HIV in Malawi

The global health problem from my title is HIV, or human immunodeficiency virus, in a country called Malawi, which is in Africa. The website “Avert,” an international charity for HIV and AIDS, discusses many topics, including the prevalence of this disease in Malawi. One main fact that stood out was that approximately one million people have the disease, out of the 15.4 million living in the country. Some other facts from the site include that the first case of HIV was found in 1985, and some contributing factors to the high prevalence of the disease include things like lack of healthcare workers in the area, and lack of access to education about HIV treatment/prevention. HIV is also more common in women of the country, which we are told is most likely due to gender inequalities in economic and social status.

As far as prevention of the disease, the site says that the government has been working on trying to increase awareness and prevention strategies, but the efforts are slow due to the lack of resources. These strategies are funded through donors from all over the world, and includes things like testing for HIV, passing out condoms, and trying to prevent mothers from passing HIV on to their children through breastfeeding.

An example of one anthropologist working in Malawi on this topic is Peggy Bently, who is discussed in the article “Malawi Study May Lead to New Approach to Improve Health and Survival of HIV- Positive Mothers and Their Infants.” Bentley’s main focus in Malawi is the study and improvement of the health of breast- feeding mothers infected with HIV, and the health of their infants. Bentley found that even though breastfeeding can lead to HIV infection of children, “infants are at a greater risk of dying if they are not breastfed rather than if they are, even by an HIV- positive mother.” The focus of the study became giving both mothers, since breastfeeding “increases nutrional demands on mothers,” and infants nutritional supplements to see if their health could be improved. Another key part of the study was to test the efficiency of certain antiretroviral drugs on infants to help combat the passing of HIV during breastfeeding. The findings of this study are still being gathered and interpreted.

Sources:

 

http://www.avert.org/aids-malawi.htm#contentTable3

 

http://www.med.unc.edu/infdis/research/hiv-stds/ban-study/study-descripton

Clinical Medical Anthropology

I chose the topic of clinical medical anthropology to do more research on. This subject applies to my personal life because I hope to one day attend medical school and become a pediatrician. At first I would most likely work in a hospital, but would one day like to own my own practice. I will want to make sure that not only each child I am treating is as comfortable in their surroundings as possible, but also want their parents to be able to trust me while treating their child. Living in a country with so much diversity and culture, I believe that it is very important to incorporate each individuals/family’s beliefs and needs into my practices. Having the ability to make connections with individual patients is a great skill to have in the field of medicine.

If I was working for a provider in a clinical setting that was not an anthropologist, I would make sure to do my best to provide each patient with the specific care they want/ need. The article from this weeks lesson, called “Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It,” tells us that providers should incorporate cultural factors that “shape health-related beliefs, behaviors, and values.” This includes the beliefs in how patients will get diagnosed and treated for their illness. Many people across the U.S have very different practices and ways to deal with certain illnesses and those practices must be taken into account. Like the lecture from this week says, no one is a blank slate and we have to consider biological, psychological, social, and last but not least, cultural factors. A clinical medical anthropologist would be able to give insight on how culture can play a role in medicine, which would overall create a better experience for patients and professionals alike.

Sources:

http://www.cpc.unc.edu/news/features/improving-health-and-survival-in-malawi

 

Lecture 6.1

Life/ Death

The phrase “culture of medicine” is difficult to strictly define, since it is made up of many different things. The main idea behind the “culture of medicine,” however, is that biomedical practices vary across cultures, and these differences can be studied by learning about the history, language, and rituals behind those practices. This, according to lecture 5.1 will help anthropologists learn how biomedical facts and models have changed over time, social values that have become natural or scientific, and has also helped to reveal different customs of both patients and professionals living in different societies. This means that the culture of biomedicine has to be both universal and objective, or in other words, it has to reflect nature and fact. Finally, we must also consider something we have been reminded of over and over throughout this course- health is not only influenced by biology, but also through culture, politics, environment, and individual choice.

The dichotomy I chose to evaluate was that of life and death. According to the Merriam- Webster dictionary and the lecture, life can be defined in many ways. These including “the quality that distinguishes a vital and function being from a dead body,” “an organismic state characterized by capacity for metabolism, growth, reaction to stimuli, and reproduction,” or “a principle or force that is considered to underlie the distinctive quality of animate beings (Mariamm- Webster).” I believe that life is a combination of many different “definitions” and that there is no clear one that stands out. Taking a look at the definitions of death from the Marriam- Webster dictionary, there are also many perpectives. Some of these include “a permanent cessation of all vital functions,” or “the cause or occasion of loss of life.” After comparing these words, life and death, it is difficult to say whether death is when the brain dies, the body dies, or when the person takes their last breath; like the lecture asks. If I had to define human death, I would have to say a person is dead when they stop breathing, all the cells in the body are dead, and the body/brain is no longer functioning.

