Infant Mortality in Afghanistan

Afghanistan is one of the most dangerous places in the world to be a pregnant woman or a young child. Infant mortality rates are the third highest in the world as of 2010, and one in 10 children in Afghanistan dies before they are five years old. The origins of such high infant mortality rates are a combination of complicated issues ranging from three continuous years of drought, lack of clean water, lack of proper medicines and treatment, lack of access to education and health care for women, estimated 10 million land mines (roughly one for every child), and only 10 percent of pregnant women receive maternal care. With the country being in war for decades, it has taken a toll on all of their resources, and the drought has made it even more complicated for mothers and their children. By improving the health of the mother, then the health of the children can be improved. Infants whose mothers die in childbirth are 3 to 10 times more likely to die before their second birthday. Many children never go to school because they must help their family make a living at a young age. With living situations difficult for an adult to live in, how could it be possible that a child survive past the age of five?

The country must first be stabilized on an international and local level. War has been going on in Afghanistan for decades with foreign countries and even war amongst their own ethnic groups. Safety and security must come first, which should be provided by the Afghanistan government. Long term goals and development are critical for the country’s long-term survival as it will help the country to become self-sufficient and sustainable. Outside of Afghanistan, it has been proven that the education of women prove to have significant success in the development of a country. Many organizations are coming in to help improve the lives of children by providing essentials such as food and safe drinking water. A supply of vaccines and antibiotics are also being brought into help treat illnesses such as pneumonia, diarrheal diseases, measles, diphtheria, and polio.

Dr. Patricia A. Omidian is an applied anthropologist in Afghanistan and has worked with women, children, and refugees in mental health programs, rescue committees, health programs, and children organizations. Her job is to help the Afghanistan and US/NATO military to understand local communities and reduce deaths. She firmly believes in her research and the people she studies, hoping to protect and provide a better future within the constant imbalance of power in Afghanistan and in the global setting.

 

“Infant and under-five mortality in Afghanistan: current estimates and limitations.” World Health Organization. Web. 10 Aug. 2012. <http://www.who.int/bulletin/volumes/88/8/09-068957/en/>.

“Afghanistan, Children in crisis.” Save the Children. Web. 10 Aug. 2012. <http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/afghanistan_children.pdf>.

“Patricia Omidian, Applied Antrhopologist in Afghanistan, on the Human Terrain System.” Zero Anthropology. Web. 10 Aug. 2012. <http://zeroanthropology.net/2009/08/05/patricia-omidian-applied-anthropologist-in-afghanistan-on-the-human-terrain-system/>.

 

 

Global Health and Medical Anthropology

Global Health is important in context with medical anthropology as it offers different perspectives and insights of health and well-being to a specific culture and country. Particularly, developing nations that do not have the same political, economic, and social resources that developed nations have are the main focus in global health. As Dr. Paul Farmer has done in co-founding Partners In Health; he gives free treatment to patients that come to his clinic in Cange, Haiti. In return, that he may provide equal and sustainable health care for the Haitians by the Haitians.

The context of understanding people in different cultural environments has always been of interest to me, particularly, in the use of language and the way things are described, communicated and sometimes translated. So when there are health disparities among different countries and cultures it’s interesting to see the different origins and interpretations of illness and health. Ideally, I would one day like to join an organization that can better improve the lives of others so they can better help themselves and live a comfortable day-to-day life.

Having an anthropological background and stance for a biomedical practitioner within global health would be very beneficial. While the healthcare provider can have a better understanding of the illness in biological terms, the anthropologist is the mediator. They bridge the gap between the cultural and scientific knowledge of healing and treatment. For example, TribalJazzman (on youtube) told the story of IUD’s placed in Ecuadorian women as a birth control mechanism. Many doctors would thus predict that women would be able to be more in control of unwanted pregnancies, however, this resulted in adverse effects. Women in this particular Ecuadorian group were not allowed to handle food when menstruating, and the IUD’s would give longer menstruation cycles. This led to longer seclusion periods, and mothers not being able to feed their children and family. A situation like this would not be understood by just the doctor. Without an anthropologist being involved, and observing these finds and cultural ideas and values, the use of biomedicine essentially becomes useless.

