Infant Mortality in China

The global health problem that I chose to focus on is the infant mortality rate in China. Economic disparity within the healthcare system is a major contributor to this increasing rate. Maternal healthcare is an ongoing issue for the women of China. Policies that have been set in place do not provide women with healthcare coverage so most of them are without healthcare. This means that if they want to have children within the hospital, they will have to pay for this service out of pocket so most chose not to. This leads to infections and complications during child birth that contributes to the growing rate of infant mortality. Political influence has also aided in contributing to this health problem.  According to the authors Chen, Xie, and Lui, “Recently concerns have been growing about the effects of the target-based one-child policy that restricts the number of children women can bear…” (pg. 162). In order to control overpopulation, the government has implemented a one-child per household law that requires a fine to be paid if more children are had without approval. It was also believed that by only have one child that this would cut down the on the infancy mortality rate but instead is has actually increased the rate. This restriction has made women fearful of going to the hospital and receiving care due to the possibility of being fined for additional pregnancies so more children are being had a home in non-sterile conditions. Finally, cultural practices and beliefs in conjunction with the political restriction have played its part in infant mortality. Son preference, the preference for only male children, has been the leading cause of female infant mortality is India, South Korea and China especially for families that have scare resources (pg. 162). Women do not want to waste their money on healthcare and fines associated with additional children on girls so healthcare is only being sought if there is a possibility of a boy being born.

To address this issue, the government is trying to provide a solution that they believe will help maintain the policies in place as well as lower the infant mortality rate. The provision of more policies that will help women afford healthcare has been put into motion with hopes that this will encourage more hospital visits. However, the policies are slightly flawed. “However, while the new health insurance policy is expected to improve access to health care and to enable uninsured mothers to give birth in hospital, it is intended mainly to help cover the costs of medical emergencies, “(pg. 162).

An anthropologist that is studying this topic is assistant professor, Mrs. Zhuochun Wu. Mrs. Wu has assembled a team of research assistants to study perinatal mortality in rural parts of China. In order to study the mortality rates, they are utilizing the local civil registration data that is taken by each town to ensure that residents are adhering to the one-child policy. From this registry, each pregnancy is recorded as well as the number of abortions, stillbirths, early neonatal mortality and perinatal mortality. In part of her research it is noted that women are required to have a pregnancy test every 2 to 3 months and if they are pregnant and have utilized their one child restriction then women are encouraged to have an abortion from fear of being fined and loss of jobs or demotion. An emphasis is also placed on the healthcare system. In many of the smaller counties and townships, healthcare prenatal healthcare is not provided and all births are left to midwives (Wu 2003, 1319).

References

Jiajian Chen, Zhenming Xie and Hongyan Liu. Son Preference, Use of Maternal Health Care, and Infant Mortality in Rural China, 1989-2000. Population Studies.Vol. 61, No. 2 (Jul., 2007), pp. 161-183.

Wu etal. Perinatal mortality in rural China: retrospective cohort study. BMJ 2003;327:1319

Clinical Medical Anthropology

I chose the area of clinical medical anthropology to investigate further because I really believe that this ties in well with what my future career goals area. I would like to pursue a master’s degree in public health but with the concentration of healthcare administration and public policy. Through this concentration I want to incorporate the knowledge I have gained in the area of anthropology to improve the quality of healthcare the patients receive. This would include training for doctors and staff on being more empathetic to cultural beliefs as well as a way to integrate biomedical practices with cultural practices. With America being known as a “melting pot” it is important that Western medicine respects each member within this pot. I am hopeful that through these improvements, better doctor/patient relationships will be established and a greater sense of trust will be placed into the healthcare system.

It would be extremely beneficial to take an anthropological approach when working within a hospital setting alongside doctors and nurses that do not have any anthropological background. By understanding a patient’s culture and religious background, the healthcare provided could be greatly improved. According to the article “Concepts from Medical Anthropology for Clinicians”, it is stated that, “A doctor’s diagnosis, though medically correct from an orthodox point of view, may not be at all representative of the patient’s view of the situation,” (pg. 932). For example, in a case scenario that was done, a 24 year old Chinese exchange student in graduate school was seen by a doctor for experiencing symptoms of palpitations, shortness of breath, dizziness, fatigue and headaches. The doctors diagnosed this as depressive-anxiety disorder and placed her on anti-depressants and routine cognitive-behavioral psychotherapy. The girl drops out of treatment, stops taking the medication and refuses to see the doctor again. IT was discovered that her family was from Beijing and that a strong stigma is put on mental illness so healthcare providers there do not use the word disorder. Instead they use the terms neurasthenia or stress related condition (Kleinman and Benson 2006, pg. 294). Getting a better view of how each patient is experiencing illness instead of just an assessment of the disease and its symptoms can be crucial in establishing trust between the patient and doctor as well as prescribing the right treatment on a per person basis.