I believe that this dichotomy is accepted as both logical and natural. Although death can be difficult to face, it is a natural bodily process that must occur. I am sure throughout many different cultures, there are many different cultural and spiritual debates on what death really is, but logic takes over and people know when someone has died. Life, also highly debated, is an amazing thing that is very difficult to place a definition on. Life and death have been debated for a long time, and I do not see that debate ending anytime soon.

 

 

Source:

www.merriam-webster.com/

Lecture 5.1

Obesity

Obesity becomes more and more of a problem in the U.S. everyday, some even saying the condition has reached an epidemic level. Culturally, we live in communities that often do not have access to healthy foods and living the busy lifestlye many Americans live today often resort to fast- food instead. This is where the problems begin; as our youth consumes foods that are often very poor for their health. The government and health professionals all over the country have been trying to inform Americans of the risks associatied with obesity, including things like heart disease and high blood pressure. Biomedically, there are a few options for those suffering from the condition. These options may include changes in diet, surgery, or possibly even medications, such as diet pills. An example of a surgery could include something like gastric “lap” banding.

Although diet pills can be a controversial subject, an example of one brand is “Hydroxycut.” The advertisement I found calls the pill “America’s #1 SELLING Weight- Loss Supplement,” and has a woman posing in a bikini, claiming she lost “42 lbs. With Hydroxycut!” I would consider this advertisement to be a “direct- to- consumer advertisement, where a skinny woman in a bikini is attesting to the product. This is so people will buy the product or switch from another product to theirs. In the U.S, being skinny is a positive attribute, so the image is used to draw people in. She is an atractive woman and when other American women see the picture they think that they should look her. There are two small boxes at the bottom of the advertisement that discuss medical facts, and a quote from a doctor recommending the product after “reviewing the studies of the clinically proven ingredients.” The medical information provided is a graph from the clinical study proving that Hydroxycut has “proven key ingredients” to provide powerful weightloss. The key ingredients of the product are then listed in very small font at the very bottom of the page. Overall, I believe many Americans would believe that Hydroxycut accelerates weightloss, but personally believe they have more of a placebo like effect.

 

11/09/ad2.jpg

Source:

http://staging.templetv.net/keith/wp-content/uploads/20

True Life: I Have Narcolepsy

The episode I chose to analyze was called True Life: I Have Narcolepsy. In this episode two girls are followed, Julie, 16, and Katy, 25. Both suffer from the conditions narcolepsy, sudden overpowering sleep, and cataplexy, sudden loss of muscle control. I believe that in this True Life, both Julie and Katy are giving quest narratives, but Julie struggles in some parts of the episode and gives somewhat of a chaos narrative. Narratives can be very helpful and important to patients, family, and healthcare providers alike in helping each other understand what the other person is feeling. The only way to portray what you are feeling- you must tell others who surround you and seek help when necessary. Some examples of these from the lecture are when people are suffering from mental illnesses such as postpartum depression and PTSD. The only way to get help is to tell others how you are feeling.

Katy had been suffering from these conditions since she was 15 years old and was already on a large amount of medication when the episode began. Her boyfriend was very concerned about her health on the medication, and wanted her to quit. Katy decided to quit cold- turkey in order to appease her boyfriend, and struggled greatly after doing so. Katy tried to stay off the medication for some time, but could barely get out of bed in the morning; which caused even more problems with her boyfriend. After arguing and almost breaking up, they decide to come to an agreement that Katy did need to take some medicine, but a more controlled amount. We are told that she did manage to cut the dosage amount nearly in half. After doing so, she began to live a much more normal every day life. The only time Katy mentioned going to a medical professional, she overslept and missed her appointment.

Julie, on the other hand, had only been diagnosed with the conditions for about four months and was not yet on an a.m./p.m. medication schedule like Katy. She was very afraid of the side effects and, to me at least, it seemed like she did not even have any interest in getting help. After some convincing from her mother, and after falling during a cataplexy attack and hurting herself, Julie decided to go see a doctor. The doctor told her that she was unlikely to grow out of her condition, especially without treatment, and suggested she started taking medications. Before agreeing to take the pills, I would say Julie’s narrative was one of chaos, but then when she agreed to try and improve herself it became a quest narrative. She began feeling better and the symptoms of her condition slowed down greatly. Julie’s mother also suggested alternative forms of healing, and decided a chiropractor could help stimulate Julie’s brain and help bring her back to normal. At the end of the episode we are told that Julie had no cataplexy attacks in months, and was doing much better.