Does being medicated enhance the quality of life?

The culture of biomedicine are the beliefs people put meaning to and trust in as sources of understanding their own health in context to our values, language, rituals, and political and societal structures. It has had an important stake in health and illness as the learned knowledge of biomedicine helps to build a solid foundation for the building blocks of a logical truth. Medication does definitely enhance people’s lives. When coming down with a flu or cold, antibiotics do just the trick in a timely manner. However, when it comes down to illnesses such as ADHD, medication in the long run can definitely be a toss up.

Due to the fact that biomedicine is based upon true logical facts, it only makes sense that the treatment process be true and lifelike in it’s form and cure. Thus, the idea and process of taking medication becomes a placebo in itself in which one can think, “by taking this medicine I will feel better.” That in itself can make medication a good starting block for people to see results in their treatment process.

Medication is now a normal process to help many people through their day. Illness has now become a part of our daily lives, and the pharmaceutical industry as well as the companies that pay off the doctors to help sell their products, deeper instill these new ideas of illness. Definitely not to say that patients and/or consumers believe everything that they hear and see, but it proves as a sort of validation or confirmation for many who are patients-in-waiting. By possessing even one or two of these symptoms, informed patients-in-waiting can easily think they have these symptoms and therefore the illness. Due to it’s heavily science-based nature, biomedicine will always thrive on medication as a treatment process. The only way to prove a logical question is to provide a logical answer.

Menstruation becoming an illness

Birth control is used by many women as a common form of treatment to menstruation and it’s symptoms. Historically, talking about your period was always considered a taboo thing, even now when you have names like “aunt flow” to describe menstruation is still a sign of keeping the conversation “hush hush.” Over time, it seems due to the lack of conversation, the mixed and different symptoms women experience for their period is a topic of emotional understanding mixed in with confusion. Birth control has become much more accessible due to many women hearing about the symptoms, but not knowing what to do with them. As birth control can have many advantages as well as many disadvantages; each women experiences birth control completely differently.

Beyaz Birth Control ad:

http://www.youtube.com/watch?v=NdSmXKRqFHM&feature=player_embedded

Beyaz is selling a birth control for women specifically with PMDD, and the commercial takes place in a department store where various women are perusing through the shopping aisles. The ad definitely tries to sell a lifestyle, and gives the viewer an option to choose what we want in our lives. More specifically the decision to have a baby or to travel the world in all it’s splendor. The fact that Beyaz is supposed to target women with severe symptoms from menstruation, and that the ads visuals have nothing to do with it’s supposed intent of treatment is bizarre. Not to say that there is anything wrong with that, but the ad definitely takes more of a social stance of how you should live your life as a woman: to conceive or not to conceive? The medical information states that it can help prevent acne, PMDD, and also prevent a rare type of hormone that causes birth defects for babies. It seems that some of the medical information is contradicting in what it’s trying to sell. The idea of lessening symptoms from menstruation or the choice to not have a “healthy baby.” There was no doctor-patient interaction at all through out the ad.

Male Postpartum Depression

Postpartum depression is a moderate to severe depression that affects many women and men after giving birth to their child. It can last as short as a week or even up to a year. In this week’s article, Craig Mullins speaks about fatherhood and his unexpected hardship of being a good father. Fathers are also caretakers as well as the mothers, and though both may take on separate roles in raising their newborn, both must go through the same experiences within different perceptions. To say that the father goes through the same postpartum depression as the mother would be playing down the role for both.

