HIV and AIDS in Malawi

Currently, approximately one million of the 15 million people living in Malawi are living with HIV. The first case of AIDS in Malawi was reported in 1985 and a short-term response program was enacted. It is argued that these government programs really did little to help, including the creation of the National AIDS Control Programme (NACP) in 1988. However, by 1989, a five-year plan was announced. Politics stunted the tackling of the growing epidemic, and by this time the effects of HIV began to take it’s toll on the economy.

In 2000, another five-year plan was established and the governments efforts in increasing knowledge about the transmission of the disease and it’s prevalence have greatly increased. HIV is most common in urban areas and 60% of cases are female. The disease has had a massive impact on children, who either contracted the disease during birth or have been orphaned by it.

Various programs created by the government and NGOs have been created to combat the disease. This includes volunteer therapy, instruction on mother-to-child transmission, and the distribution of condoms. However, all of these solutions are facing complications such as lack of funding, shortage of supplies, and human resources. In terms of culture, traditional gender inequality puts women at a disadvantage, and the stigma surrounding the disease often hinders treatment.

A medical anthropologist focused on the problem of AIDS in Malawi is Dr. Anat Rosenthal. Rosenthal “has comprehensively studied how both international and local health organizations impact the impoverished communities and villagers”, and the socio-cultural effect AIDS has on those in Africa. She is dedicated to assessing, preventing, and fighting HIV/AIDS outbreaks. Despite the bleakness of her topic, Rosenthal believes she has found her calling and gives lectures that highlight the “very gray” world of health care. She is focused on Malawi because of their staggering HIV rates in comparison to other countries.

Sources:
http://www.avert.org/aids-malawi.htm

http://www.smudailycampus.com/news/medical-anthropologist-promotes-aids-awareness-in-malawi-1.1922507#.UCWX26GPWyg

Global health and Medical Anthropology

Years and years back, I checked out a book from the public library about the use of forensic anthropology to identify the bones that are still being found in areas like Vietnam and Korea and how those soldiers are being identified and returned to their families. Seeing as my grandmother had been permanently affected by how her cousin was declared POW/MIA in Vietnam, this sparked my interest in anthropology. Though I am an avid fan of the show Bones, unlike most people assume, I am not in this business to “work with a hot guy”. Or dig things up in Egypt (though I would like to dig things up here). I went into college at Oakland University as an anthropology major not really understanding what I was getting into. Especially since coming to MSU, I have gained countless knowledge about what it means to be an anthropologist: everything. Anthropology will invade your field of practice and completely turn your way of thinking around, as we have seen here in the medical field. I often wonder what would be the result of having an anthropologist for president – someone who understands global health from a medical anthropological perspective, that culture is a bit more complicated than “Somalia is starving, we have extra corn, let’s give them corn”.

Something that got my attention in previous anthropology courses is the concept of “volunteer tourism”, where people volunteer on a two week or so trip to do things like fly to Africa and help starving children. Or, similarly, the fact that first year medical students are being flown to Africa to practice on third world patients. From an anthropological perspective this is very, very damaging and if I were working for an NGO or similar institution that basically exported “medical care”  I would definitely work to shed light on these issues. As explained in the reading, though it may not always be the case, culture plays a huge role in biomedicine and these factors need to be taken into account on a global perspective.

PMS

I know the medicalization of menstruation has been covered pretty in-depth already, but there are so many ridiculous commercials for it that depict women in outlandish scenarios that I love being annoyed by them all. So here’s another!

Let’s face it, with the right wording and dramatic scenarios you can convince the common person they have just about any disorder. The common encouragement to “ask your doctor if such-and-such is right for you” is a significant indicator that these companies are more concerned with distributing their product than protecting your health because theoretically, if such and such WERE right for you, your doctor would prescribe it without you having to tell them a specific brand name.

With about half the population being female and a large majority of those females experiencing what is essentially a disturbing natural process every month, it’s hard to ignore the market that creates. If you think about it, nobody actually wants this to happen to them, but it has been happening forever and ever to women throughout the entirety of space and time so it’s definitely a survivable process. However, Western media has made it out to be something that is absolutely crippling, and for some, it is. Not all, though. And definitely not everyone.

The commercial I found, for Zenstral, appears to be low-budget and more like one of those as-seen-on-TV ads which is actually kind of creepy. My favorite thing is how the commercial emphasizes that her period is “natural” and feeling all of these symptoms is “natural”. It begins with this incredibly pissed off woman being annoyed by everyone at work. I guess she decides she has PMS because she goes out in some random field, dramatically rips off her jacket, and starts doing yoga. Though she never takes the pill or stops looking pissed off, the commercial narrates the “strict pharmaceutical grade standard” and all the “physical and mental symptoms” the drug relieves including normal things like “irritably, mood swings, anxiety, lower back pain, cramps, and fluid retention”. The entirely too angry girl is now seen on a date in a club, still looking pissed off, and the commercial says “you have enough aggravation in today’s 24/7 world” so take this pill. I’m not really sure what she’s so mad about at this point, I think some guy tapped her on the shoulder and walked away. She never consults a doctor or talks to her friends, she just looks angry all the time and the TV tells you to order your $30 value free trial. Yes, medication without a doctor. I’m convinced.