References

Benson, Peter and Kleinman, Arthur. Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix it. PLoS Medicine. 2006; 3.10: 294.

Katherine K Perry. Concepts from Medical Anthropology for Clinicians. Phys. Ther. 1984; 64:932.

Female/Male

The “culture of biomedicine” implies that the concept of biomedical practices is not solely based on facts alone. The practices performed in Western medicine are not independent of cultural influence. In fact, many of the rituals practiced in places such as hospitals are largely influenced by Western beliefs on health and medicine. This is an important concept because it explains how health disparities are viewed, how people experience health within the Western culture and the reasons behind the treatment and medical remedies prescribed to treat illness. An example of how culture has influence over biomedicine can be seen in the surgery room. In the article, “Rituals in the Operating Room: Are they Necessary?” the everyday rituals observed in the operating room are examined closely in terms of cultural belief and practices. One ritual analyzed is the use of masks while operating on a patient. It is believed that the masks protect the patient’s wounds from being infected by bacteria coming from the mouth and nose of surgical team.  A test was conducting to measure the infection rate dispersed from the surgical staff and the patient being treated.  The test concluded that the CFUs observed within the air surrounding the patient from those without masks did not show a significant difference than from those wearing masks . This is just one of the ways that cultural beliefs affect the rituals observed in patient care.

I believe that dichotomies arose from the need of contrast for explanation and conformation. Dichotomies are used to validate that something is real because it possesses an opposite. In the culture of biomedicine, dichotomies were needed in order to explain certain principles of the life such as life and death and mind and body. It gave separation so that each factor is easier to understand. My personal take on dichotomy is that it can be seen as a positive and negative thing. The positive side is that it does allow for the basic understanding of each element. For example, for a person that does not have extensive medical knowledge, understanding the principles of death  and what it means to be dead allows for a greater understanding of what it means to be alive. However, a negative side effect to this is that is doesn’t allow for much grey area such as in the understanding of male and female. Setting two set genders as the basis for all life does not give room for cultural interpretation, intersexed individuals, hermaphrodites, and other non-gender specific identifications.

I believe that the dichotomy of male and female is highly accepted and seen as logical in Western society because there is a scientific explanation for it. It is strongly believed that if you can test for it then there is validity in the results. Sex is defined as the biological identification of an individual as male or female. Therefore, if a person has ovaries and a uterus then by definition that person is a woman biologically. This means that society can then function normally by prescribing this individual gender roles to follow. This takes apart all cultural understanding and interpretation of gender and just group sex and gender together. This also relates back to the idea of contrast for validation. The opposite of male is female so the sex male must be true because it has an opposite to oppose it. This allows for simple understanding and validity.

True Life: I Have Schizophrenia

In the True Life episode, “I Have Schizophrenia”, a group of young adults is followed throughout their everyday lives to evaluate how this illness has come to affect their lives as well as how they manage to cope with this mental illness. Each one of them experiences this illness different and that influences their decisions on medical care, personal relationships and everyday interactions with the outside world. Within the American culture, people that suffer from schizophrenia are often thought of as crazy and mentally unstable. It is common for society to want to separate them out from the rest of society by putting them in mental hospitals or psychiatric wards.

Amber is a college student that was diagnosed with Paranoia Schizophrenia after her first year in college. The symptoms of this disease began to affect her schoolwork and her interaction with the people around her so she was hospitalized, treated and is now doing much better. Upon her return to school, she feared that her heavy schedule could possibly trigger an episode of her illness so she decided to cut back her course load and is now back on track. The illness narrative that she used to tell about her illness is the restitution narrative. She utilized this method in order to tell how she started, how she sought treatment and how through monthly visits to her therapist and daily medication there is a resolution to her problem. She states towards the end of the episode that after going to a support group meeting she was able to, for the first time; tell a group of people that she had this illness but that she was still a normal person. She has taken on her sick role by acknowledging that something was not normal with her health, received treatments and took some time away from her normal life to get better.

Josh’s story is told using the chaos illness narrative. His story does not have a concrete beginning, middle and end. He starts out living in this hotel because his mother kicked him out in fear for her and her daughter’s safety. He decided to not take medication because he enjoys hearing the voices in his head, stating that they keep him company. Josh has chronic episodes of delusions and paranoia that he admits to experiencing but does not see an end to these symptoms of his illness because he does not believe that he has a problem. He uses this illness narrative to display distrust in medical practices and medicine. He has been hospitalized 16 times and feels that self-medication through marijuana is the best means of help.  Josh did not take on the sick role. Acknowledgment of an illness is not present and therefore feels that any sort of treatment is deemed unnecessary.