I believe that culture does not have a very good understanding of narcolepsy and cataplexy. People seemed very concerned and uncomfortable when they would be around Katy or Julie and an attack would occur. It also seemed that Julie was somewhat embarrassed by her conditions at first, but at the end of the episode opened up to her fellow classmates about them. Furthermore, Katy’s boyfriend helped her with basically every thing at the beginning of the episode, but then slowly became less and less empathetic towards Katy. He did not understand how she felt, or understand the possible effects of asking her to stop her medicine cold- turkey.

Finally, according to the lecture, the sick role is the practices, rights, and responsibilities that come with being a person suffering from an illness. This includes things like submitting to the care of a professional and sometimes being excused from regular responsibilities. I believe that both girls used their rights and responsibilities to try and take control of their conditions and keep themselves safe. Julie was slow at this at first, with not wanting to get help from professionals, but eventually learned that it was a way to get help. The only thing about Katy, is that she has a responsibility in controlling the amount of medication she was taking, though, and seemed to have a lot of trouble doing so.

 

Source:

True Life: I Have Narcolepsy

MTV.com

PTSD: Post- Traumatic Stress Disorder

According to the National Center for PTSD, on the United States Department of Veteran Affairs website, PTSD is a “stress-related reaction” that occurs in people after experiencing things such as “combat exposure, child sexual or physical abuse, terrorists attacks, sexual or physical assault, serious accidents, and natural disasters.” This reaction does not go away over time, and disrupts the lives of those whom it affects. The website tells us that some common symptoms are fear or anxiety, sadness or depression, guilt and shame, anger and irritability, and behavioral changes accompanied with “reliving the event, feeling numb, avoiding situations that remind those of the event, and feeling constantly alert or always on the lookout for danger.”

I believe that the American culture did not look upon PTSD as a serious illness until it became so prevalent with military personell returning from war. All of the horrible things our soldiers had to face/ still face can, and often do, cause a great emotional toll. There is the point, however, that many people may not believe that PTSD is a real thing because it is a mental condition that can not be measured in a biological, scientific way. Post- traumatic stress disorder can happen to anyone and I believe that it may be hard for people, especially soldiers, to seek help because they fear they may be viewed as cowards.

Biomedicine gives those suffering from PTSD a few different options for treatment. These include different types of therapies and medications, including SSRI’s (antidepressants). Culture can have both positive and negative effects on those seeking treatment. Some people view a diagnosis and treatment plan as a way to get better, and a way to get their normal lives back, while others may view a PTSD diagnosis as a sign of weakness, and not seek treatment at all. An example from the lecture of society making those suffering from a mental illness feel guilty about themselves is with postpartum depression- where mothers feel bad and have guilt when they feel they can not fulfill their motherly roles. Many view military personell as strong and tough, and many may feel badly about themselves for seeking help for this reason. Society can be very judgemental and place sterotypes on those suffering from mental illness.

I think that both going to therapies, such as counseling, and SSRI’s can be very important for healing depending on the person. Talking out problems and gaining an outsiders perspective can be very enlightening, and sometimes SSRI’s can be necessary to balance chemicals in the brain. I also think that there is a strong correlation between belief and healing. The mind is an amazing thing, and the film “Placebo: Cracking the Code” shows many examples of this connection. A few of these examples from the film are the use of “placebo surgeries,” and the use of a placebo to help with depression. In the film, two Army veterans were secretly given a “placebo surgery” to see whether knee surgery was actually helping those suffering from knee pain, or whether some sort of placebo effect was occuring. Both veterans had trouble walking and were very in-active before the operation, and now it is just the opposite. One man, who eventually found out he had indeed had a placebo surgery said in the film, “Anything is possible when you put your mind to it.” I believe this to be a very true statement. Another example was a woman in Los Angeles who was suffering from depression. She was put in a trial where some people suffering from depression were given actual medicine, while some were given a placebo. The woman was convinced that she must have been on the real medicine because she felt more “hopeful and happy,” but eventually found out that she was not. Simply taking the placebo and believing she was getting better helped her live a better every day life.

