FGM/C in Sudan

     According to the World Health Organization (WHO), as of now, 140 million girls and women are living with the consequences of the cultural practice termed female genital mutilation/cutting (FGM/C). The WHO defines FGM/C as the “partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other non-therapeutic reasons.” It is usually carried out on girls ranging from a few days old to 15 years old. It is most prominent in Africa where an estimated 92 million girls, 10 years of age and older have been subjected to FGM/C. It is not only practiced in 28 African countries, but also in the Middle and South East Asia. (1)
      In most countries, including Sudan, where FGM/C is performed it is viewed as a way to protect the woman’s virginity, and to discourage “female promiscuity” thus ultimately preserving and protecting the family’s reputation or honor. Some other cultural reasons are aimed towards promoting femininity. For example, if the clitoris is not removed via FGM/C t is believed that it will grow longer between the legs to resemble a penis. Therefore, by removing the clitoris which is viewed as a feature of masculinity the woman is ultimately achieving femininity; this is also why this procedure is viewed as a rite of passage into womanhood for the women in these cultures. Many of the pro FGM/C groups have stated that there are also religious regions backing this procedure, but as of now one common statement from the religious leaders in Sudan has still not been attained. (1)

      Some of the attempts of advocacy for the women who suffer physically and psychologically have come from NGOS or other national organizations. Some of the different advocacy efforts have involved “the combination of health-based approach and behavioral change strategies; including peer education, use of positive deviants, and community conversation” (1). After evaluation of the success of the different approaches taken to reduce FGM/C, one of the most successful approaches seemed to be introducing alternative rights of passages, while the least successful approach was the traditional medicalization of FGM/C. (1)
      One major national attempt to end FGM/C came from the National Council of Child Welfare (NCCW) which included the coordination of different groups at a local level such as Sudanese Network for Abolition of FGM/C (SUNAF) which is made up of NGOs and academic institutions, line ministries, and legal experts. One of the major successes of this advocacy movement was the passing of the Child Act Bill in 2009 which includes an article to make FGM/C illegal based on health and social reasons. So far in Sudan, this law has been ratified in the State of South Kordofan in 2008 and in Gadaref State in 2009(1).
      Not everyone views this procedure as an unnecessary act of torture both physically and socially. Some people really do feel this is an act of empowerment of woman, a launch into her femininity. One of these individuals is an anthropologist from Sierra Leonean, Dr. Ahmadu, who actually underwent this cultural procedure herself. She aims to break down the surrounding negative perceptions about FGM/C by sharing her own experience. As illustrated in one of her articles, Dr. Ahmadu feels that countries of the West look at this African cultural practice with an ethnocentric point of view. She also demonstrates how in the U.S. state of California women are choosing to undergo a similar type of procedure as a form plastic surgery to enhance the physical appearance of the vagina (2). Which brings forward some critical anthropological questions. Why is this procedure viewed as inhumane in some countries, but not in others?” Is it really only  a matter of cultural perception?

SOURCES:
( 1.) Bedri, Nafisa M. “Ending FGM/C through Evidence Based Advocacy in Sudan .” (March 2012). http://unstats.un.org/unsd/gender/Jordan_Mar2012/Presentations/Panel 3/Panel 3_6_paper_Sudan_Ending FGM.pdf (accessed).

(2.) Ahmadu, Fuambai. “Rites and Wrongs: An Insider/Outsider Reflects on Power and Excision.” African Holocaust. (2000). http://www.africanholocaust.net/fgm.html (accessed).