As a form of depression, one can be prescribed antidepressants, and can go to individual counseling to help better connect their situation with others going through the same thing. It’s difficult to say whether many men believe they have postpartum depression. As Mullins states, “…men tend to avoid talking about things that might make them appear weak, and our culture tends to discourage men from disclosing their feelings….” Although, antidepressants and counseling is available, it seems that even to convey those feelings is a difficult step for many men to make or to even come to terms with.

Once a man comes to terms that he has postpartum depression, it is an illness that can be cured without medication. The woman from Placebo: Cracking the Code was cured of her severe depression after trying a new “clinical antidepressant medication.” Only to find out that she was part of the pool that took the placebo. She was completely taken out of her black hole she found difficult to escape on her own. The belief that her mental illness consumed her really did consume her. When there was a slight sense of hope within a new type of medication she might have symbolized that opportunity as her one and only chance. In this way, mental illnesses are difficult to diagnose and heal for they are completely subjective, and can be cured within the connection of emotional belief and healing.

Being a parent is overwhelming, and when changes and emotions come at high heavy speeds, it can be overwhelming for anyone. To come into something confident and then feel stuck and confused in the middle of it is a paralyzing feeling. It seems many parents feel they should know what to do in their children’s everyday lives, but they too are going through this new experience with them. Maybe the idea of taking on the sick role as a male is not acceptable as they must take on responsibilities of their child and their own.

I have Narcolepsy

Julie and Katie both suffer from narcolepsy, and their stories follow both a chaos and quest narrative. Narcolepsy is a sleep disorder that causes excessive sleepiness from irregular sleep cycles, frequent sleep spells during the day, and cataplexy (a sudden collapse in the muscles that can paralyze you anywhere from a couple seconds to several minutes). At first, their stories started off as chaos narratives with lots of symptoms, frustration, helplessness, and social anxiety. Towards the end of the video, the audience sees that it is an unpredictable illness that needs to be embraced and improved and is accepted as a part of life. There was not too much specific information whether or not there was a definite long-term cure or treatment process.

Both Julie and Katie had a supportive environment around them, in terms that their family or significant other understood their illness, and had good intentions to try and help them get better. Culturally, narcolepsy is not understood until explained. If you were to see someone suddenly collapse or fall asleep on the wheel it would be a very confusing thing to witness and act upon. The main stigma seemed that many people thought narcolepsy and cataplexy could be more controlled through their daily activities. There was one scene in which Katie could not keep her head up at the bar because her friend had made her laugh. The illness is completely unpredictable, and can only be regulated through medication, alternative treatments, and/or a healthy lifestyle specific to narcoleptic patients.

Julie had already been taking medication for her cataplexy, but without much improvement on her well-being. Her mother started to look into alternative medicine, specifically a chiropractor. She stated in conjunction with the medication, the chiropractic session helped her feel a lot more energetic, and not so dependent on the medication. She was also doing a lot more physical activity that she normally wouldn’t have been able to do with her cataplexy. Katie would try to be without her medication for a couple of days, realizing that she was much worse without it. She did not try to seek out alternative treatments outside of her medication, other than completely cutting it off. It was hard to see whether or not she could have gotten better in other ways. However, one could see that with her taking regular medication and regulating her body and sleep schedule she was able to function better throughout the day.

The sick role became debilitating for the both of them in the long run. Katie and Julie knew what their illness was doing to them and did take responsibility to help them adjust them back into society. However, if they did not take responsibilities and measures and seek help they would not be able to live a healthy adult life on their own. It was very insightful to see Julie and Katie’s illness narratives. Although, they did suffer from the same illness, they both had different environments, social settings, and treatment processes that were different and specific to them. This put into perspective that an illness can be interpreted completely differently from teller to listener, vice versa, as both can come to terms and encourage each other on an illness that is happening, but is not necessarily fully understood medically.