 

Source:

“National Center for PTSD.” United States Department of Veteran Affairs. 26 July 2012. Web. 27 July 2012. <http://www.ptsd.va.gov/>


					

Obesity in the United States

The culture-bound syndrome, or CBS, that I chose to research was obesity in the United States. The author of this article, Cheryl Ritenbaugh, is a phsycial antropologist that decided to study these syndromes that she says can be defined as “symptom constellations localized to a single or a few non-Western societies.” The author tells us that “these syndromes are recognized, defined, and named by native users,” and expresses the idea that “each culture is unique and each population has a unique gene pool and environment, [therefore] it is logical that each society may differ to a greater or lesser degree from all others in terms of its exact biologic pattern/disease category profile.” Ritenbaugh’s main point in this being that a CBS may have multiple factors playing into its occurrence in different cultures.

Ritenbaugh goes on to discuss the interpretation of obesity as a disease. In the US, Americans place a huge importance on how they look, including their weight. As most people know, being overweight can often lead to many health problems, and insurance companies in the US even go as far as to charge more money for those deemed “fat.” Obesity has become such a large issue mostly due to the increasing amount of unhealthy, easy access food sources. Wealthy Americans have access to healthy, nutrient- rich foods, while the poor often live in food desserts.

Furthermore, Cheryl Ritenbaugh says, “the negative associations of obesity are not universal today, but geographic dispersal of this concept is increasing as these negative associations are exposted with Western culture and biomedicine.” This means that Western culture is beginning to influence other cultures with the prevalence of obesity, most likely due to medical issues associated with obesity and things like the media placing such high value on weight, or being thin.

From my own perspective, obesity can be caused by many different things. On a biological level, obesity can be caused by genetic factors and instability of bodily processes, such as how the body digests, or proccesses, food. Culturally speaking, traditions, environment, food availability, and socioeconomic factors can play a role in what people eat and how they respond to obesity and body size. Finally, individually, people view obesity in different ways. Diet, exercise, and self- image are all individual choices that affect weight. As it turns out, the evauluation and treatent of obesity is done through all of the things listed above. (diet, exercise, food availability, socioeconomic factors, self- image, etc). I believe in times to come we will be hearing much more about obesity from cultures all over the world.

 

Source:

Ritenbaugh, Cheryl. “Obesity as a Culture- Bound Syndrome.” Cult Med Psychiatry 6.4 (1982): 347-64. NCBI- Pub Med. Web. 19 July 2012. <http://www-ncbi-nlm-nih-gov.proxy2.cl.msu.edu/pubmed/ 7160198>. 

 

 

 

 

 

 

 

Clown Doctors: Shaman Healers of Western Medicine

 

The reading I chose to reflect on was “Clown Doctors: Shaman Healers of Western Medicine.” In this article, we are told about The Big Apple Circus Clown Care Unit that travels to hospitals in the New York City area in order to entertain and comfort children and families. Although the clowns operate in a system composed of professionals practicing Western medicine, the author compares the Clown Care Unit, or CCU, to traditional, non- Western healers that focus on alternative styles of improving health. Non- western healing focuses on the “human dimension” and personal experience of an individual’s illness, while Western medicine focuses on biology and treatment of symptoms.

 

The main group that the CCU is compared to in this reading is the shaman. Although they may appear very different at first, there are many similarities between the two groups. Some of these being the use of performing arts to heal the ill, the wearing of costumes, the use music and singing, and in some ways the use of “magic tricks.” The main job of the CCU is to go around to different pediatric units in hospitals, dressed in full costume, and to make people laugh. Whether it was patients, parents, or hospital staff, the CCU does what they can to entertain and make the hospital a not so bad place. The reading tells us that the clowns “lift the spirits of the hospital staff,” which overall improves caregiving. Children are also less afraid, and parents are often relieved to see their children happier. This overall creates a “more positive interation between parents, staff, and patients.”

 

In the discussion section, we are told that the “CCU clowns don’t claim to cure anything.” The author, however, believes that “in collaboration with health care providers, they play a beneficial role in Western medicine.” The type of healing taking place, I believe, may be psychological, and can play a huge role in the overall attitude the patient has towards their illness. I believe that this is a very important step in the healing process.

 

Source:

Van Blerkom, Linda Miller. “Clown Doctors: Shaman Healers of Western Medicine.” Medical Anthropology Quarterly 9.4 (1995): 462-75. Jstor. Web. 18 July 2012. <http://www.jstor.org/stable/648831>.