Epidemiology and Medical Anthropology

        I am most interesting in the preventative side of medicine; therefore I plan on pursuing a career within the field of public health. I have always believed it is vital to treat individuals by considering all of the different possible factors that could be influencing their health such as economical, political, cultural, and social. Now I realize it is not only important to consider how these different factors are affecting an individual’s biological health, but more specifically the way these factors are influencing the way an individual may perceive or experience their illness. Furthermore, I have always been intrigued by the investigative aspect of science which has led me to look further into the field of epidemiology which investigates the origin and spread of many different categories of disease.
          As an anthropologist working with a professional within the field of public health with a specialty in epidemiology who has not been educated in anthropological methods and theories, I would be able to contribute towards the implementation of new preventative health practices by decreasing the chance of noncompliance. Noncompliance is when patients choose not to follow an implemented medical protocol. Instead of just throwing forward a solution to a health problem, and expecting the people of the culture to not only comply with the policy but also to continue to maintain it, regardless of their cultural beliefs seems far from practical. Therefore, as an anthropologist I could do some qualitative anthropological research by conducting interviews with the people of this culture to better understand what they think about this implemented solution, or more specifically whether or not it conflicts with one of their strong cultural beliefs.

        As described in the YouTube video “Medical Anthropology,” some non-anthropologist medical providers tend to underestimate the power of cultural beliefs. To better illustrate how a proposed solution to prevent the spread of disease may not be successful even if the “plan” seems flawless I will use an example from the YouTube video, “Medical Anthropology.” In the video, a woman in Brazil attempted to prevent the spread of E.coli in a village in the Andes by teaching the people to boil the water before use. The use of this simple education seemed promising, but ultimately fell through. Eight months later, when the woman decided to ask the people why they weren’t boiling the water, she realized she overlooked a very powerful cultural belief. These people believed that by boiling the water they would be destroying one of the essential Spirits of the Earth resulting in the persistence of E .coli within the village. By taking into consideration the beliefs of a culture before implementing preventative protocols, the implemented solution will be much more effective for the people of that culture.

References:

YouTube: “Medical Anthropology”- Tribal Jazzman Scholar, Episode #26; 2011.

 

Erectile Dysfunction (ED)

Erectile dysfunction, ED, is a medical disorder that has been highly medicalized within the culture of the United States. One of the cultural influences that propelled this medicalization was the ideology that men who exhibited the symptoms of erectile dysfunction were viewed as less competent and ultimately were viewed as less of a man. This chip on the man’s ego compelled men to seek medical treatment in order to live a “healthier” happier life, and to restore his “manhood.” ED was no longer seen as a flaw in the individual, but rather a legitimate biomedical disorder in which the disorder and its symptoms could be managed and treated. An economic force that further propelled the medicalization of ED came from the pharmaceutical companies.

As men came in large numbers to their doctors for the drug to treat ED, Viagra, the pharmaceutical companies, such as Pfizer, pushed the advertisement for this drug. As stated in the BBC Horizon film, “Pill Poppers,” Viagra is now one of the most prescribed drug in the world; Six tablets are dispensed somewhere every second. After Pfizer discovered the economic potential of Viagra, ED and its diagnosis was further expanded to not only include the 9% of men with chronic ED that consistently couldn’t get erections (usually older men), but also men who only occasionally couldn’t get erections. (1) This implied that if men experienced occasional erectile dysfunction that they weren’t perfect, and that they were exhibiting some level of illness and this illness could be treated. This created an unlimited marketing potential for Viagra within Pfizer and other pharmaceutical companies. Soon after, other drugs such as Cialis or Staxyn, started to play the same role or similar roles as Viagra.

In a 2011 Viagra advertisement, it portrays a strong confident competent man out sailing on the water. As the ad is talking about in this day and age an individual knows what needs to get done, it is also showing a problem that comes about on the sail of the sailboat. In the ad, the man quickly improvises and solves the problem and maintains sailing again; this is illustrating the American ideology that to be a competent man he must also be “Mr. Fix It.” The ad is implying that today with all this medical information and knowledge it’s not a question of knowing what needs to get done, but whether or not an individual will be smart enough to make a decision to fix the problem. The ad also states, “With every age comes responsibility,” which is implying that men have a responsibility to correct their disorder.

