Tuberculosis in Sub-Sahara Africa

Tuberculosis is only the second leading cause of death in the
world with AIDS/HIV being the first according to the World Health
Organization (WHO). What makes this infection so harmful to
sub-Saharan countries is that AIDS/HIV and Tuberculosis is found to
have a positive correlation with each other. (Cantwell, 1996)
Tuberculosis is a bacteria that can be easily passed through the air
from an infected individual. Because most of its symptoms are mild,
many people who are infected are unaware for months. Treatment
programs in these countries are in their teenage years with some
major kinks to work out, the larges being how drug interactions with
HIV/AID treatments cause one to be inefficient. The WHO and Global
health organizations such as The International Union against TB have
been in the forefront fighting this battle. Many individual countries
do not participate because many of these countries are poverty
stricken and have nothing that they would want, such as oil. As we
saw in the video clip from this weeks lecture material, a group of
four men had to bring TB treatments to countries because no one else
would due to the belief that they would die and it would not make a
difference. Major organizations have been working at enforcing laws
that cause people to be tested for TB before working in places such
as the coal mines. Sadly they found this to be inefficient as the
percentage of workers who had TB increased from 1% to 30% in a matter
of twenty years. (Corbett, et. Al, 2006) While the reasons as to how
the amount of infected persons increased so greatly with such high
standards are long and unknown, many organizations feel that
establishing preventative actions and some treatments cause more harm
that good.

In the article, “Barriers
and outcomes: TB patients co-infected with HIV accessing
antiretroviral therapy in rural Zambia”,
anthropologist
Chileshe followed a series of patients with TB and HIV and how easy
or hard it may be to get treatment. It was discovered that living in
the rural areas of Zambia made treating TB and HIV more difficult.
With having to foot the bill for transportation to the facilities and
then upon arrival learning that blood work was lost, the electricity
was off or lack of staffing prolonging treatment caused the
financially incapable to suffer even more. When the person was sick
or not feeling well some normal family roles were changed such as the
woman becoming the bread winner. In many cases the families were
ashamed to be acknowledged with having such a disease so they moved
further away from their communities. Having the illness caused the
same financial strain on the families as the funeral for the family
member. At the end of her year long studies of the seven individuals,
only three were taking the treatment and two were to start treatment,
the other two had already passes. Several months after leaving the
three that were on treatment when she left were the only survivors.
The lack efficient treatment options and accessibility for the
patients caused the mortality rates to decrease significantly
alongside with the inability to eat the proper foods. In conclusion,
treatments are only helpful if they can be given in a reasonable
amount of time and other factors do not exist such as lack of
transportation to hospitals and lack of nourishing food. It is only
when theses factors are eradicated that treatment can be effective in
these countries.

Sources

 

1. Cantwell, M. F., and N. J. Binkin. “Result Filters.” National Center for Biotechnology Information.U.S. National Library of Medicine, June 1996. Web. 10 Aug. 2012.
http://www.ncbi.nlm.nih.gov/pubmed/8758104.

2.Corbett E., Martson B., Churchyard G.J., De Cock K.M., “Tuberculosis
in sub-Saharan Africa: opportunities, challenges, and change in the
era of antiretroviral treatment” Lancet 2006; 367: 926–37

3.Muatale Chileshe, Virginia Anne Bond,
Barriers and outcomes: TB patients co-infected with HIV accessing antiretroviral therapy in rural ZambiaAIDS Care Vol.22, Iss. sup1,2010

4.Dye C, Harries AD, Maher D, et al. Tuberculosis. In: Jamison DT, Feachem
RG, Makgoba MW, et al., editors. Disease and Mortality in Sub-Saharan
Africa. 2nd edition. Washington (DC): World Bank; 2006. Chapter
13.Available from: http://www.ncbi.nlm.nih.gov/books/NBK2285/

5.”Tuberculosis.” WHO.
N.p., n.d. Web. 10 Aug. 2012.
<http://www.who.int/mediacentre/factsheets/fs104/en/>.

 

 

 

 

Clinical Medical Anthropologist

If I were to further investigate an area of applied medical
anthropology it would be Clinical medical anthropology because of my
own person fascination with the health. I also would find this area
most helpful in my pursuit to be a physical therapist. I believe that
ones culture and beliefs can make a difference on whether they truly
feel healed or can recover from an injury. With further
investigation, we can combine the culture with medical practices and
have the greatest benefits for the patient.