Falling out/Blacking out among Afro-Carribbeans and Black Americans

Falling out and blacking out occur primarily in southern U.S. and in Caribbean groups.  The disorder is described as a sudden collapse and fainting of the body usually occurring without warning. Symptoms can usually be described as an inability to move, inability to see with eyes open, dizziness, and sudden weakness of the body.

It is stated that falling out usually happens in context of intense anger, rage, or fear. Specifically, it is an accepted response when attending funerals, receiving shocking news, hot weather, and in stressful school situations. It is a coping mechanism for some as it prevents certain situations to escalate or produce an undesirable conclusion. Falling out can be chronic because of it’s use as a coping mechanism, and thus debilitating because it can affect everyday life. Studies do not suggest that it is a biological or genetic illness, but more of an environmental trigger that can cause it.

This disorder can also be found among Afro-Caribbeans in which symptoms are similarly described with episodes of a loss of consciousness. In the Bahamas, it shows that falling out happens to 23% of the population. In Haiti, it is referred to as “Indisposition.” The article states that most Haitians have known someone who has fallen out. Outside of that, not much else is known about the illness in the Caribbean region. It is not known why this illness occurs among African Americans (based on 1970’s data), but a hypothesis shows that falling out is more prevalent among people of African descent living in the U.S. than any other ethnic group.

It seems to be that falling out and blacking out are due to high levels of stress in an individual’s surrounding environment. The article states that the stress-induced illness has many roots in inner-city life because of the overcrowding, high levels of violence, safety issues, and financial concerns.

It was very difficult to find a written article about the treatment process in falling out because it generally tends to happen as an unexpected one time occurrence. In general, it is suggested that when a person looses consciousness that you check their pulse, and make sure that oxygen is somehow reaching the brain. If the person does not regain consciousness, then a medical professional should immediately be seeked out. As a long-term treatment, falling out can be cured by preventing environmental stressors. Definitely an easier statement said than done. However, due to the fact that it is an environmentally triggered illness, the only treatment process would be to seek out a different surrounding or find a different coping mechanism.

 

Jackson, Yo. “Culture-Bound Syndromes: Falling Out, Blacking Out.” Multicultural Psychology. 2006 :136-137. Web. 20 July 2012.

http://books.google.com/books?id=_hcurFqnQioC&pg=PA136&lpg=PA136&dq=falling+out+blacking+out+disorder&source=bl&ots=YSf83hWUtp&sig=TTeVe_FrHoS44nEElW8A3KYyrR8&hl=en&sa=X&ei=Ga0JUJrmN-To0QHLk734Aw&ved=0CFIQ6AEwAA#v=onepage&q=falling%20out%20blacking%20out%20disorder&f=false

Okpaku, M.D., Ph.D., Samuel O.. “Somatization and Psychologization.” Clinical Methods in Transcultural Psychiatry. 1998: 238. Web. 20 July 2012.

http://books.google.com/books?id=1roAZcsU_ZwC&pg=PA238&lpg=PA238&dq=falling+out+blacking+out+disorder+afro+caribbean&source=bl&ots=O8N2Gs52mg&sig=-Ry0xGNh9Rl5T63yNxBpilDHM30&hl=en&sa=X&ei=bq4JUPbNA-ja0QHNoozlAw&ved=0CFMQ6AEwAQ#v=onepage&q=falling%20out%20blacking%20out%20disorder%20afro%20caribbean&f=false

Shamans in Mongolia in The Horse Boy

Rowan has autism. He was diagnosed with autism at a very young age, and that diagnosis changed the way that Rupert(Rowan’s father) and Kristin(Rowan’s mother) lived. According to the film, autism would be described as “early abnormalities of the brain or a neurological impairment that influences a person’s ability to view the world in a socially typical way.” Therefore, people with autism have a great attention for detail and have an intense ability to focus on one topic, but cannot process lots of information all at once. Due to the nature of the illness, autism affects people in varying degrees, and thus there are varying definitions of how the illness is described and can be treated. In the film, Rowan’s symptoms ranged from unexpected temper tantrums, isolation, difficulty in communication, and delayed cognitive skills.