You can find the commercial here:

Mind/Body

The “culture of biomedicine” is an important concept because of the misconception that culture does not exist within biomedicine. Most people rely heavily on the Claim of Universality and the Claim of Objectivity to support their beliefs that biomedicine is the most rational, effective form of medicine and it will do it’s best to heal them. To elaborate, the Claim of Universality states that “biomedicine is a direct reflection of nature and a reflection of a universal truth”. This thought encourages that biomedicine is much more legitimate than traditional methods because it’s effects can be proven in a laboratory, despite the fact that a majority of people have never witnessed this themselves. Similarly, the Claim of Objectivity states that “biomedicine is value-neutral and autonomous from cultural context and human influence”. For whatever reason, Western societies put a lot of effort into removing all traces of religion and ritual from as much as they can in the pursuit of “equality” and “truth”. I’m not saying this isn’t a noble cause, but as we can see from this weeks materials, biomedicine and culture are actually impossible to separate.

The positive effects of the mind/body dichotomy suffer because of these trains of thought. As seen with the placebo effect, the mind is actually a very powerful tool in regards to healing. However, the process of the mind is often equated with religion and culture and so it is cast out in favor of solely focusing on the tangible and scientific body. Though Western medicine has proven that factors such as a positive attitude, strong support system, and personal environment have a beneficial effect on the healing body, this is often second-thought after the rituals of sterilization and surgery that are enacted to protect the body.

While Western society would like to separate the mind and body, my own anthropological background teaches me that things are never really as separable as they may seem. Mostly, this pertains to the fact that you cannot remove culture from a situation. Everything we do and believe is influenced by our socioeconomic surroundings, essentially, like our faith in biomedicine. So even when it fails to heal our bodies, our minds convince us to return.

True Life: I have Orthorexia

(While I was watching the episode a commercial for Midol came on and I rolled my eyes at the cultural construction – hehe)

Anyway, I watched the episode True life: I Have Orthorexia which follows three young people and their lives dealing with an eating disorder focused around an obsession with healthy eating. This is neither bulimia nor anorexia, but may contain elements of both. The stories follow the same basic pattern: they grew up with normal eating patterns, but some event or change in mindset lead them to become obsessed with their healthy eating for various reasons. All three take steps to improve their habits and selves, but the disorder will always be a struggle.The narratives given are in the style of restitution or quest, where finding a cure and making an effort to restore health is primary; Western ideals (namely body image) are prevalent. Different medical interventions occur, mainly in the form of therapy and stress-relieving techniques. The goal is ultimately to improve one’s self while managing the disorder.

The first example, a stay at home mom named Spring, will not eat any cooked foods and ultimately eats the same foods every day. This takes a toll on her social and home life. She actually avoids social situations because of the pressure placed on her to eat and cannot eat a normal dinner with her family. A similar situation occurs with Andrew, who is convinced processed food will give him cancer, and Lauren, who receives much grief from her friends and family because of her rigid eating habits. The stress and weight loss accompanied with the cultural emphasis on dining together takes it’s toll, however, they initially avoid admitting to the sick role. As a means of healing, all three see some form of therapist or professional such as dietitian to help them come to terms with the extremes of their beliefs.

Illness narratives are useful for patients/family/healthcare providers because they expose an experience that cannot be quantified in terms of a blood test or medical scan. The effects of disorders such as orthorexia nervosa may been seen in the form of low blood sugar and body weight, but that does not give any clues as to how to properly treat the disorder. When Spring admitted to her mom she was purging, her mother was able to use her own knowledge to help her heal, legitimizing her experience.

Fibromyalgia

Fibromyalgia is a complicated disorder because there are no true biological signs of it’s presence. As seen in the blog post given as an example of living with the disorder, fibromyalgia can cause any sort of physical discomfort that seems humanly possible. This includes but is not limited to severe aching muscles, irritable bowel syndrome, dry skin, stiffness, burning and tingling sensations, chronic fatigue, insomnia, and poor vision. Basically, the disorder is severe chronic pain that makes daily tasks extremely difficult.

Culture plays an important role in fibromyalgia because it is often equated to the historical concept of a woman’s “hysteria” and the manifestation of a desire to escape the role of homemaker, child bearer, and other responsibilities in order to fulfill the image of the damsel in distress who needs to be cared for. This makes it exceptionally difficult for men to come forward and manage their own experience with the disorder because the condition is thought of as being unmanly. In our culture, it is typically very degrading for a man to succumb to the female role in any way, so the way they manage their diagnosis tends to differ. Biomedically, a cure-all for fibromyalgia would have to tend to too many areas of illness. Symptoms can be treated individually, such as anti-anxiety drugs and antidepressants.