Working for a doctor as a clinical medical anthropologist could be
very beneficial for the doctor. The language used in translating what
is occurring in their bodies could be better understood by the
patient.  It would also allow the doctor to treat the patient in a
way that does not conflict with their cultural values. Very similar
to how a priest may come to visit the sick in the hospital and pray
for the patient, the same could be done with other cultures. It is
much like how we learned of  shamans being allowed in hospitals to
perform various rituals for the sake of the patients. Being a
clinical medical anthropologist would allow us to use the
ethnomedical approach and  explain why a patient did not initially
consult a physician when the first symptoms occurred. This would help
with what treatment options would be best for the patient because the
doctor would know how their culture feels about medications, therapy,
and so forth.

In providing services to the doctor, the patient benefits from
having complete understanding of how to go about the situation with
their culture taken into consideration. The patient will also be able
to tell their illness narratives without feeling stereotyped and
someone realizing why this is considered an illness to them. If a
doctor was to encounter Kuru in America and was unaware of the
cultural ritual of eating the flesh of a recently deceased family
member,  he would not know the meaning behind the action or how it
came about.  They may even consider it to be an epidemic of some
sort. Clinical Medical anthropologist would cause the blurred lines
between patient and physician to be clear so that there is no longer
misunderstandings.

 

Life/Death

When someone talks about the culture of
biomedicine, they are speaking about the three main aspects of it:
the institutional history, the language of biomedical facts, and the
rituals. The institutional history is about how it became what it is,
what is symbolizes, and how it has changed over a long period of
time. The language is the equivalent of how we as people pass down
stories and explain things to others in an illness narrative. The
ritual speaks of the things that we believe we must do before,
during, or after the process for the most effective outcomes, such as
wearing masks and sterilizing the instruments. Knowing the culture of
biomedicine is an important concept because it explains to us the
who, what, when, where, and how of the illness and who should have
the authority to diagnose oneself or another. Learning the culture of
biomedicine is equivalent to learning the cultural aspects of a
person. You can not truly help someone unless you know the various
aspects that go into what makes them who they are and the same is
true of biomedicine.

 

I chose life and death because of much
headway it is making in politics today. My definition of life varies
for the different stages of life. If a child has yet to be born or
leave the mothers womb I do not consider it to have a life of its own
because it needs the support from its mother. When it leaves the
womb, even if on some respirators or other machines I consider it to
be alive. If a person has suffered a traumatic accident or is an
elder and living on life support I no longer consider them to be
alive because they can not come out of that state and regain control
from that point. Whenever the possibility of recovery out weights the
actuality of death, I consider them to be alive, if not then they are
dead. With that being said, when someone is on life support and still
has some sort of brain activity then they are alive. I know my
definition varies in so many ways but it stems from the long line of
deaths that occurred when I was younger. When my great uncle was put
on life support and he no longer had brain activity we had to decide
if and when to pull the plug. Having to go through this at such a
young age combined with this being a heated debate amongst peers have
caused me to view life and death in this way.

 

I think that this dichotomy is accepted
as a mixture of 65-70% logical and the rest natural. In the western
societies we must find some sort of evidence and proof that something
is true or is really happening. This is how we determine to take some
medical conditions seriously or not. I do not think that life/death
would ever be based purely on logic or natural because of the
sporadic phenomenons that occur.

True Life: I’m a compulsive shopper

In this episode, Gabby and Ali use the
quest narrative to tell their stories. Gabby was raised by two
parents where the mother has Multiple Sclerosis. Due to her mother’s
illness, she was given her parents credit cards at a young age to
shop for herself.  She feels that her family does not understand that
she needs to shop because fashion is everything to her. She will not
see a therapist and has ran her parents into over $10,000 in debt,
not including her own. After much threatening, She finally goes to
see a therapist.

 

Ali was given a privileged life where
her mother and step father gave her everything she ever wanted until
her mother and step father divorced.. Ali feels the need to keep up
her wealthy image and does not feel that paying her bills is
important, until she learned she was over $8,000 in debt. She tends
to justify all of the things she purchases that are high in price.
She has never disclosed the information to anyone until the show. She
decided to go to a debt anonymous group meeting. After attending the
meeting she feels somewhat better because there are others like her.
When she realized that it was not working, she went to therapy. The
therapist helped her to realize that she was not happy with the
person she is. Seeing the therapist helped her to realize the
severity of her actions and a better way to deal with her problems in
a proactive way.

