Clinical Medical Anthropology

I chose clinical medical anthropology as my area to investigate further. I chose this because I am considering going to medical school after graduation. If I do choose to enter the field of medicine I think a good foundation in clinical medical anthropology would help me to be a better physician.

I think taking an anthropological approach in a hospital setting when surrounded by doctors and nurses is very important. The doctors and nurses hired by the hospital were only trained to heal with science and facts of the biomedicine world. Their training does not include cultural complexities we are facing in today’s world now that globalization is happening more rapidly. In the article this week, Anthropology in the Clinic, it states that cultural processes include the embodiment of meaning in psychophysiological reaction, the development of interpersonal attachments, the serious performance of religious practices, common-sense interpretation, and the cultivation of collective and individual identity. Doctors and nurses are unequipped with the knowledge of each culture and how a patient will react to each treatment option provided to them. If an anthologist gets involved then the different situations are better understood and a patient can receive the best treatment for their individual needs related to their culture and self-identity. Also I think it is important for NGOs and other aid that may be provided to be looked at with an anthropological approach. Like in the lecture when bed nets were given to protect people from disease carrying mosquitoes that could infect people with malaria. The providers of the bed nets did not understand why the intended users where not using them or were doing so incorrectly. When they took a step back and view the situation as an anthropologist then they got their answer and with an answer come an understanding in how to fix the situation. With a fix like the bed nets more lives can be saved. There are many more examples and more many more reasons why one should take an anthropological approach in a hospital setting or when talking with NGOs.

HIV in Swaziland

I chose the HIV/AIDS in Swaziland as the global health problem. Swaziland has the highest HIV/AIDS prevalence rate in the world at 38.8 percent according to the Kaiser Family Foundation. Here HIV is mostly spread through heterosexual sex and most deaths occur among young people. Also in Swaziland women are the hardest hit and account for over half the adults predicted to have HIV. This is could be caused by the Swazi culture. The culture discourages the use of condoms and promotes non-monogamous relationships. Polygamy is common and sexual aggression is prevalent enough that many girls admitted that they were coerced into their first sexual encounter. These factors are what facilitate this health problem.

According to AVERT an international HIV & AIDS charity many different organizations are helping to address the problem. The Elizabeth Glaser Pediatric AIDS Foundation began the prevention of mother-to-child transmission (PMTCT) program in 2004 and in 2009 the AIDS Healthcare Foundation (AHF) launched a free condom and HIV testing campaign to help battle HIV transmission. Also several countries provide funding to Swaziland for HIV prevention activities like United States, the United Kingdom, Italy, and the European Union. As well as UNADIS and the UN Family also support a variety of HIV prevention activities in Swaziland.

Daniel Halperin is medical anthropologist and an epidemiologist for the Harvard School of Public Health. He was among the first to spotlight signs that male circumcision could be a pivotal link in the AIDS pandemic. He noticed that the regions with the lowest HIV rates were also those where circumcision was also commonly practiced. Doctors have thought for decades that the foreskin is the portal of entry for HIV so Halperin has been trying to raise awareness for circumcision for males to decrease the high HIV prevalence in Swaziland and other parts of Africa. This is being addressed as a low tech way to combat the HIV/AIDS infection.

Sources:

AVERT

http://www.avert.org/aids-swaziland.htm

Harvard School of Public Health

http://www.hsph.harvard.edu/news/magazine/spr08/spr08halperin.html

Kaiser Family Foundation

http://www.kff.org/hivaids/upload/7366.pdf

Obesity

I chose obesity because it is being what some say is an epidemic. Americans are having a problem with weight manage and it has gotten worse over the last few decades. The Conrad article states “Most medicalization studies focus on how nonmedical problems become defined as medical problems, usually as illness or disorders.” I see this condition as a nonmedical problem that has been reframed into illness and disorder that now requires medication to treat it. Our culture has changed and our diets have changed with it. Americans eat so unhealthy with fast food and prepackaged foods. Also with stationary jobs and entrainment like TV, movies, and video game we get so little exercise. This had added to our expanding waist line. Now instead of just changing those factors we chose to just say obesity is an illness so we can get a quick fix (another part of American Culture) in prescription form to treat it.