The music also contributes to the ad because it is upbeat and acts to aid in motivating the consumer/patient to take action and seek medical treatment. The physical appearance of this man is characteristic of the Western culture’s stereotypical manly man which most men whether or not they admit it strive to be like. This makes the ad more appealing to the consumers of the West. Also, at the end of the video it shows the man after a long day of fixing problems on the water returning home with a more confident smile then before because he knows he will have no more problems to face that night, thanks to Viagra. Lastly, the ad states that 20 million men have already taken action; which is basically asking, “Why should YOU be missing out?” At the end of the ad, it instructs YOU as the consumer to ask your personal doctor if it is right for YOU, implying that the pharmaceutical company wants to help YOU personally, while in the same sentence also mentioning that its product, Viagra, is the most prescribed treatment for ED. At the same time it is also implying that your doctor knows what is best for you. All of these factors are effective advertising techniques used by the pharmaceutical companies to hook you in as a consumer of their product which in this case means you first have to become a patient.

SOURCES:

1.) YouTube, BCB Horizon, “Pill Poppers” (Part 2)

2.) YouTube, Viagra Commercial, 2011.
http://www.youtube.com/watch?v=of91buu5MWM

 

Life/Death

       The phrase “culture of biomedicine,” is referring to the fact that the biomedical knowledge and ideology behind the dominant form of ethnomedicine in the U.S., Biochemistry, is not natural or universal, but rather culturally constructed. Biochemistry as an ethnomedicine focuses mainly on the biology of an individual, and aims to cure this individual by medically treating the biological problem. As demonstrated in this week’s lecture, the acceptance of the germ theory, the mass production of antibiotics and other pharmaceuticals, and the establishment of the genetic sciences are all historical cultural events that transformed the way the U.S. viewed health and healthcare which ultimately aided in establishing the authority of biomedical knowledge. It is important to recognize that biochemistry as an ethnomedicine isn’t universal, but rather culturally constructed because by recognizing this, individuals can be treated more efficiently by considering important factors that may be playing a key role in their disease beyond that individual’s biology. Such nonbiological factors include an individual’s social, political, economical, and/or cultural status.
       In biomedicine, there is an assumption that there is a defined boundary between life and death. The idea that an individual is either alive or dead is very over simplified and does not consider the cultural or individual beliefs surrounding the individual in question. Personally, I believe that life begins at birth when a baby is able to live outside of the mother’s womb. For me, death is a little harder to define. I believe that when a person is no longer able to live without extreme measures such as life support, and there isn’t a chance that they will recover this constitutes that this person is no longer alive, but rather dead.
       I have never been put in a situation where I had to decide whether or not to let a loved one go, so my views on death have not been formed via this. However, my opinion of death changed from reading a book written by Jodi Picoult called the Lone Wolf. In this book, a family has to decide whether or not to terminate the life support that their father was on. The decision ultimately came down to what was believed to be the fathers view about life/death. The fact that it is so hard to define these two concepts, life and death, just further illustrates that they cannot be defined by biomedical knowledge alone. I feel that Western culture accepts this dichotomy of life or death as natural and true, because it is easiest to look at life and death as extremes rather than consider any gray area between the two. How can someone be both alive and dead at the same time? Is this biologically/physically possible? To consider the gray area that may exist between life and death requires the loss of the objectivity that has been engraved into cultures that are so dependent on biomedical knowledge. This jump from objectivity to subjectivity is a hard one for such cultures to make when considering dichotomies such as life or death.

 

 

“I have an embarrassing medical condition”

The two types of medical conditions discussed in this episode of True Life are Tourette syndrome and Hyperhidrosis. In this episode, Melissa is a young girl who suffers from Tourettes, and who is facing the challenge of leaving for college and living on her own. When it comes to Tourette syndrome there is definitely social stigmas attached to it. At the beginning of this episode Melissa addressed one of these stigmas by saying “I’m not doing it on purpose.” Sometimes people who are not educated about the disorder believe that people with Tourettes act as they do to get attention. She also addressed this in the episode by saying that the people who did not know her well thought she was faking it. You can also tell how this alienation affected her because she stated how she just wanted to be “normal.”

Throughout the episode Melissa seemed to experience many different moods. At some points she seemed to be frustrated by her Tourettes and the associated judgement she faced, while other times she seemed empowered by the acceptance she felt from family and friends. The illness narrative that Melissa used in this episode was the Chaos narrative. Since Tourette syndrome is a chronic condition associated with social stigmas, this narrative is the most useful when describing this illness. Since the episode illustrated how Melissa suffers from Tourettes while successfully living on her own at college, it seemed that the purpose of this narrative was to empower others who suffer from Tourettes to learn to accept themselves, and live their life free from the stigmas and judgments associated with Tourettes.

