Malaria in Ethiopia

The global health problem that I chose to look at is Malaria inEthiopia.  Malaria inEthiopiahas been a problem for nearly 50 years and is one of the leading causes of death in this country.  This is a problem in this country because it is a poor developing country were many people live in close proximity of each other.  Another thing is thatEthiopiais a part ofAfrica, and there can be large rainfall one day, followed by a large drought the next, which is were the real danger of malaria come in.  Malaria is transmitted through mosquito bites, and mosquitoes generally nest in areas of standing water, which are easy to find after rains inAfrica.  In an effort to try and help people who have contracted malaria, there are community nurses who go from house to house in a community and check on people and give them shots and medication.  Another thing is some of the people have mosquito nets to try and keep the mosquitoes away, but this does not work for long because the nets get holes in them from use and then are unable to be used by people.

Source

http://www.globalissues.org/article/588/global-health-overview (Video)

http://www.ethiodemographyandhealth.org/MedVectoredDiseasesMalaria.pdf

An anthropologist working on this problem is Dr. Rory Nefdt.  He is working with UNICEF and other researchers to help the fight against malaria inEthiopia.  What he and many others have been doing is helping to distribute medication and other supplies like mosquito nets to the people ofEthiopia.  One problem is that the medication available does not have a very long shelf life than the previous drug used.  Researchers like Dr. Rory are trying to figure out a ways to elongate the expiry on these drugs so that they last longer so patients can use them before they expire.  Another problem facing this country is there are not enough of the mosquito nets, so they ordered 10 million more nets, but the firm inVietnamwhere the nets are expected from is saying they need more time to manufacture the products.

Source

http://www.panapress.com/Ethiopia-faces-challenges-in-fight-against-malaria–13-480355-18-lang4-index.html

Clinical Medical Anthropology

I chose Clinical Medical Anthropology as my area of intersection for anthropology because I plan on working in the clinical setting in the future.  As a pediatrician, which I am working towards becoming, I will be in the clinical setting everyday working with patients and my colleagues.  It is critical to have an understanding of anthropology when working in such a setting because you need to understand the cultural differences in treatment for each culture.  You will run into many different problems as a physician, and the biggest problem is working around these cultural differences.  Once these differences are understood it makes for a much smoother and easier visit.  Some things that cause this are different cultures do not accept certain treatments.  You need to know what is acceptable in what culture and medical anthropology can help with that.  One example of clinics trying to help with this problem is at theMercyMedicalCenterinMercedCalifornia.  During week three in our lectures we talked about what this hospital did to lessen the problem of cultural boundaries.  This hospital took on a new policy which allowed traditional healers, or shamans, to work in the building and make regular rounds just like the doctors.  These shamans would go into the rooms and perform rituals on patients that did not allow traditional medicine because it was not part of their culture.  On top of having unrestricted access to the hospitals like the doctors, they also made house calls, which is something that doctors can not always do because they are so busy.  These shamans were not only there to help heal the patients with cultural boundaries, but are also a base of security for other patients.  The hospital can be a scary place, but the shaman can help patients feel more secure by performing a ritual.  This policy inCaliforniashowed that if you incorporate a cultural understanding in the medical workplace it can have a positive affect on patients.

Source

http://www.nytimes.com/slideshow/2009/09/19/us/20090920-SHAMAN_index.html

I Have Narcolepsy

I watched the True Life episode “I have Narcolepsy.”  This episode followed the lives of two young women, Julie 16 and Katy 25, who were suffering from the disorder of narcolepsy, as well as cataplexy, which is when a sudden loss in muscle control.  I believe that both Katy and Julie start out with a quest narrative, but run into a problem which brings them into a chaos narrative, but then are brought back to the quest narrative.  With this and many other illnesses, the most effective way of getting better is to seek out help.  This could be going to your doctor and seeing what can be done to alleviate some of the symptoms, or get rid of them entirely.  Another thing you can do is talk to someone who is also suffering from the same illness.  You may not get any medication or anything, but you get to talk with someone who knows what you are going through and understands how you feel which can help relieve some of the stress that you may feel.  Also, that person may be able to help with some non medical approaches to alleviating some symptoms.

Julie had been diagnosed with narcolepsy for 4 months and she tried to go through her daily live as she used too.  She would go out with her friends, tried to go to her dance class, and go to school.  Eventually the narcolepsy and cataplexy got to be too much for her, and with some coaxing from her mom she went to see her doctor.  He told her that her condition would probably not get better, and not taking anything to help with sleep and her cataplexy was not helping.  At this stage she goes from a quest narrative to a chaos narrative.  She feels lost and alone, not wanting to take the medication because she is afraid of the side effects.  Her mom eventually points out some alternatives to medication and she begins to go to a chiropractor.  After doing so she says she feels better than ever and has had no major cataplexy attacks in over a month.