The ad I found was for Meridia. The ad shows larger women who are presenting the medical information. This is so the “consumer=patient” will be able to relate to the actors portraying the sufferers if obesity. These women were smiling and doing normal household activities and entertainment to show that you too can get back your normal life and do the things you use to. Later a man’s voice can be heard informing the side effects of the drug. I think they did this so it wouldn’t be related to the happy smiling ladies giving the “happy” medical information. Also the clip shows full plates of food and then skips to a half-eaten plate to show that you can stop yourself from eating too much. Also the food looks good desirable to show that you won’t be giving up your favorite foods, you’ll just be eating less of it. The only doctor patient interaction was at the end it asks you to ask your doctor about Meridia but no doctors writing prescriptions were shown like some ads.  

Knoll

Meridia TV Commercial (1999)

http://www.youtube.com/watch?v=epyo-_JEFJQ

Life/Death

Biomedicine in the western culture plays a huge role. I see the culture of biomedicine as a collection of trends it follows like the areas of mass production, consumer capitalism, mass media, information technologies, communication technologies, and biotechnologies. Also I see a lot of emphasis the hospital as a symbol and all the different things it means to people. Similarly see the culture of biomedicine revolve around the doctors who practice it. They are given the authority to many things that ordinary citizen cannot like control their patients eating and sleeping along with being able to write prescription medications. Another thing about doctors and the culture of biomedicine is the stressed placed on their training. It is said it is one of the hardest career paths to follow with so much schooling and long hours of work. These doctors learn a lot of science related topics and not just straight healing treatments. This last idea is why I think the biomedicine is important in our culture. With this extra science that these doctors learn they are able to not only health us but enhance us.  

I chose life and death as the dichotomy. It really can be hard in this day and age to know which side of the line of the dichotomy of life and death you are on with technology. Now there are almost different levels of death to choose from. Are they Brain dead? Can the person breathe on their own? Did their heart stop beating?  Personally I think when a person’s heart stops beating any they cease to breathe on their own they or with the help of a ventilator they should be pronounced dead. I think these views have come from a couple different places but most from my family’s views and from the media. I think western society is still trying to define the division of the life and death dichotomy because of all the advances in technology we have today. Some people accept the death of the body as true while others believe death has to take place in the mind.

 

Restless Leg Syndrome

According to the RLS Foundation restless leg syndrome is “is a disruptive neurologic disorder that seriously affects 2-3% of the adult population. RLS results in an irresistible urge to move the legs which is often accompanied by unusual or unpleasant sensations in the legs that may be described as creeping, tugging, or pulling. Because RLS most often occurs in the evening, it can severely disrupt sleep and reduce quality of life.” I think the American culture and biomedicine does influence the illness experience of the sufferers of RLS. Many people in our culture do not believe it is not a real illness. Due to this fact it is easy to make fun of the condition and its sufferers like we saw in lecture with that Mad TV skit. This may cause sufferers of RLS to not believe in their diagnosis or for doctors to not believe in their patients symptoms. Both of these influence biomedicine by resulting in sufferers not getting the right treatment. If these people diagnosed with RLS do not believe their diagnosis is real then they may never get treatment or try to manage their illness. On the other hand doctors who doubt the illness’s validity then they may prescribe the incorrect treatments and therapies for people who do in fact have RLS.

I do believe that belief is healing’s counterpart. As we saw in the video “Placebo: Cracking the Code” many people were healed by the belief that they were cured in some method that by all accounts should not have. It seems like the mind does the curing or thinks its pain free because it was told it should me. Also in the video we saw how placebos can cause a really physical reaction like when a placebo pill can cause the brain to release endorphins which then stop the pain the body is experiencing. So because we believe the pill will cure us then our mind will do the work to heal us.    

 

Source:

http://www.rls.org

True Life: I’m deaf

This episode of True Life was about two young people who were born deaf. There was a 16 year old boy, Chris, whose primary type of communication was sign language. He struggled to feel connected to hearing people at school. For this reason he chooses to undergo cochlear implant surgery. Also the episode follows a 21 year old girl named Amanda. Her primary way of communicating was speech and reading lips which was different than Chris’s. Amanda was following her dreams to be a dancer and to join a dance team. She could follow along by feeling the vibrations of the music.