The other young girl in this episode, Krystal, suffers from Hyperhidrosis or excessive sweating. In an attempt to mask her condition she chose to wear long sleeved black sweatshirts in order to hide her sweating. She was viewed as strange because she always wore sweatshirts while living in Florida. She was masking her condition because there are definite stigmas attached to sweating such as poor hygiene. Therefore, she chose to suffer from being alienated due to her choice of black sweatshirts rather than her actual medical condition.

Krystal plays the sick role by first realizing that she is suffering from some sort of medical condition, and then after doing some research seeking medical treatment. Krystal’s experience with a medical doctor seemed to be a positive one because she seemed to have left the doctor’s office hopeful that there are possible treatments for hyperhidrosis. The type of narrative she used to discuss her illness was the Chaos narrative. She seemed to be using her narrative to address how she suffered socially and physically, which may help others who suffer from this condition to feel less alienated. She also seemed to be using her narrative as a way to inform other individuals who suffer from this condition that there are certain treatments, such as botox injections, that can help individuals with hyperhidrosis live a happier, healthier life free from alienation.

Illness narratives such as in this True Life episode can benefit the” teller”, or the individual suffering from this condition, by allowing the individual to make sense of their own illness through expression. Also, the individuals who express their illness through an illness narrative can benefit by feeling empowered. It was clear in this episode that both individuals felt empowered by the end of their narrative. Both girls also seemed to strive to empower other individuals who suffered from these medical conditions. This is a good example of how the narrative serves not only to benefit the “teller,” but also the “listener,” who can benefit by feeling less isolated, encouraged to share their story, or by feeling inspired to serve as a role model on how to live with this illness. The different benefits of illness narratives mentioned previously were displayed in this week’s lecture, “Understanding Illness.”

Restless Leg Syndrome (RLS)

In the United States, restless leg syndrome or RLS has become somewhat of a joking matter. This seems most apparent from the video clip from MAD TV that was shown in this week’s lecture. With the exaggerated images of this syndrome in the media and the lack of biomedical proof, it is clear how people who claim to be suffering from this illness might not be taken as seriously as they would like to be. It is also hard to legitimize this syndrome because the symptoms are so subjective as seen in the video in this week’s lecture from health.com in which the women describes her symptoms as an “electrical surge of energy” not only in her legs, but also her arms in which the only alleviation is moving.

Unfortunately, the only way I see this syndrome being taken seriously in the American culture is if there is some sort of well-proven biomedical evidence that seems to be responsible for causing the associated symptoms. Since the individuals might not be taken as seriously as they should be by other individuals whether it be friends or family they may never even seek professional help by their healthcare provider, and thus will continue to suffer from this syndrome. If they do seek professional care via their healthcare provider they may become frustrated due to the lack of science/treatment for this syndrome.

Lastly, I think one of the most underestimated remedies that exist today is hope. To be hopeful means you are thinking positively about yourself and your surroundings. The power of belief or hope is easily portrayed by the placebo effect. One thing I think most people can agree with is that disease can be accelerated by distressing or worrying. Or if you aren’t suffering from a disease, your own state of biological/psychological/physical health can suffer due to stressing too much. Therefore any removal of stress or introduction of positivity seems to benefit the individual or patient. There definitely seems to be some sort of biochemical event that occurs when a patient believes in the effect of an administered placebo.

In the video, “Placebo: Cracking the Code,” scans taken from the brain of a woman who had received a fake anti-depressant ,or placebo, showed that there was a real physical change occurring in the brain. The brain was more active in the areas that controlled mood, and less active in other areas of the brain. Although the placebo effect is still not completely understood, it would be hard to argue that this effect isn’t attributed to something occurring within an individual’s biology as a result of the introduction of hope. As far as my own experience goes, taking a sleeping aid at night, such as melatonin, tends to help me sleep. Now that I think about it, I’m not too sure how much of the assistance actually comes from the pill compared to my belief that by taking this pill I will be able to sleep.