Postpartum Depression

Postpartum depression is an illness experienced by some American woman right after giving birth. Soon after a woman has given birth to her new baby, her hormone levels experience an immense amount of fluctuation that can lead to the onset of severe depression. According to the Mayo Clinic this depression is associated with symptoms such as insomnia, lack of joy in life, severe mood swings, difficulty bonding with the baby, thoughts of harming yourself or the baby and feelings of shame, guilt or inadequacy.

According to the lecture, the biomedical community has stated that postpartum depression is a recognized form of depression that can be caused by a hormone imbalance. However a problem arises because there is not a specific medical examination that can test for this depression. This invokes questions of legitimacy amongst the members within our society. Within a cultural context, society looks at this depression as just an excuse for mothers that are too lazy or irresponsible to take care of their children. For the woman that experiences this illness, there can be a sense of comfort knowing that there could be a cause that is outside of their realm of control that is influencing this depression. But in turn, the negative stigma placed on woman from a cultural perspective can add to these feelings of inadequacy and shame, elongating the time required to move past these symptoms.

Support from Western medical practices could aid in the treatment of this illness. Having doctors that recognize the signs and symptoms provides a sense of trust and comfort within the woman to seek medical treatment options such as medicine that can be taken or mental exercises to regulate hormone control and influence positive thinking  and better mental health. However, having a society that provides a negative connotation on this illness could make is difficult for a woman to feel comfortable enough to seek medical attention and therefore lead to months and years of experiences with this illness.

The phrase, “seeing is believing” ties in very well with the coorelation between belief and healing. A strong enough belief in the healing practices being received, whether it is medicine, prayer, rituals, spiritual cleansings or whatever the treatment may be, can result in the physical observation of positive outcomes. In the YouTube film, “Placebo: Cracking the Code” this phrase is demonstrated a multitude of times. In the case about the two gentlemen that received a fake surgery on their knee, the trust and faith that they had in medical system and belief that surgery would in fact cure their knee problems lead to actually experiencing the same amount of healing as the patients that did undergo real surgery. A negative effect however of the placebo effect was seen in the case of Sam Lunde. He was patient that had cancer back in 1970s and during those times, patients that had his particular strain of cancer were often thought of as absolutely being positive to die. Even after surgeries were performed and as much of the cancer was removed as possible, most patients still died soon after so that is what Mr. Lunde’s doctor informed him off. A few weeks later, Mr. Lunde did die so there wasn’t much surprise to his passing. However, once the postmortem autopsy was performed, Mr. Lunde showed very little signs of cancer within his body so it was determined that Mr. Lunde did not die from the cancer. It is believed that being told that he was going to die and him believing what he was told is what lead to his death. Both of these stories prove that a strong enough belief, whether it is positive or negative, in the overall healing of a person can manifest to a physical observation of those beliefs.

Reference

Mayo Clinic. Postpartum Depression. 2012. http://www.mayoclinic.com/health/postpartum-depression/DS00546/DSECTION=symptoms

Shamans within Western Medicine

The article that I found most interesting was, “A Doctor for Disease, a Shaman for the Soul”. In this article the focus has been placed on integrating cultural practices with Western medicine. In particular, in the Hmong culture, Shamans are seen as very important members of this community and are healers/protectors of the human soul that is believed to lead to healing of the body. In a hospital in Merced, California, a policy has been implemented to allow for Shamans to interact with Hmong patients in cooperation with Western medicine in order to give the patient the best medical care with respect to their cultural beliefs. Other hospitals are starting to adopt these policies as well on the behalf of their patients. This new policy and interactions has allowed for better understanding between the Hmong patients and doctors, easing fears among the patients and enabling better doctor/patient relationships.

The Shamans treat their patients by securing their souls from being lost or stolen. It is believed that a person’s soul is just like a child and can be lost or stolen by evil spirits so when someone is sick, a Shaman utilizes different rituals to protect the soul while the body is healing. One ritual that they perform is the transference of evil spirits from the body to another vessel such as an animal by allowing the animal to walk across the patient’s chest while performing a chant. Another ritual that is performed is encasing the patient in an invisible protective shield. The Shaman draws symbols in the air over the patient’s bed and this shield is supposed to keep their spirit from being taken by evil spirits.