Katy has had narcolepsy since she was 15, and has been taking a large amount of medication for her condition.  With the help of her boyfriend she has been able to get through her normal day to day life.  But recently her boyfriend has been worried about the amount of medication she was taking so he tells her she should try not taking any medication for a while and see if that helps.  She quits taking the medication, and her condition begins to worsen.  This is when she takes the path down the chaos narrative.  Her condition is worsening, she is having cataplexy attacks, and through all this she is beginning to lose her boyfriend.  Eventually they make up and Katy begins to have more control with the amount of medication she takes.  She is down to less than half the medication she used to take and she has never felt better.

Narcolepsy is not a very well known illness so it is taken differently in different cultures.  With Julie, whenever she would have a cataplexy attack her friends would worry about her and wonder if she was alright.  With Katy, when she was at the bar with their friends and she had an attack her friends would help her out but everyone else would talk softly and ask each other what is wrong with her.

From lecture, the sick role is the practices, rights, and responsibilities that come from being a person suffering from an illness.  These things include following instructions from care providers and other officials.  Both these women followed this to try and take control of their situation.  Julie was a little reluctant when she found out her condition would not get better, but once she took control and started to do what was asked of her, her condition started to improve.  With Katy, she was very dependant on her boyfriend and took too much medication.  But once she realized what was important and what she had to do, her reliance on her boyfriend and the medication lessened and she was able to cut her medication usage my more than half, and improve her relationship with her boyfriend.

Restless Leg Syndrome

Restless Leg Syndrome or RLS has become a joke of a disorder inAmericanow a day.  Due to the misinterpretation of it in the media, like the Mad TV skit shown in this weeks lecture.  People do not get a real understanding of this syndrome, and with the only things shown about it being negative, people do not fully understand if they have RLS or not.  The clip from the lecture showed a woman who has RLS and describes the feeling as “an electrical current that goes through her legs, and pain in her back and shoulders.”  This is a start to showing people what having RLS is like, but there needs to be more out there showing the signs of this syndrome.

With all the negativity about RLS, like from Mad TV, it is hard for patients who actually suffer from this to go and seek help.  The little information in popular media does little to tell people how to help themselves with this, so the only thing that people can do to actually get some help is to go see their doctor.  Once there the doctor can tell them exactly what needs to be done to help them into the right direction, rather than struggling through their day to day lives knowing that something is wrong with them.

One last note on this subject is that the mind is a wonderful tool.  It can do many wondrous things, but generally the human population only uses about 10% of their brains function.  Using things like the placebo affect, we think that what we are taking is actually going to help us, when in reality it has no beneficial or adverse effects.  This is where the brain comes in.  Since we think that what we are taking is helping us, our brain sends signals to the affected area, and begins to go to work healing us, without any outside medical help.

I believe that belief and healing are very closely related.  If you believe something will happen, eventually that thing will happen.  In the movie “Placebo: Cracking the Code” there are many cases that they show were the placebo has had beneficial effects.  One that I really was interested in was the elephant skin boy who was hypnotized and cured of his disease he was born with.  The doctor believed it was warts and treated him as such with hypnotism.  When it worked he showed a surgeon, who was very surprised.  The surgeon told him that that wasn’t warts but a very rare skin disease that some people are born with and should not have been cured like that.  He tried to do this to many other patients with the disease, but none showed any sign of being cured.  He eventually said that he believed it was because he knew the disease was incurable.  Before he thought it was warts, but now knew it was something else.  This is one example of belief being closely tied to healing.

Shin-Byung Korean Women

Shin-byung is a cultural bound syndrome that affects Korean women.  The first stages include somatic complaints like dizziness or gastrointestinal problems.  This syndrome is when a spirit tries to enter the females body and take over it physically and mentally.  Those with the syndrome report having vivid dreams about spiritual entities telling them to let these spirits into their bodies.  Once this starts to happen they usually consult a shaman or psychiatrist or physician for help.  It is said that there are three stages to shin-byung.  First of which is the prodromal phase, where the victim experiences the somatic symptoms and some anxiety.  The second phase is the trance phase.  This is when the victim reports having dreams of being beckoned to let spiritual beings into her body.  The last phase is possession.  The victim can show signs of double or even multiple personalities from the possession of one or more spiritual beings.  The second and third phase can range from taking a few weeks to decades to complete.  Once the possession is complete the women is considered a shaman herself now due to the possession.  This is in most cases welcomed because a shaman is a well respected member of the community and is a step up in the social ladder for women.