Dhat Syndrome in the Indian Subcontinent

In this article, the authors hypothesized that when analyzing culturally diverse clinical populations suffering from dhat syndrome or “semen-loss anxiety” and the associated symptoms of anxiety the results would show that this syndrome and its symptoms would be found across many different cultures. Thus, disproving the concept that dhat syndrome is culturally bound. This syndrome, “semen-loss anxiety” was analyzed among clinical populations from the Indian subcontinent, Sri Lanka, China, and Western countries. “Semen-loss anxiety” and its correlating symptoms of anxiety, depression, etc. were found among all of these populations suggesting that dhat syndrome or “semen-loss anxiety” is not culturally bound. It was also mentioned that this syndrome seemed to be historically/economically related because it was found to be diminishing in Western countries that were becoming more and more industrialized/urbanized.

The naming of dhat syndrome came from the Indian culture, more specifically the Sanskrit word, “dhatu” which meant  ‘elixir’ or ‘constituent of the body.’ Men suffering from dhat syndrome experience symptoms such as fatigue, weakness, anxiety, loss of appetite, and sexual dysfunction. In the Indian culture, these symptoms were thought to be due to the loss of semen either from masturbation, nocturnal emissions, or urination. The Indian culture believed that semen originated through a chain of conversions starting from the consumption of food. It was believed that food was converted into blood and that blood was converted into flesh and that flesh was converted into marrow and that marrow was converted into semen. Thus an imbalance in semen seemed to be due to an imbalance in any of the essential bodily constituents which were believed to cause the significant somatic symptoms mentioned previously. To lose semen would mean to lose the essential balance of the body. This is where the dhat related symptoms of anxiety and depression stem from. As a result, an individual’s state of health, biological, physical and/or psychological, can be damaged from these dhat related symptoms.

When evaluating a clinical population of men from Sri Lanka who suffered from sexual dysfunction attributed to “anxiety-loss syndrome”, the men were clinically diagnosed with significant somatic symptoms such as anxiety, hypochondriasis, or stress reaction. Thus, although not exclusively stated in this article some forms of possible medical treatment for these men could be to alleviate these psychological symptoms.

SOURCE:
A. Sumathipala, S. H. Siribaddana and Dinesh Bhugra. Culture-bound syndromes: The story of dhat syndrome. The British Journal of Psychiatry. 2004. 184:200-209.

Hmong Shamans in Merced, CA

The New York Times article, “A Doctor for Disease, a Shaman for the Soul,” is describing the increasing accommodation of culturally diverse patients’ preference of treatment in hospitals across the US. An example of this is the formal certification of the use of a Hmong shaman in a hospital in Merced, CA. This formality includes a badge worn by the shaman, and unlimited access to his patient. This formal relationship between the folk sector of healthcare and the professional sector of healthcare will hopefully aid in diminishing the distrust between diverse cultures, such as the Hmong, and the hospital that they are being treated in. This distrust stems from that fact that the Hmong view illness as a matter of the soul whereas medical doctors take a much different approach which is mostly biologically based. This distrust was illustrated in the article by a situation in which the disconnection in communication between Hmong parents and the medical doctors who were treating their child for epilepsy resulted in her death.

The healers in this article are the Hmong shamans. The healthcare sector that these Hmong shamans belong to is the folk sector, although they are operating within the means of the hospital which is known as the professional sector. Within the Hmong culture, shamans are viewed as sacred. However, the shamans share the same cultural ideology/beliefs as the patient they are treating; thus they share the same social status. This equality in social status also contributes to the trust that is built between the patient and the shaman, and ultimately this relationship can aid in the treatment of the patient.