This collaboration between the protection of the soul and the use of Western medicine to treat the body has shown improvement in the healthcare provided to Hmong patients. Hmong community members have gained an understanding of how Western medicine helps to ride the physical body of illnesses and ailments. In turn, Western physicians have gained an understanding of the importance of body and spiritual healing amongst the Hmong people and with this new found cultural understanding medical practices can be improved to provide all refugees, immigrants and culturally different communities with better healthcare.

Dhat in Eastern India

In the article, “Culture-bound syndromes: the story of dhat syndrome” the topic of culture-bound syndromes as well as a more indepth look at the illness “dhat” was examined and analyzed. In the analysis of culture-bound syndromes (CBS) it is discussed that this classification of illness is culturally relative. Each culture has its own set of diseases and illnesses that are not part of mainstream categorized diseases and whose names are culturally specific. An example of a CBS is dhat. This illness is found within the Eastern Indian culture and only affects the males of this community.  A common name for this illness is semen-loss anxiety. It is believed that loss of semen through means such as nocturnal emission, urine and masturbation causes such anxiety among these men that they develop symptoms associated with depression. These symptoms include fatigue, weakness, anxiety, loss of appetite, guilt and sexual dysfunction.

This illness can be evaluated based on biological, cultural and individual dimensions. Within the realms of culture, it is a clear culturally based disease. Within this community, semen is seen as a very important aspect of a man. It is believed that it takes 40 days for 40 pieces of food to be converted into one drop of blood. After this conversion, 40 drops of blood is necessary to produce one drop of semen so any loss of semen that is apart from reproduction is seen as detrimental. Semen is the key to the survival of the population so all sperm cells are vital. This leads into the understanding of the effects on the individual. Since so much importance is placed on semen then these men begin to experience immense amounts of stress and anxiety. Questions arise about their fertility which could lead to concern about their importance within their community. It is possible that the inability to reproduce could damage the self-image of each male. These concerns lead to biological ramifications. The anxiety causes depression-like symptoms that manifest into physical and psychological issues. Symptoms such as loss of appetite and fatigue begin to wear on the body leading to even more severe medical disparities.

Treatment for this illness is still being researched. Psychological help is being made available to these men in hopes of reducing the amount of anxiety and depression they experience. Western medicine is also looking into this illness to possibly find a way to tie in professional medical practices for the biologically manifested issues without conflicting with the cultural values. Other cultures have demonstrated similar illnesses associated with semen-loss anxiety so it is a collaborative effort to locate the appropriate treatment.

References

A. Sumathipala, S. H. Siribaddana and Dinesh Bhugra. Culture-bound syndromes: The story of dhat syndrome. The British Journal of Psychiatry. 2004. 184:200-209. http://bjp.rcpsych.org/content/184/3/200.full.pdf+html

When the Bough Breaks

Going into the Health Equity quiz I was not sure how well I would do. After taking the quiz I correctly answered 5 out of the 10 questions. The question that seemed to be the most surprising was regarding the group that had the best overall health within the United States. I thought for sure that it was Non-Hispanic white Americans because in a previous question it was stated that wealth was a large determining factor as to whether or not a person was healthy. However, recent Latino immigrants were considered the healthiest group. It did go on to state that after five years that status starts to decrease but I still found this answer to be very surprising.

The case study that I chose was entitled, “When the Bough Breaks”. In this film, the topic focused on the high rate of premature infants within the African American population. African American women are among the highest minority to give birth to underweight and premature babies. There have been several theories devised over the decades to explain this occurrence. One theory was that it was based on a socio-economic principle. However, they found that an African American woman with a college degree, practicing in the field of law, living comfortably as a middle class American still gave birth to a premature baby. A survey was taken that African American women with an education still had a higher rate of premature labor as compared with a Caucasian woman that had not even completed high school. The next theory was that African Americans had a genetic predisposition so a study was conducted on the percentage of premature infants that were African American, women that were of African orgin and Caucasian Americans. The study showed that the women that were of African descent and white Americans were very close in percentiles whereas the African American women still maintained the highest percentage of premature infants. Finally, the current theory is that cause is racism. The stress of feeling like a second class citizen has provided a life cycle’s worth of stress on the baby and that therefore induces premature labor.

The development, spread and treatment of illness is influenced by many factors. Within the realms of politics, governed officials are the one that decide on what health measures are important and how the system of healthcare should be handled. This is entangled with economics. The government decides how much money and resources are allegiated within the health system which dictates the amount and quality of the health care provided to each region. Culture is also a major influence because each culture views illness differently. For example, the children in Africa that catches Schistosomiasis from the water flowing off of the Nile River. This disease is so common that it has become a right of passage for young boys. This is now looked as a culture norm instead of a medical abnormality. This affects their view point of a need for medical treatment so the disease continues to spread amongst the community. Cultural understanding of illness affects the individual choice for treatment of an illness. If the choice is made to not seek treatment then illness can has adverse effects leading to additional illness and changes to their biological makeup. This could make a person more susceptible to other illness or have the adverse effect and aid in development of immunity to other common illnesses.

