Dr. Anat Rosenthal.  She started focusing on HIV/AIDS in Israel in 2002.  Her research has now broadened and deals with the impact of HIV/AIDS on rural communities in Malawi, especially the impact on children.  She points out that according to the UN, “more than 11 million children under the age of 15 in Sub-Saharan Africa has lost one or more parent to HIV/AIDS.”  Her work in Malawi included, “12 months of fieldwork, participant observation and 45 semi-structured/unstructured interviews.”   Part of her work included creating different projects like family strengthening projects, care projects, and communal infrastructure projects. The projects are not aimed at the children specifically, but are focusing on the families that take care of the orphans.

Kondowe, Mulera   A Cultural Approach to HIV/AIDS Prevention and Care http://unesdoc.unesco.org/images/0012/001222/122214e.pdf

http://www.smudailymustang.com/?tag=anat-rosenthal

http://www.ghdonline.org/users/anat-rosenthal/

Obesity

I would say that obesity is very medicalized in U.S. culture.  Part of the reason for this, I think, is because it so easily can be medicalized.  The rate of people becoming obese just keeps increasing, and there are so many ways companies can come up with “treatments” for it.  Culturally with busy lifestyles, fast food, less exercise, and spending so much time in front of T.V.s and computers is leading to so many people getting this “illness”, but culture also puts so much pressure on looking good and being thin that we need a “treatment”.  Economically any company that can benefit from making obesity an illness that requires biomedical intervention is going to profit, so it is in their best interest to go along with it.  Weight loss pills or surgeries can be huge money makers. And considering obesity can lead to pretty bad stuff it is not too hard to convince people they need to do something about it early and then give them an easy way out with some kind of pill.

The ad I found was for PhenObestin.  It had a guy’s voice in the background giving all the information. I think some of the advertising strategies here were to give all the information really quickly.  It started with a thin women smiling, and the voice saying “this could be you” and then throughout the rest it always has someone who is wearing pants that are too big trying to show how much weight they lost.  It focused on the more visual aspect with bar graphs showing how much weight someone lost per month trying to show big results.  There was also the strategy of them trying to make it seem like you are getting a good deal by always showing graphics offering free shipping, buy 3 get it 20% off, and mention something and get an extra 15% off,  35% off.  They also make sure to mention key words like rapid weight loss, and made sure to point out that there are no empty promises here.  When it comes to cultural values I think they exploited our culture’s need to look good.  The people in the ad weren’t like the ones with the before and after photos, instead they are like athletic, good looking people who go to the gym quite a bit.  As far as medical information goes, there basically wasn’t any.  They mentioned it was an appetite suppressant and that it used “100% PURE pharmaceutical ingredients”.  There were also no doctor patient interactions in the ad most likely emphasizing that you don’t need a prescription for it, or because a doctor wouldn’t approve of it. Either or.

Fibromyalgia

According to commercials for drugs to help treat the symptoms for Fibromyalgia it is a widespread pain that doesn’t go away.  According to the Mayo Clinic, “Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.”  According to the blog of a lady who has it that is still and oversimplification.  The list of symptoms she gives is kind of ridiculous.  She lists, muscle pain basically everywhere, random back and shoulder spasms and she describes it “as if someone is reaching in and ripping my spine out through my skin”, waking up and it’s as if “she has no knee joints”, having allergies in all seasons, feeling like having a heart attack which is really non-specific chest wall pain, memory issues, mood swings, insomnia, chronic fatigue, numbness, headaches, anxiety and panic attacks, and vision problems.  Those were just some of the things she mentioned.

From the biomedical side of things it is hard to treat because there is no real set of symptoms and it varies widely from patient to patient.  The treatment is just managing the symptoms they do have with a pharmacy worth of drugs and a heating pad.  Patients have to just tolerate the symptoms and try to go about their lives.  It is not something others can really see or understand easily, and the women said, “when people don’t understand how I can be so sick, but look so “normal” it makes me sad…..it frustrates me.”  I guess it can be frustrating for people when others make light of their suffering.

I think belief has a strong affect on healing.  When I was younger my mom told me that your mind can make your body sick because if I started to think I was getting sick I would keep focusing on it, and it would just keep getting worse.  Then the second I got distracted from thinking about it I’d start feeling better.  So I’d figure if you can make yourself feel worse then you could probably make yourself feel better.  A lot of times just the thought that something is being done can be enough to help.  At least that seems to be the deal with placebo pills or the fake surgery in the “Placebo: Cracking the Code” film.

http://www.mayoclinic.com/health/fibromyalgia/DS00079/

http://www.blogher.com/fibromyalgia-type-personality-chaos-frustration-and-near-insanity?page=full

True Life: I Have Narcolepsy

This episode was about two girls who have narcolepsy and cataplexy.  Narcolepsy is a neurological disorder that causes excessive sleepiness and frequent daytime sleep attacks, and Cataplexy is a condition associated with Narcolepsy that causes sudden muscle failure.  The first girl Julie had had the disorder for about four months and was afraid to take medications for it fearing the possible risks that go with taking the drugs.  The other girl Katy had narcolepsy for about ten years and was taking a lot of medication for it.  Her boyfriend tried to get her to stop taking them because he thought they were bad for her health.  Both of them suffered from cataplexy attacks whenever they would start laughing at least while they weren’t taking any medication causing them to fall randomly.