As stated in the article, the primary concern of the Hmong shaman is the condition of the patient’s soul. This concern is based on the fact that the Hmong believe illness is associated with the running away of an individual’s soul; therefore in order to alleviate the individuals’ illness the shaman performs rituals or ceremonies that can also be referred to as “soul calling.” More specifically, in the article the shaman, Va Meng Lee, believed that Chang Teng Thao’s diabetes and hypertension were due to an attempt by Thao’s late wife to kidnap his soul. The “soul calling” ceremony performed by Lee consisted of soft chanting and the formation of a protective shield via hand gesture around Chang Teng Thao. Other techniques used in rituals performed by Hmong shamans can consist of gongs and finger bells which must be approved by the hospital in order to assure that the noise does not disrupt other patients.

SOURCE:

Brown, Patricia Leigh. “A Doctor for Disease, a Shaman for the Soul.” New York Times. Sept. 2009.

MENSTRUATION

     I defined health as the biological, physical, and psychological state of a person. I defined illness as any condition or disease that affects the biological, physical, or psychological wellness of a person. I think these definitions come from my belief that the health of an individual should be viewed from a holistic approach rather than just strictly the biological state of a person. I have come to lean towards this approach towards health because I have been gearing my studies towards getting into an osteopathic school of medicine, and so the courses and the experiences I have had have taught me the importance of looking at the individuals health as a composition of these different aspects of their wellbeing rather than just whether or not they are exhibiting a set of symptoms.

    I pretty much viewed all of these conditions as illnesses based on my definition because all of these conditions affected either one or all of the different states of an individual’s well being whether it was psychological, physical, or biological. The one condition I had the hardest time categorizing as an illness or not was menstruation. I ended up categorizing it as an illness because although it only affects an individually mildly and temporarily it still does have an effect on an individual’s physical, biological, and psychological state of well being.

      I categorized anxiety as an illness because it definitely affects the physical and psychological state of an individual. For example, a person with anxiety may physically feel like their life is endangered most of the day. Due to this others may judge this person, and this individual will begin to question whether or not they are sane which will affect their psychological well being. I categorized ADHD as an illness because it definitely effects the physical, and psychological state of a person. For example, a person with ADHD physically has a hard time focusing on a given activity and because of this may view themselves in a negative light. I categorized cancer as an illness because this will affect this individual’s physical, biological, and psychological well being. For example, a person diagnosed with cancer will have to undergo a certain schedule of treatments that will most likely prevent them from doing some things that they had previously planned on doing, and as a result they may view themselves differently ultimately affecting both their physical and psychological well being.

Ecological Approach

   I think the Ecological Approach to health will be most beneficial towards my study of health because it takes into account all aspects that I find to be most influential in the current healthcare system today. I have always preferred taking a preventative approach towards health and medicine and this approach seems to support this perspective the most.As I understand, the distinction between disease and illness is a matter of subjectivity vs. objectivity. The definition of disease lies more on the objective side because this is the actual outward manifestation of a symptoms and signs of a clinically diagnosed disease. The definition of illness leaned more towards the subjective individuals perception of what they believe is going on with their own self. This distinction between disease and illness was not apparent to me at first. I had never thought that there was a difference between these two concepts. I thought to be ill meant you had some sort of disease, but I guess I never believed illness to be defined as a subjective term.
   The culture that Miner is referring to is the American culture. The first little hint that led me to believe this was the reference to cutting down a cherry tree which made me think of George Washington, but I wasn’t completely convinced at this point. However, as soon as Miner started describing the annual ritual about caring for the mouth I realized he was describing the annual visits to the dentist that are highly encouraged in the US.
    As previously mentioned, the ritual described by Miner about the Nacirema’s fascination with “holy-mouth-men” describes the American idea that an annual dentist appointment is essential to maintain your health. Also, it represents just how vain we are as a culture because a lot of time people will judge other people based on their physical appearance such as bad teeth. This leads me another ritual of the Naciremas in which it is a rite of men to “scrape and lacerate the surface of their face with a sharp instrument,” daily. This ritual refers to the fact that men are expected to shave their facial hair daily. This belief ties into what Americans view as healthy. Lastly, the ritual that describes a fascination with breast size is describing the American idea that as a woman, the more similar your body looks to the woman we see on popular magazine covers, the more successful you will be in life. This also describes some factors which have lead to an explosion of eating disorders that have been seen in throughout America.