However, he found paradise in animals, and especially horses. A mutual and profound connection to animals that gave him the ability to deeply relax, converse, and connect. Rupert and Kristin tried all sorts of treatments(medicine and therapy sessions) for Rowan’s autism, but with no real success in anything. Rupert (given his background living with the Bushmen in South Africa and their shamanistic healing powers), researched and found that Mongolia had a strong connection with horses and horseback riding, as well as shamanism being the state religion.

They traveled mostly by horseback, sometimes by car and, shamans from all over Mongolia came to see Rowan and treat him together. All understood he was ill, and had much confidence that they could treat him. They dressed in various layers, all adorning some sort of metal jewelry, bird feathers, and various head wear. Some in silk garb and some in animal hide, they wore head pieces with braid-like extensions that would cover their face, and various pieces of cloth that would flow downwards from their belt. Some would talk to spirits, some would ring bells, some would beat on drums and sing to the spirits. There were scenes in which Rowan was embraced and playing with the shamans, and scenes where Rupert and Kristin were literally whipped and stripped of their bad energies. The Shamans were then able to figure out that Kristin had a family member that was haunting and negatively affecting Rowan. Kristin then explained that her grandmother was manic and depressive, and was mentally ill while she was alive.

Shortly after Rowan then met Tomo, the son of the Mongolian travel guide, and embraced him and called him his “Mongolian brother.” He never interacted with anyone his same age the way he did with Tomo. This became the beginning of his spiritual journey. Shortly thereafter, they reach an indigenous group called the Doukas, and they are known as the reindeer herders. There were definite ups and downs of Rowans symptoms, but the shamans were always patient, kind, and confident in treating Rowan.

In the end of the film, we see that Rowan’s autistic challenges were overcome. He no longer has temper tantrums, became potty-trained, plays with kids his age, is able to talk to people, and most importantly learns to ride a horse by himself; giving himself the freedom he needs to be a growing child soon to be an adult. He is not cured by all means, but his progress cannot be undermined.

Through the film, I was able to see that the Mongolians and shamans they encountered were very in tune with their surroundings, nature, and particularly the animals that resided in their environment. The ability to see a bad spirit surrounding a person and the ability to understand what the specific spirit is doing to a person is naturally understood. Many cures and treatments followed a spiritual cleansing symbolized by a physical cleansing. These would range from physical whippings to ingesting various liquids to cleanse the body. There would be occasional prayers made by Rupert and Kristin to the spirits to help continue the cleansing process of the bad spirits. The audience realizes that the animals become a sort of medium for Rowan to understand people and most importantly himself. The most important realization that I made was that Rowan was constantly included in all of his treatment process with his parents and the shamans. They were always involved and never secluded, and this is the key. His integration with everyone in the Mongolian society helped Rowan become a part of society, and this helps him start to understand the meaning of societal values and relationships.

Asian Americans are more likely to die from complications in hospital care

The first problem is the general grouping of Asian Americans. Asia is a huge area with over 100 different cultures and 48 countries, and to say that someone from India would be the same as someone from Mongolia would be a complete understatement. In order to understand race in context with health disparities, specific groups must be targeted. Without the lack of specific data on specific ethnicities and their living environment, it’s hard to make a conclusion based upon a community and in this case Asian Americans.

For example, according to this NPR interview, (http://www.npr.org/templates/story/story.php?storyId=127091480) many Korean Americans are four times more likely to have no health insurance than others. Native Hawaiians and Pacific Islanders experience high rate of diabetes and obesity. U.S. Born Vietnamese women, are four times greater of dying of breast cancer than other groups. Even as Americans, each specific Asian group is overcome and affected by different health care access, symptoms, illnesses, and diseases. To say that this is mainly caused by genetics is possible, but there is more of an underlying issue than just those aspects.