 

 

In both cases, both girls are looked
upon negatively by family, friends and professionals. They are seen
as irresponsible and looked at as children. Their friends and
boyfriends disapprove of their actions but continuously feed their
need to shop. It seems that their narratives were trying to convince
you of why it was okay and normal for them to have this condition. It
was like hearing them argue with themselves out loud and trying to
portraying normalcy. The one thing they both have in common for their
healing process is the need for something. Gabby wants a boob job and
after being told by her parents they would not pay for it, she
decides to save her money and sell some of her clothes to pay her
parents back. Ali’s rent is past due and her furniture was taken. It
seems a desire or traumatic event causes them  change their habits.
In the end, Ali was in $15,000 in debt and stopped seeing her
threapist because she felt it was not working. Gabby never received
help and her problem and they did not say what became of her.  Their
roles never changed, they both had to be responsible for their own
actions and were not off the hook because of their disorders.

While this may not come across as a medical illness, I think it is comparable to Obssessive compulsive disorder. In both cases the person has had something happen that has caused them to behave differently. They constantly feel the need to satisfy the urge of a certain action to feel comfortable with continuing their day. It affects their daily lives in different ways but does not allow them to surpass a certain point in life. While this is not your traditional medical illness, it can be categorized as one.

This narrative is help helpful to those
who are watching because someone can relate and if they see a little
of themselves in the person telling the story they may be able to get
help for themselves. As we learned in lecture, it helps the teller to
feel empowered, make sense of the illness, and make adjustments which
was needed in both cases.This can be very helpful for healthcare
providers because it allows them to understand what the patient is
going through and how to treat the problem from within instead of
with medications. Family members can know how to handle the
situations and how they can help or see how they enable them.Treating a person with a condition likethis requires more insight than others because there can be other
issues that cause the problem to exist.

Restless Leg Syndrome

The medical dictionary defines restless
leg syndrome as a condition where “a distressing need or urge to
move your legs(or arms)”. I think that culture plays a large role
in this condition because before it came about, many people would
probably have just said their legs were sleeping or the tingle they
feel in their limbs were just a result of poor blood circulation. I
believe that because the condition is based solely on the description
of the patient and can not be treated, it is not a “serious
illness” to most people. As we saw in the television skit, it is
fairly easy to make fun of. When I first heard of the condition, I
was with a group of friends and we quickly decided that it was a way
to categorize any unfamiliar feeling one may be having in their body.
This is not to say that people do not have these symptoms. I think
that in western culture anything that is not normal or slightly out
of place is automatically considered an illness or disease so that
someone can create a prescription drug and make money. Since the
condition is based purely on what the patient says they are feeling,
bio-medicine seems to not acknowledge it as a disease. Due to the
bio-medicine not identifying it as a problem, it is not seen in our
culture as an issue.

 

I think belief and healing go hand in
hand, you can not have healing without belief. In cases such as the
two war veterans that had a placebo knee surgery, it was going
through the ritual and the belief that something had changed in that
time. I am a true believer in mind over matter, you can believe
something into existence. It is very much like life, if you believe
that you can accomplish certain goals and make them real, you are
more likely to achieve them. Just as you can believe yourself into
being sick, you can believe yourself well.

Bhang Psychosis in India

As we have learned in our lectures this
week, cultures tend to have illnesses or diseases that are only
prevalent in those cultures. They can be a result of ritual
practices, traditions, dietary consumption, and more. In India, Bhang
Psychosis is just that, a cultural bound disease. It is characterized
with symptoms that are similar to schizophrenia: nervousness,
paranoia, and visual hallucinations, but combined with lack of
confusion. Bhang is a form of marijuana combined with other herbs
(Indian hemp) that is used in spiritual ceremonies affiliated with
the God Shiva, destroyer of evil. Believers ingest this toxin in a
liquid and pill form to rid themselves of evil on a daily basis. If
one to two pills are taken, then the effects are mild, but three or
more can cause the Bhang Psychosis symptoms. These symptoms may
continue past the current usage and is only deciphered between
schizophrenia when the user remits from the mixture. Bhang has become
a more popular tradition in India than it was in the past in the
amounts to cause these effects.

 

This illness is predominantly a
cultural effect. If it were not for their practices, the drug would
not be consumed and the illness would not exist. The individual’s
need to ward of evil spirits also plays a role into how much that
person consumes. If they believe themselves to have more evil around
them than others, they consume more, causing greater effects, which
may cause long term effects and some form of dependency. I could not
find an article that spoke about the treatment for bhang psychosis,
but my guess is that since everyone to some extent partakes in the
activity, it is seen as the effects of evil leaving your body. To
some, ridding themselves of evil spirits outweighs the symptoms of
bhang. In America, taking this same or similar drugs is in some ways
culturally accepted. It becomes a religious practice for most college
students to take aderall during finals and exam weeks, and drink
alcohol in mass amounts on your 21st birthday as a right
of passage. We treat these conditions with some form of
rehabilitation and it is frowned upon in the public eye, even though
most people engage in these activities. With this information it
makes me wonder if it is truly a problem/syndrome for a country that
openly allows this for regular usage?