On the cultural level, these women go to shamans and other healers to see how this can be remedied, depending on the culture.  Where as inAmericathese people would be considered mentally unstable and put together in a special institution.  On the individual level these women have a choice to have a shaman try and convince the spirit to not control the host they have chosen, or let the process take place and assume the role of a shaman themselves.  If they do reject the spirit it is believed that they will live a life of torment from the spirit because it was not allowed to take possession of its intended host.

In western culture there have been similarities seen between Shin-byung and multiple personality disorder.  There is still some debate as to whether the condition is considered a mental illness or not.  As for a treatment, there is no known treatment other than having a shaman try and convince the spirit to leave the intended host alone and find another.

Shamans in Mongolia

In the film “the Horse Boy” the family traveled all acrossMongoliato seek the help of many different shamans to try and cure their son of autism.  When the family first arrived inMongolia, many of the shaman had been alerted of their arrival and had already gathered at the base of a mountain to perform their different rituals to try and heal Roan of his autism.  This was said to be the largest collection of shamans in a long time.  When Roan and his family reached the gathering of shaman they began a four hour long series of rituals from each of the different shamans.  Each shaman believed that the spirit of a relative with mental illness on the mothers side had connected itself with Roans causing the state he is in.  After the rituals were complete there was a noticeable improvement in Roans actions.  He began to play with one of the children there and do things he did not before.  As they ventured acrossMongolia, Roan went in patterns of improvement and regression with his condition.  His parents didn’t know if what they were doing was actually helping him, or just making it worse.  They kept going until they made it to a tribe of reindeer herders that were said to have the most powerful shaman inMongolia.  He agreed to help Roan, and he had one last ritual performed on him.  After the ritual the shaman said that the tantrums and other fits would end the next day, and they would see a steady decrease in Roan’s autism.  As Roan and his family traveled back to their home inAmerica, they did notice that Roan was starting to act different.  He would go to the bathroom by himself, and would rather play with other children rather than with his parents.  Like the shaman said, his condition did steadily become better, but you can never fully get rid of autism.

The healers were the shamans who performed various rituals to try and alleviate the different ailments of their patients.  They could come from any social status, but one that we saw in the movie was a tribe of herders.  These people specifically herded reindeer.  The techniques for the rituals differ from shaman to shaman, but a common thing I saw was the beating of drums and dancing around while waving some kind of smoldering incense.  Some differences were whipping of the parents of Roan in the movie, or making the person receiving the treatment drink some kind of potion.

The culture these people are part of is very spiritual.  They believe that if one were to cleanse the spirit one can cleanse the body.  That both are very closely connected.  The health care in this area is administered through a series of rituals given by a shaman.  You tell the shaman what is wrong with you or someone you know and they will perform a ritual that will help you or that person.

Collateral Damage

I did not do so well on the health equity quiz.  I got a 5 out of 10, but the statistic that caught me off guard was that the United Stateswas tied for 29th for overall life expectancy.  I knew we were not number one but thought that we would be within the top 10.  This stat through me for a loop because the United States are one of the wealthiest and most powerful countries in the world and to be tied for 29th for life expectancy seems like a bit of a slap in the face.

I chose to read the “Collateral Damage” article from the Unnatural Causes archives.  This is about a population of people who live in the Pacific Ocean on a group of islands called theMarshall Islands.  These people over the past century have been exposed to many different illnesses, the big one being TB, and have been relocated to many of the different islands due to American influence.  At one point after WWII, the Americans had started to test atomic bombs off shore of some of the northern islands, and one day they made a miscalculation.  The blast ended up being much larger than anticipated, and radiation leaked onto some of the inhabited islands near by.  The people were treated for burns and were tracked to see how they were doing.  Eventually one of the islands was taken by the Americans to build a military missile base and living area for those Americans working there and their families.  With the allure of new jobs, the Marshallese people began to go to theislandofKwajaleinwhere the base was located, and many who went got jobs, but could not live on the island.  The Marshallese working there had to take a ferry to a near by island were they lived.  This causes a health problem because not only do they get diseases from poverty where they live, but they also get diseases from developed areas where they work.  As an escape some Marshallese have gone toArkansaswhere there are plenty of jobs and the cost of living is low.  But they cannot escape the poverty they once lived in, where they still are at a high risk for TB and other diseases in developing countries

The development, spread and treatment of illness is influenced by many factors.  Politics can influence these by passing laws and such that prohibit or allow the use of certain drugs that can better or worsen ones health.  The environment can be full of animals and insects that carry different diseases that can easily be spread, but can also be full of plants that hold the answers to treating those diseases.  Lastly, culture can affect illness by some people refusing medication because it is not accepted in their culture, or they only use certain practices when treating an illness.