I would say this narrative would be the Quest type mainly because of how MTV is trying to portray it for the show.  It is showing how they struggle with the illness and through that their life tends to improve in the end.  Julie was able to get on a low dosage of medication combined with chiropractic treatment was able to get into extra curricula’s at school and improve her  ACT scores and took part in a Narcolepsy research experiment and now wants to go to med school and become and anesthesiologist.   Katy learned she still needs the medication but she can get by taking a lower dosage.

It didn’t show there being much of a stigma or anything just confusion of what was wrong and them being embarrassed if they passed out in public.  It showed the effects of the medication treatments, good and bad, on their life and on friends and family.

Illness narratives seem useful to basically everyone involved.  According to lecture 4.2 the six parts to illness narratives can kind of a way of explaining everything to someone who doesn’t have the experience to they can understand the patient’s point of view.  It explains what happened but also why they should care.  It’s the closest most people are going to get to understanding what’s going on.

Baridi Among the Bena Peoples in Tanzania

In the article Baridi: A Culture-Bound Syndrome Among the Bena Peoples in Tanzania researchers went to Ilembula village in Tanzania and interviewed the Bena people about baridi.  They found out that family had an important role in the life of the Ilembulian Benas.  Family unity and respecting your family, especially elders, was very important.  Baridi was defined by the informants that were interviewed as being caused by acting against culture which meant, “neglecting the values, norms, and customs maintaining unity among the family.” Baridi would cause someone to feel cold and restlessness and then move on to fatigue and loss of appetite.  Advanced baridi would cause deformations in joints, weakness in limbs, and mental disturbance.  The treatment started with the diagnosis and then moved on to fixing relationships with the family mainly through an apology and public confession.  The main prevention of baridi was to have self control, and to be considerate of others in the family.

The illness itself is caused by the individual’s actions.  They choices they make when dealing with their family is what determines whether they get baridi or not.  The rules they are supposed to follow are based their cultural beliefs, and if someone is affected with baridi they acted against the culture.  The most severe form of baridi is laana which results in social and economic losses including losing your job, failing an exam, losing property, lack of a marriage partner, and loneliness.

The professional and folk sectors were commonly combined in the treatment of the illness. The first step of the treatment was being diagnosed with baridi by a traditional healer.  The traditional healer would interview the person and tell them what actions led to them getting the illness.  They would then have the person give a public confession to the family, an apology, and the healer would determine whether the person had to give any gifts or money to the family members that were offended.  The healer might also include herbal remedies.  Commonly people with the illness would combine these treatments with hospital treatments as well.

Baridi: A Culture-Bound Syndrome Among the Bena Peoples in Tanzania

J Transcult Nurs 2005 16: 15 Anitta Juntunen

http://tcn.sagepub.com.proxy1.cl.msu.edu/content/16/1/15.full.pdf+html

A Doctor for Disease, a Shaman for the Soul

The article I read was about how at Mercy Medical Center in Merced, California, they have integrated Hmong shaman into some patients treatment.  They designed the shaman program in hopes of building trust between doctors and the Hmong community.  With the Hmong belief system “surgery, anesthesia, blood transfusions and other common procedures are taboo.”  So it has been difficult in the past to help with their health needs.  The new policy allows shamans the same unrestricted access to patients as clergy members, and they are able to perform nine approved ceremonies for patients.

The shamans are the healers, and I would assume they have a somewhat high social status considering how serious they take these ceremonies.  When they are not at the hospital, “suburban living rooms and garages are transformed into sacred spaces and crowded by over a hundred friends and family members…shamans go into trances for hours, negotiating with spirits in return for sacrificed animals”.  In the hospital they do more toned down versions or these ceremonies including “soul calling” and chanting in a soft voice.  The use of gongs, finger bells require permission from the hospital.  One shaman Mr. Lee preformed a spiritual inoculation on a diabetic patient, “meant to protect his soul from being kidnapped by his late wife and thus extending his ‘life visa.’”

The shamans work in the folk sector, but are working with the professional sector.  Healthcare was delivered in the home with friends and family, and has now moved into the hospital as well with this program. The symptoms are due to the belief that souls can either be captured by malevolent spirits, or just wander off.  The shamans can go into trances and try to negotiate with spirits, or perform other ceremonies that try to prevent the soul from being taken.  The doctors that view the ceremonies from the professional sector say that social support and beliefs affect a patient’s ability to rebound from illness, but then Dr. McDiarmid points out that, “over half of the people who respond to antidepressants do so because of the placebo effect.”

http://www.nytimes.com/2009/09/20/us/20shaman.html?_r=3

In Sickness and in Wealth

I did okay on the Health Equity Quiz.  I got seven questions out of ten correct.  I found it surprising that the United States went from top five in life expectancy to 29th in 50 years.  You would think that life expectancy would continue to get better not worse.  I also thought it was interesting that Latino immigrants though poorer, have better health than the average American, but then just being here for five years causes their health to decline.