There is also said to be a model minority myth for Asian-Americans in that they don’t suffer from health problems. In the case of not dealing with many Asian American patients, some physicians could and have believed this idea.(http://www.npr.org/templates/story/story.php?storyId=127091480).

The second issue would probably be communication. Language barrier is a huge issue for immigrants, and particularly among the first generation. My dad as an immigrant does not speak English fluently, and when he had intestinal and stomach pain he refused to go see a doctor. Mainly due to the fact that he didn’t want to go alone without my mom who speaks English fluently. It seemed that the idea of just going to the doctor gave him more pain from the stress and anxiety than the physical pain.

Not only on the part of the patient, but the doctor or hospitals should make it a priority to hire translators or make sure that each other is understood based upon symptoms. Different languages have different ways to describe their symptoms, while as some symptoms don’t exist and even the words to describe it don’t exist in translation.

In an emergency situation, there aren’t going to be translators, and without speaking the same languages, there will probably be miscommunication and misunderstanding of certain pains and symptoms, and more importantly providing the best care and treatment. In the case study of the Hmong child in The Spirit Catches You and You Fall Down, is a perfect example. From the perspective of the Hmong family, evil spirits had taken over the girl, but the hospital diagnosed her with severe epilepsy. Long story short, there was much miscommunication and lack of understanding on both parts linguistically and in their cultural ecology. Thus, not giving the child the proper treatment and delays in what we would be the best for her current state. The idea of genetic determinism can easily misconstrue the idea of social race versus biological race.

When the Bough Breaks

I got a 4/10 on the Health Equity Quiz, and I found that despite the U.S. being a strong economic power they were only ranked 29th for the world life expectancy. I originally checked the top ten, but was completely surprised to see it wasn’t close at all.

The main question was posed, why were black American babies born twice as small and prematurely in comparison to white American babies. Even more shockingly, expecting black mothers, who were college graduates, had three times the higher infant mortality rate than white mothers that were high school drop outs. With that statistic in mind, genetics doesn’t seem to play a big role in answering this question, and so an even deeper question is asked. Does the mother’s social race affect the life of the infant that she bears?

Many people believe racism is a thing of the past, but racial inequality and discrimination occur everyday in the U.S.. Even more so with women, and the significant find in the study was how black American women internalized racism in comparison to white American women. In Black women, 50% thought about racism at lease once or more a day, and 21% think about it constantly in comparison to 50% of white women who never think about it. As an expecting mother, and to be put on with this sort of chronic stress and anxiety releases extra stress hormones thus labor begins a lot sooner than expected.

It’s not easy being a double minority in any society, where you not only have to face the social stigmas of your race but your gender. All Black Americans at all income levels are more denied in mortgages, pay more for automobiles, and offered less job interviews than other racial groups. On top of that, it’s the everyday encounters of racism that make each individual’s experience more clear that social racism still exists. Making these experiences that much more vivid and recallable such in the case of Kim Anderson. To ever feel like a second class citizen is a completely degrading feeling, and it’s not an understandable feeling until one goes through it personally. Politically, these ideas have historical roots from segregation laws. With those policies, it seems that much of the chronic stress felt by Black American women stem from the still ongoing but silent thoughts of people’s predisposed beliefs.

One study showed that 70% of Americans believe racism as a part of the past. So is it ironic that many believe racism is a thing of the past, when it occurs everyday and in this case to the point of inducing early child birth. The historically charged ideas of the past seem to continuously resurface. Can this illness be rooted specifically from racism in all cases? No. However, it seems considering the factors and the variables that were tested, cumulative stress for a woman and more specifically black American women can strongly affect the baby and the mother.

It could also be true, that maybe by even watching this short documentary, you could be more conscious of how racism effects your mental psyche and your everyday stress levels. Thus, having more of an effect on you than before. It’s a funny thing, how much aware your mind can be when certain things are put in front of you.