White American-Cardiovascular Disease

 

A=Cardiovascular Disease

Source

http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319575.pdf

 

 

Cardiovascular disease is so prevalent in white Americans today because there are so many overweight people.  Obesity is the leading problem in white Americans that leads to cardiovascular disease and with all the fast food and things around today it seems like it may never get better.  People who are overweight see that they have a problem but cannot break out of their habits they have to get into a program or schedule that will help them steer clear of heart disease.  Another problem is that many kids don’t get out and play enough because of all the video games now available.  They sit and play these games and eat junk food which eventually leads to adult obesity, and later to heart disease.  This can be averted if parents get involved in what their kids are doing and either get them involved in sports or get them to go outside at least once a day for the recommended amount of time.  This can slowly help get out country away from being called the most obese country.

Source

http://circ.ahajournals.org/content/125/1/e2.full.pdf+html

 

These three terms are rather closely related within healthcare.  Unlike what some people may have thought though, what race you are is not encoded within your genes.  After the human genome project was complete this was found, but there are many health problems that affect some races more than others.  This may be due to the area that that race lives, for example more African Americans have sickle cell disease due to living in African areas that are home to many mosquitoes, some of which are carrying the disease malaria.  Over the years African Americans had begun to evolve a certain mutation in their genetic makeup that allowed them to resist this disease.  Having only one copy of this mutation allowed them to live normal lives and resist the deadly disease, but if someone ended up with 2 copies of the mutation, then they would still be resistant to malaria, but would show symptoms for it due complications with their red blood cells.

Anxiety

My definition of health is the harmony of the body and mind, clear of disease or physical deformity.  This could be being physically active, and stimulating the mind with some brain teasing puzzles or games.  Illness is the perception of the mind that something is wrong, causing the person to feel a symptom that is not really there.  My definitions of these words have come from things I learned in school, and from my own observations of others.  Also, I am able to draw from my own personal experiences, especially with the illness part because if I did not want to do something and if I thought about it hard enough I could cause my own symptoms.

I do not believe that “Infertility” is an illness.  Some people and animals are born infertile and there is nothing they can do about it.  It is a part of them just like any emotion we may feel.  There is no escaping it and it is accepted into their everyday lives.  I do not believe that “Poverty” is considered an illness as well.  Poverty is an economic status felt by those in low class and should not be confused with a state of mind that people choose to live in.  Nobody wants to live in poverty, but some are forced due to the choices they made at an earlier point in their lives.  It is reversible, but it is not treatable like an illness.  I do not consider “Sadness” to be an illness as well.  Sadness is an emotion that everyone feels, but it is in no way an illness.  Depression, which is a much more severe version of sadness, is an illness, but depression is not felt by everyone.  If someone is exposed to sadness on a regular basis, it may upgrade to depression, but sadness itself is not an illness to me.

Applied Approach

I chose the applied approach, because it will help me to understand the cultural differences that can occur during a patient visit.  With this approach I can learn what is acceptable in the way of treatment for different cultures so that there is little time looking for a happy medium and the patient can have a speedy visit.  Also, I will be able to know how to interact with different cultures so that nobody is offended, or left in the dark.

The difference between disease and illness is not always evident to people.  Some may think there is no difference and the words are interchangeable, but there are in fact two different meanings of the words.  A disease is a physical manifestation of a treatable problem that is diagnosed by a doctor.  Where as an illness someone’s awareness of a change within themselves and a self diagnosis of the problem.

The culture that Miner is describing in the article is that of the American culture.  This was evident when they were explaining of a hero who chopped down a cherry tree, and the name of this hero was “Notgnishaw”, which isWashingtonspelled backwards.

Within the “Nacerima” article there are many rituals described.  One such ritual that caught my attention was that of seeing a “holy mouth man” once or twice a year.  This ritual describes drilling into people’s teeth and placing a magical material to prevent further tooth decay.  This is like going to the dentist and getting a cavity filled or just a routine check up done.  Another ritual that caught my eye was the daily body rituals.  One such body ritual was the “mouth rite”.  This ritual is much like getting ready in the morning where you brush your teeth and wash your face or take a shower.  One last ritual that I found interesting was the charm box.  The medicine men would come and diagnose the patients much like a doctor does, and then would write down the specific charms they would need in a language they and one other person knew.  This is like a prescription written by a doctor, which is then taken to the herbalist, which can be seen as a pharmacist who then delivers the certain charm required for treatment.