 

Akhtar,
Salman. “Four Culture-Bound Psychiatric Syndromes in India.” 
International Journal of Social Psychiatry 34.1
(1988): 70-4. 
PsycINFO. Web. 18 July 2012.

 

Godlaski, Theodore M. “Shiva, Lord of Bhang.” Substance use & misuse 47.10 (2012): 1067. ProQuest
Criminal Justice; ProQuest Psychology Journals. 
Web. 18 July 2012.

Shaman in Mongolia

In the movie/documentary, The Horse
Boy, a man and his wife are on a mission to cure their son who was
diagnosed with autism. They initially took the traditional western
approach with medications and hoping it would lessen the blow of his
actions. When they saw how calm he was with their neighbors horse it
dawned on the father to eastern treatments. Once he learned about the
Shaman in Mongolia, they went on an expedition.. In the ritual, the
shaman prayed and learned that an evil spirit had enter the mother
when she was giving birth so she had to cleans herself. They also
said the mother’s grandmother’s spirit was attached to the son and
was the reason he was having so many problems. After a serious of
whipping the parents, washing, and eating various items, the ritual
was over. The couple saw a change in their sons behavior. He began
speaking, interacting with the travel guide’s son, and had not had a
crying/nervous tantrum for a few days. While some of their same
problems came back, his social skills did not stray. During their
travels, the mother and father kept repeating the rituals the Shaman
had ordered them to do. The parents were trying not to be so hopeful
that a change would occur that they would settle with small victories
instead of 100% remission. When they arrived to the second group of
Shaman, they were told that after the Shaman spoke to the ghost
overnight, they would tell them if they could treat their son. They
were able to go through the rituals the next night where the Shaman
told them that the next day the problems would no longer exist. The
parents do believe that the Shaman cured their son because for the
first time ever he did defecate in his pants and wanted to play with
a large group of children instead of with his parents.

 

In this film the Shaman were the
healers and used a series of rituals to heal people. They would first
pray and speak to the spirits to determine what needed to take place.
From there, they would eat certain foods, or wash themselves facing a
particular direction, whipping in which they could not cry or yell,
and chanting by the Shaman. The interaction between the Shaman and
the people they are healing seems to be quite personal, they sit with
you and speak directly with you. There is no need for a chain of
command and their seems to be more of a family like feel.

 

This form of healthcare would fall
under the Folk sector. It uses the family to help with treatment and
recognizes the spirituality of the illness. They are only recognized
in certain cultures, and uses more holistic approaches for
treatments. The body and symptoms are seen more as vessels to a
spirit that has encompassed their body and needs to be removed. In
this arena of healthcare, people seek out the help of the Shaman and
the rituals are practiced outside in the environment. While the way
people seek out treatment is no different than one going to the
hospital and family doctor, the treatment varies greatly. It takes
into account other variables that our culture does not such as the
spirit of the person being treated and the deceased family members
that may be involved. It is not a problem for just the one whom is
ill, it is a treatment in which the entire family participates.

Hypertension in African Americans

In the African American community,
there are various diseases that are more prevalent than in other
cultures. One of which is Hypertension also known as high blood
pressure. Hypertension can cause heart disease, kidney failure,
stroke, and congestive heart failure. According to the Center for
disease Control and Prevention, African Americans are more likely to
attain Hypertension than other races. There are various factors that
causes African Americans predisposed to the condition some of which
are  obesity/overweight, unhealthy eating ( high sodium intake), low
adherence to treatment, and missing appointments. (Martins, D.,
Norris, K., 2004) I do agree that these are some of the main reasons
why Hypertension is so common. When living at home with my extended
family this past year, I noticed just how much they fried food and
how little physical activities they performed. Food that would
normally be healthy are soaked in salt and cooked twice in bacon fat
left over from breakfast. I think there are some genetic factors that
cause African Americans to not absorb the medications as well but the
reason is still unknown

.

In the lecture material this week, we
learn there are other factors that contribute to the well being of a
person and or community. This is shown  in the Pima Indians and Type
II diabetes. Pima Indians have a genetic predisposition to store more
fat for longer periods of time to accommodate for famines. I believe
this to be a similar trait in African Americans that came about first
in Africa where those who were of larger size are seen as the
healthiest and second when slavery when they were only fed once a
day. Their bodies had to learn to adapt to the changing circumstances
of their new found lives. The high sodium diets are part of our
cultural ecology. In some African communities, boys were not yet men
until they urinate blood. While we know this to be a disease, they
call it a rite of passage. In the African American community, a girl
can not truly cook until she can make a mean fried chicken, smothered
pork chops, and candied yams. Everyone I know that is African
American has grown up knowing to have at least one fried meal a week.
It was the quickest form of cooking for large groups of people and
with every adult working from sunrise to sunset, waiting a long time
for a meal did not cut it. Food was also the center for most family
functions and is associated with some of the happier times in our
past so the tradition is passed down from one person to another. They
say that some ways to decrease hypertension is to reduce stress. Most
African Americans deal with various situations that elevate stress on
a regular basis in their work environment, financial challenges, and
inequalities. This is a display of the political ecology that affects
the health of the African American community.