The” In Sickness and in Wealth” episode discussed the relationship between health and wealth.  It showed a little bit of the lives of a CEO, an unemployed mother, a janitor, and a lab supervisor in Louisville Kentucky trying to demonstrate how class affects peoples’ health.  They said there is a health-wealth gradient that showed there is a 3-5 year life expectancy difference between the rich and middle classes, and a ten year difference between the rich and people at or below the poverty line.  This pattern is similar for the occurrence of different diseases as well.  They discussed the factors associated with poor health like education, diet, environmental hazards, unsafe living conditions, and lack of control over work and schedule.  According to the video all of these things tied back to wealth and are all “inextricably intertwined”.

Politics, economics, environment, culture, biology and individual choice are all very connected when it comes to illness.  Politics and government can lead to the development, spread, and or treatment of illness. According to the video, the gap in wealth leads to issues with health and they, “arise as a result of policies or the absence of policies that create these enormous inequalities and resources.” And policies in other countries have helped bridge the wealth gap.  For example, they mentioned Ireland having free college education and how education is one of the factors affecting health.  Individual choices can lead to illnesses like smoking, or they can help prevent illness like good diet and exercise.  Hazardous environments can easily cause and spread illness, like poor water quality.  And as we learned last week culture can determine the types of treatment someone will choose.

arise as a result of policies or
the absence of policies that create these enormous inequalities and resources

Cystic Fibrosis Among White Americans

 

http://www.ntdlabs.com/molecular-testing/

This table show the carrier frequency of cystic fibrosis in different ethnicities.

Cystic fibrosis is a common genetic disease within the white population in the United States.  It is an autosomal recessive disease that occurs in 1 in 2,500 Caucasian newborns, 1 in 17,000 African Americans, and 1 in 31,000 Asian Americans.  According to http://ghr.nlm.nih.gov/condition/cystic-fibrosis, Cystic fibrosis is caused by a mutation in the CFTR gene that disrupts the function of chloride channels and causes “cells lining the passageways in the lungs, pancreas, and other organs produce mucus that is unusually thick and sticky.”  The mucus clogs the airways and glands causing the symptoms.  The main symptoms are persistent coughing, frequent lung infections, wheezing or shortness of breath, and poor growth/weight gain in spite of a good appetite.  http://www.cff.org/AboutCF/ In the end, it is usually end-stage lung disease that is the principal cause of death.

A possible reason that cystic fibrosis is common in white Americans could be similar to the situation where people who are carriers for the sickle cell anemia are resistant to malaria.  An article, Cystic fibrosis heterozygote resistance to cholera toxin in the cystic fibrosis mouse model suggests that “cystic fibrosis heterozygotes might possess a selective advantage of resistance to cholera”.  Since cholera was a problem in Western Europe in the 1800’s they could have passed on the resistance to their offspring leading to a larger number of the population being carriers for cystic fibrosis.

In lecture 2.2 it said there is no way to genetically test for race.  So I would say that there is no direct relationship between race and genetics.  There is obviously a relationship between genetics and health considering how mutations in genes can affect someone’s health, but genetics is not the only factor that determines health.  Also according to lecture 2.2 you have to self identify yourself as black to be prescribed BiDil.  The fact that you can self identify yourself as one race or another sounds like you could identify yourself as black one day and as white the next. If that is true, and then your health doesn’t change at the same moment you change your mind, then I would say there isn’t any real relationship between race and health.

http://www.ntdlabs.com/molecular-testing/

http://ghr.nlm.nih.gov/condition/cystic-fibrosis

http://www.cff.org/AboutCF/

http://www.sciencemag.org/content/266/5182/107.abstract

http://advan.physiology.org/content/29/2/75.full

Biological

I chose the biological approach as being most useful to me in studying health because it deals with genetics and the environment.  Genetics definitely has a lot to do with health.  Environment too can easily affect health.  And if individual choice means things like to smoke or not to smoke then they also affect health.  I think these are some of the most obvious things when you think of health so it’s good to try to understand them fully.

The difference between disease and illness is that disease is more clinical and defined.  Illness is more subjective.  It is more dependent on cultural and social contexts.  Some people would consider something an illness while others wouldn’t.  I do not think the difference is very obvious because of how much they can overlap.

The culture that Miner is talking about is American culture.  This is the second time I had to read this for a class.  The first time I got all the way through it and did not figure it out.  Someone had to tell me.  This time through it definitely made more sense.

The ritual of going to the holy mouth men once or twice a year, going to the dentist, shows the large emphasis put on good oral hygiene.  From the perspective in the article it sounds pretty barbaric.  People are willing to go through quite a bit of pain sometimes to be healthy.  The charm box filled with charms, also known as medicine cabinets, shows a large dependence on medicine.  Even after they forget what the medication does they still keep it around.  It’s like if worst comes to worst at least you know there is something there that might help.  The last ritual is going to see the medicine men in the latipso, or doctors at the hospital.  It says that, “every-day life the Nacirema avoids exposure of his body and its natural functions.”  Basically, medical treatment and health tend to outweigh most other considerations.