 

 

 

 

Not Just a Paycheck

On the Health Equity Quiz I only got a 3/10! I was surprised by many of the statistics but some of the most surprising to me was that we spend two and a half times as much money per person on health care than other industrialized nations, yet American life expectancy is in 29th place compared to other countries. The case study I chose to summarize is the episode “Not Just a Paycheck.” As you might be able to decipher from the title, the episode discusses the turmoil that things like job loss and globalization can have on the health of Americans. Specifically, the example of the Electrolux Corporation, formally in Greenville, Michigan, that closed in 2006. The factory moved to Mexico in order to save money on salaries and maximize company profits. This meant job loss for many people that relied on their job to support themselves, and maybe families, which can lead to great stress and many health problems, some of which may be due to increases in stress hormones in the body. Some of these issues include conditions like depression, anxiety, gastrointestinal issues, and cardiac issues. The episode even tells us that “in 2004 this local hospital treated 80 cases of depression, attempted suicide, and domestic abuse. In the year following the Electrolux closing, that caseload nearly tripled.” Continuing on, we are also told that, “Where you stand on the economic ladder is a good predictor of health.” This is because “wealthy Americans have more options, resources, and power” when it comes to health. This fact, overall, helps further the point that unemployment, which can lead to being “un- wealthy” can have an negative effect on health.

Politics, economics, environment, culture, biology, and individual choice all influence the development, spread, and treatment of illness. Politics and economics can play a role in illness by controlling things like who receives health care and vaccines. Culture plays a role by influencing life styles and how people react to illness. Biology plays a role because illnessses are developed and spread biologically, and biology is also required for finding a treatment. Finally, individual choice plays a large roll because people chose for themselves the way they want to live and deal with illnesses. A person’s lifestlye has great affect on their health, and how they respond to illness.

 

Source:

Not Just a Paycheck. Unnatural Causes. NACCHO, 2008. Web. 13 July 2012. <http://www.unnaturalcauses.org/episode_descriptions.php?page=7>.

Spinal Muscular Atrophy in Caucasians

 According to the online “Journal of Medicine and Life,” spinal muscular atrophy is the “second most common lethal autosomal recessive disorder in Caucasians.” Spinal muscular atrophy is a group of related diseases that affect neurons in the spinal cord and brain stem. Death, or even decline, in these motor neurons leads to improper functions of muscle cells, and weakness in those who have SMA (Leshner, R.T). Paralysis, respiratory illnesses, and death are also possibilities associated with the condition. SMA is “an autosomal recessive disease, caused by a deletion or mutation in the Survival Motor Neuron 1 (SMN1) gene.” This makes SMA a genetic disorder that is passed on from parent to offspring. With one copy of the abnormal gene, a person will just be a carrier of the disease, not a victim. In order to fully express the disease, a person must have two copies of the abnormal gene. I can not really say why SMA is so prevalent among Caucasians, but perhaps the mutations occur more often in Caucasians, or originated in Caucasians, making them more susceptible to either inherit or pass on the condition.

Chance of Being an SMA Carrier Based on Broad Ethnic Groups in the US:

Ethnic Group

Carrier Risk

Any (general population)

About 1 in 50

Caucasian

1 in 35

Ashkenazi Jewish

1 in 41

Asian

1 in 53

African American

1 in 66

Hispanic

1 in 117

This chart shows the chances of being a carrier of SMA based on ethnicity. I could not find a chart or graph comparing ehtnic groups of those who actually had SMA. This is taken from the “Spinal Muscular Atrophy Carrier Testing” website.

 

The relationship between race, genetics, and health is very controversial and undefined. Although there can be correlations between race and occurrence of certain diseases/ conditions, the lecture tells us that there is no biologically defined races, and race is not representative of genetics. Many diseases are passed on genetically, but health can also be affected by environmental and socioeconomic factors.

Sources:

“About SMA: Overview.” SMA Foundation. Spinal Muscular Atrophy Foundation, 2012. Web. 10 July 2012.

Leshner, Robert T. “What is Spinal Muscular Atrophy? (SMA).” fightsma. Spinal Muscular Atrophy, 2012. Web. 10 July 2012.

“Spinal Muscular Atrophy Carrier Testing.” El Camino Hospital: DNA Direct. Medco Health Solutions Inc, 2011. Web. 10 July 2012.

Stavarchi, Monica. “Spinal muscular atrophy disease: aliterature review for therapeutic strategies.” Journal of Medicine and Life. Ed. Florian Popa, Prof. University of Medicine and

Pharmacy “Carol Davila” Bucharest, 21 Jan. 2010. Web. 10 July 2012. <http://www.medandlife.ro/medandlife367.html>.