 

While some of this information is not
proven, the effects of these issues and factors have been shown to
greatly change one’s health in regards to hypertension. If a person
can change their diet, exercise, and  reduce the stress in their
lives, their challenges with hypertension can decrease.

Graphs

http://www.cdc.gov/bloodpressure/facts.htm

http://www.sciencedirect.com/science/article/pii/S002571250570568X

Information

 

Martins, David, and Keith Norris. “Hypertension Treatment in African
Americans: Physiology Is Less Important than Sociology.” 
Cleveland
Clinic Journal of Medicine
 71.9
(2004): 735-43. 
Www.ccjm.org.
Web.

 

In Sickness and in Wealth

When taking the health equity quiz, I
answered seven out of ten questions correctly. I did know some of the
information from previous classes, from my own research, and
experiences that did make it easy for me to identify the correct
answers. There were some very shocking statistics that I learned from
the quiz. The first being as a country we rank in 29th
place for life expectancy but we spend two and a half times more on
health care than most countries.  This to me shows that our country
does not properly allocate money to where it should go and find the
real underlying problem as to why our life expectancy is so low.

In the clip, “In sickness and in
Wealth” researchers analyzed the various economic classes of
individuals and the corresponding health issues. It was found that as
your wealth increases, so does your health. When a person has more
control over their life, not in the sense of your mother controls
what you do, more on the lines of financial control and power, that
person’s health with benefit. Those people who have low paying jobs,
live paycheck to paycheck, do not own their own homes, and more work
place stress have higher levels of cortisol in their system and can
not lower their blood pressure even when sleeping. This causes
hypertension and heart attacks to be more prevalent in those people.
It was also shown through a study where healthy individuals were
exposed to a cold virus and they recorded how many times they were
actually sick. People who had low financial stress did not get sick
as much as those in high stress financial situations.  They also
showed how in other countries no matter what the financial situation,
ones health is not compromised. More of an explanation of this was
shown in the unnatural causes clip “More that a Paycheck”.

 

I believe that politics plays a large
role in the health of our various communities. It is politicians who
decide how the money is to be spent, and how much of it goes to the
various facets of our communities.  In countries like Sweden, the
taxes are much higher than in the United States but the tax dollars
go farther. They help to transition recently unemployed workers into
a new job/career field by giving them 80% of their previous pay as
long as they are actively looking for a job or in school to become
qualified for a new career. If our politicians found better ways to
allocate the money provided to tackle the underline reasons for such
poor health and even implement better work environment practices,
then we can move toward a healthier community.

Menstruation and Old Age

My definition of health is the biological state of ones body. I do not necessarily believe it to be good or bad. Illness to me is when the mental state of one is
compromised into believing that something is wrong physically. Can
not be tested or shown to have some sort of proof that it exist. I
believe the terms came from society when so many issues arose with
health. People need to make sense and clarify things to either
justify or determine if they are in the same category. No one wants
to say that their sickness is the same as another if one has a mental
issue and another has the common cold. I think for these  reasons it
is hard to identify if these two words describe an illness or not.
Old age can not truly be tested based upon how a person feels or acts
because it can vary from person to person. Menstruation is a natural
bodily process that can be proven through test but we treat it as a
disease with various medications. Both can easily be seen as an
illness or not because of the various contexts and perceptions of
what is normal for that person.

I believe spirit possession is an illness because it can not be proven. Some people can simply be seen as acting or pranking someone. There is no way to show another spirit
has possessed ones body. Most people depending on their religious
affiliations would simply brush it off or take it seriously. This
could also vary depending on what is considered spirit possession to
the individual.

While some people believe restless leg syndrome to be a disease, I think of it more as an illness. It is on of those “diseases” most people do not know they have until they
watch a commercial for it. I think it is a mental issue that then manifest into an actual “symptom”, although it can still not be
tested for.

Cancer is not an illness because it is an actual manifestation of an abnormality in ones body. While they say that your mental state can either help or hinder its progression or remission, it does not begin that way. Most people do not believe
that they have cancer until it has been proven.