Type II Diabetes in African Americans

The health disparity that I chose was diabetes, particularly type 2 within the African American community. According to the American Diabetes Association, “In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin”. Insulin is important in the breaking down of sugars to be processed as glucose that can be turned into energy for the body to utilize. When the body does not created enough insulin a medically formulated source of glucose must be injected into the body to supplement. I believe this disease is so prevalent in African Americans for a few different reasons. One of these reasons is obesity. Marshall Jr. (2005) stated that, “…it is estimated that diabetes can be attributed to abdominal obesity in 39.9% of African Americans than white Americans”. African Americans have the highest rate of obesity which is induced by poor eating habits, lack of physical activity and health related complications. Another reason for the high rate of diabetes amongst African Americans is insulin resistance. Insulin resistance is very problematic and can lead up to glucose intolerance and diabetes. This issue is seen among African Americans especially in young girls. Obesity can contribute to insulin resistance so both reasons tie in to each other.

Race, genetics and health can all be related under one term, genetic determinism. Genetic determinism breaks down an individual into their basic biological aspects and then these aspects are used to explain a person’s health (Lecture 2.2, slide 5). Since race is a self-proclaimed categorization many people that claim to be part of the same race often share some similar genetic characteristics. When a common medical occurrence can be documented amongst people of the same race then often suggested that most of the people within that race will be subject to the same medical occurrence. This is an incorrect assumption that can often lead to racial designated diseases.

The following graph comes from the Center of Disease Control. It displays percentage of Americans diagnosed with diabetes over the last 30 years. The data is divided into three main racial groups, Caucasian Ameicans, African Americans and Asian Americans.

Age-Adjusted Percentage of Civilian, Noninstitutionalized Population with Diagnosed Diabetes, by Race, United States, 1980–2010

Graph showing number of persons with diagnosed diabetes, United States, 1980-2010. Links for methodology and data limitations follow this figure.

 

References

American Diabetes Association: Diabetic Basics. http://www.diabetes.org/diabetes-basics/type-2/?loc=HomePage-type2-tdt

Center of Disease Control and Prevention. http://www.cdc.gov/diabetes/statistics/prev/national/figbyrace.htm 

Marshall Jr., M. C. 2005. Diabetes in African Americans. Postgrad Med Journal. Vol. 81:734–740.

 

Ethnomedical Approach

I picked the approach of ethnomedical because I believe that it really focuses on the understanding of illness in relation to the cultural definition and how those illnesses are treated based on cultural practices. This approach allows for the comparison of defining what each culture constitutes as a disease and illness and how multiple approaches to the topic affects each individual’s physical being. For example, when I am sick I seek help from a respected medical physician. However, some Native American tribes seek health treatments from a medicine man or a respected spiritual tribal leader. Though, we seek medical treatment from different people we do share a common goal of getting help from someone that is known within the community as a respected member that possesses the ability to enable better health. The way that we experience disease and illness is different because of our differences in cultural representation. Disease and illness fall under the umbrella of sickness but each one as different constructs of sickness. The disease aspect is the outward expression of your physically altered state whereas illness is our individual interpretations of physical ailment.

In Miner’s article about the Narcerima people, he is describing a culture that focuses on health through the understanding of magical and spiritual belief. I realized this when he started talking about how each family has an alter room that they store their potions and relics in a box in the wall. Their belief in the power of magic explains why they provide gifts to the medicine men and use potions to ward off disease and illness. The fact that these people still experience all the ailments that they believe magic will alleviate shows just how deep of a cultural bond they have to their understanding and experience with illness.

There are a few rituals that demonstrate their cultural beliefs of health and the influence of medicine. One ritual is exorcisms. The belief that a witch doctor can exercise evil out of an individual shows a high value on spiritual healing. There is an importance on the cleansing of the spirit and that evil can cause harm to one’s health if allowed. Another ritual is unclothing of sick individuals as they enter the imposing temple. Since nudity is so taboo within this culture, the stripping off of the clothing and allowance of others to wash them shows how strong the beliefs are put into the healers of this temple. The faith that they have in their healers parallels the faith we put into doctors and the medical system. The last ritual is the packing of the gums with magical relics and potions. This ritual is to stop gum decay and even though individuals still experience this decay and disease, the fact that they continue to go and have this practice done continues to demonstrate the belief that these healers and medical men know all and that all faith is put into spiritual healing.