Amanda and Chris’s narratives were both Quest Narratives. They both told a story of their condition as if it were a journey that had taken. Also they both talked about how there were opportunities to improve themselves during their experiences. These both fall under the Quest Narrative category so that is why I classified that way.

In today culture there is a slight stigma with being deaf. People view deaf people as someone who handicapped. Some people judge incorrectly that the deaf have lower than normal intelligence or that they are unable to complete a task because of their impairment.

In this episode Chris seeks help from medical doctors and surgeons to receive a surgical implant so he can hear. Also he sees a speech therapist to help with the way his voice sounds and how to pronounce words correctly.

Chris takes on the sick role more than Amanda does in this episode. He attends different classes at school because of his hearing which gives him different responsibilities. Amanda takes on more normal responsibilities that hearing people have like attending normal college classes and being a part of a normal dance team both which are meant for the hearing.

In Lecture 2 this week we talked about the benefits of illness narratives to patients, family, and healthcare providers. For the sufferer an illness narrative can make sense of the suffering, help adjust to the new disability, and help them to feel empowered. For listeners like family, friends, and doctors the illness narrative can help them to feel less isolated, encourage them to share their own suffering, model on how to live with the illness, and help them to understand what the sufferer is going through.

Hwabyeong in Korea

Hwabyeong is a Culture Bound Syndrome related to the Korean culture. The disorder occurs in middle-ages women of relatively low socio-economic standing. The disorder is an anger syndrome with symptoms that include a subjective feeling of anger with anger-related bodily and behavioral symptoms. The literal meaning of Hwabyung is “anger disease” or “fire disease”. A survey of the general population in a rural area in Korea reported that 4.1% were reported having Hwabyung. These women believe that they have suppressed anger that had built up over time that then disturbs the balance of the five bodily elements. Suffers might experience heavy feeling in the chest, perceived abdominal mass, sleeplessness, hot or cold flashes, and blurred vision. Also some suffer from dry mouth, heart palpitations, insomnia, and anorexia.

Biologically this illness can cause other potentially more severe health issues that stem from stress and depression even if the Hwabyeong does not the sufferer directly in a biological sense. Culturally this illness is perceived as a real illness and is believed to be brought on by the culture which these women live in. Individually the women who claim to suffer they are the victims of chronic social aggression. Others say they are the victim of social unfairness including suppression, deprivation, discrimination, exploitation, poverty, betrayal, or swindling that caused their manifestation of the illness.

For treatment these women first seek help from physicians, including internists before visiting a psychiatrist. Others patients search for treatment with pharmacists and traditional herb physicians again before reaching out to a psychiatrist. The treatment methods include psychotherapy, drug treatment, and family therapy. These treatments are mostly in the professional sector. Others are known to have sought help in the folk sector. Some patients converted to Christianity for Christian faith healing and confirming prayer while other turned to shaman rituals known as ‘goot’.

World Culture Psychiatry Research Review

http://www.wcprr.org/pdf/04-01/2009.01.1221.pdf

Medical Doctors in Great Britain

In the Frontline: Sick around the World film they compared the health system of Great Britain’s to America’s healthcare. The film also covered other countries like Japan, Germany, and Taiwan. In Great Britain the healthcare is run by the government and called the National Health Service (NHS) for short. This system covers everybody in the country. The cost of healthcare is free everybody who lives there. Nobody pays insurance premiums or copays. Since there are no medical bills of any kind their country can also claim no medical bankruptcy either. The healthcare is paid from tax revenue so they do end up paying higher taxes. Also their system can claim better healthcare statistics than us with longer life spans and lower infant mortality rates. The healers there are licensed doctors who are really salaried government employees who make good money and live in a higher social status because of their income. Some the techniques Great Britain is known of is their preventative medicine. The government and doctors push preventative medicine on their patients. Doctors even get monetary bonuses when their patients stay healthy. Some doctors interact with their patients as gatekeepers. You have to see a general practitioner before seeing a specialist. Also they are known for having long waiting lists to see the doctor but this is changing and the waiting lists are growing shorter over the years.

The Great Britain healthcare system operates in the professional sector. The doctors there are organized, legally sanctioned health professional that are also the gatekeepers of knowledge and treatments. There in Great Britain, biomedicine is the authoritative form healthcare since it is western society so that is what is used to understand and treat symptoms of the body when ill. Prescription drugs are also another way to look at how doctors treat their patients and are the only ones who can prescribe them as well.

Prevalence among Caucaian Women

 

 * I tries fixing the picture but it isn’t working. You can click in the link to get a clearer picture. The graph states:

Percent of Women:

  • Total: 10.1
  • Non-Hispanic White: 12.6
  • Non-Hispanic Black: 3.2
  • Hispanic: 3.5

Source:

U.S. Department of Health and Human Services

Health Resources and Services Administration Website

http://mchb.hrsa.gov/whusa09/hstat/hi/images/49a_bar_OSTEOPOROSISrace.gif

 

Osteoporosis had found to be more prevalent among Caucasian women compared to other ethnicities. The graph above shows that among Non-Hispanic Whites it about 4 times higher than in Non-Hispanic Black and Hispanics. Some of the risk factors for osteoporosis could shed some light on why Caucasian women are more susceptible to it. Since family history of osteoporosis is a risk factor it is easy to see that there is a genetic component it would create a health disparity among a group. Also the US National Library published an article that states that there is a correlation between bone density and race which would cause some ethnicities to have bones that would be weaker and easier to fracture since they would have a lower bone density to the other ethnic counterparts. Similarly hormones play a role in osteoporosis and therefore could be another key to why there is a health disparity among Caucasian women. Since hormones can be affected by some foods in a person’s diet and different ethnicities consume different foods then there could a correlation between hormones levels and different ethnicities.

From this week’s lectures it was shown there is a relationship between race, genetics and health. The relationship between race and genetics is closely related. In lecture 2 this week we talked about the Genotype Hypothesis. Since there is a genetic drift and gene flow among races their genetics are similar as well. The relationship between genetics and health is also interrelated. Some genes can cause or prevent certain illness and consequently affecting one’s health. Furthermore from lecture 2 we learned that the Pima Indians which are a race that shares similar genetic material has a health disparity with Type 2 Diabetes which causes this group to have a statistically higher chance of having the disease. This shows there is a link between race, genetics and health.

Sources:

1. National Osteoporosis Foundation

http://www.nof.org/node/40

2. Racial difference in the correlates of bone mineral content/density and age at peak among reproductive-aged women

A. B. Berenson, M. Rahman, G. Wilkinson

Osteoporosis Int. 2009 August; 20(8): 1439–1449. Published online 2009 January 13.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2708327/

In Sickness and In Wealth

I think I did pretty well on the health quiz. I got score 9 out of 10 on the quiz. I had already heard a lot about our health care statistics as a country and how as one of the richest countries in the world we rate very poorly in health care and life expectancy. The health care statistic I was more surprised about and the only question I got wrong was about how recent Latino immigrants have better health outcomes than other U.S. populations.

In the episode 1 of the unnatural causes episodes titled In Sickness and In Wealth, the episode takes place in Louisville Kentucky. It compares three different people on different rungs of the socioeconomic ladder and there corresponding health. The outcomes to this study showed that the more income a person makes correlates to better health and longer life expectancy than a person with lower income. The study showed that people on the top rung have better access to healthy living choices and less stress leading to an overall healthier life while people on the farther down on the ladder haves less resources and more stress in their lives leading to poorer overall health and shorter live spans. Also the clip discussed that racial inequality also plays a part health as well.

The development, spread and treatment of illness is influenced many different issues in today’s world. Politics and government play a big role in health care. Each country is different in the way they run their health care system and how the government allocates money for healthcare issues. Some governments have better health care for this reason. Economics also plays role in illness as well. The better of a country is economically generally the healthy its people are and have a longer life expectancy because of better development and treatment of illnesses. Culture plays a role too in the spread of illness. In the lecture this week Schistosomiasis was discussed and its spread was a cultural one because playing in the water was rite of passage for young boys while some women don’t go in the water would be less likely to contract the parasite. There are many more factors the influence the illness.