I think the lack of a cure and various ailments makes it very difficult for an outsider to take fibromyalgia seriously, much like one would view an illness like depression. Without any real evidence to go off of, it would be extremely difficult to treat the condition or convince others that it is not “all in your head”. I do believe that at least a portion of the disorder may be affected by personal beliefs, and a way to test this would be to perform placebo experiments on sufferers of fibromyalgia similar to the tests that were done on people suffering from depression. Results similar to the woman who was miraculously cured of her depression may actually occur, as even placebo surgeries have been shown to be effective. Personally, I have typically limited my use of medications such as pain relievers because I found myself to be “immune to the placebo effect” and therefore, the number or type of pill has always had limited effect on decreasing my pain.

 

Taijin Kyofusho in Japan

Taijin Kyofusho is a mental disorder that is essentially anthropophobia, which means the fear of interpersonal relations. The disorder is studied greatly from its cultural perspective, as it is especially prevalent in Japan and appears in various degrees and forms. Essentially, those with the condition suffer from severe introversion and anxiety. This anxiety and depression are the result of a tendency to focus on one’s weak points, such as “their own staring, blushing, facial expression, stuttering, bodily odors, blemishes and/or body deformities”. When an individual develops Taijin Kyofusho, the disorder begins with a hypochondriacal temperment and an accidental experience worsens the condition because the individual becomes very sensitive. The disorder is described as being different from typical social phobia, however. This is mainly because the patient does not suffer from social situations with friends and family, as is the case for social phobia. Also, those with Taijin Kyofusho are more focused on certain parts of the body.

A treatment for Taijin Kyofusho was originally developed by Masatake Morita, and the disorder is often conceptualized based on it’s treatment. Although the treatment has evolved over time, the original process was approximately 40 days long and involved various stages of isolation and activity. The Morita therapy was designed “to restore the patient’s mind to its condition before it was caught up in psychic interaction”. In the first stage, the patient was confined to bed rest and left alone to ponder his or her problems. The purpose of this stage is for the patient to learn that anguish leads to deliverance. In the second stage, the patient is still isolated but required to do simple chores. The third stage involves heavier chores. The fourth stage is more like modern treatments, with group meetings and lectures. The entire process has a very high success rate.

The treatment process for Taijin Kyofusho was developed around cultural values and mental processes. The treatment itself helps one to understand the disorder. Psychologically, the formation of ideas and beliefs were studied and approached. Biologically, the hypersensitivity and focus on certain body parts (resulting from these beliefs) can be broken down from the treatment. Cultural values and belief formation are what essentially separate Taijin Kyofusho from typical social phobia and form its prevalence in Japan.

Source: Journal of Psychosomatic Research
http://www.stanford.edu/~fumiko/publications.files/Maeda_1999JPsychosomRes.pdf

Shamans in Mongolia

The film The Horse Boy is about the journey and risks the family of four-year-old Rowan take in an effort to not necessarily cure, but improve upon his autism. Autism is a mysterious disorder in which the person lacks social skills but often possesses a very specific talent. In Rowan’s case, he has a special connection with animals. The constant tantrums that Rowan would have (except for when he was on a horse) lead his father to experiment with a journey to Mongolia, where shamanism and horses could be combined. Their first experience with the shamans was encouraging, as Rowan developed an interest in interacting with another little boy, something he had never done before. The shamans all agreed that the spirit of his mother’s manic mother was affecting the little boy. As their journey continued through the hills, Rowan’s progress was up and down, typical of autism. At the last shamanistic ritual the family participated in, high in the hills and reindeer herds of Mongolia, Rowan’s parents were told his autism would improve. Sure enough, his tantrums subsided and his social skills improved. His autism did not disappear, but there was significant change.

The healers in Rowan’s case were the shamans of Mongolia. Mongolia happens to be a country where shamanism is the national religion. Rituals involving much chanting, drums, whipping, trance and movement were used to drive away the negative spirit of Rowan’s manic grandmother. The specifics of shamanism and the ritual vary by location, and the most well-known shamans are highly respected. The rituals performed by the shamans required Rowan to at least be present, even if he wasn’t paying attention. Some rituals also involved physical contact such as holding him and gesturing with another hand over his body. An interesting point to consider about this relationship is that if Rowan were to have been into a society that practices shamanism, his condition may have resulted in being a shaman himself.

In rural Mongolia, people are few and far between. There are no hospitals nestled in the vast fields. So, the body is understood largely in terms of traditional (folk) medicine, with illnesses such as Rowan’s being credited to things such as spirits and bad energy. Whether Rowan’s improvement was the result of the shamans or being pushed to his limits on the journey cannot be proven, but the methods of shamanism serve its people well.

Bad Sugars

I scored a 5/10 on the health equity quiz. I’m not too terribly disappointed with this score, as I got the first four or so wrong and was expecting to bomb them all. As it turned out, the later concepts I was more familiar with. I was definitely surprised with the first statistic, that the US is placed 29th for life expectancy. There are senior water aerobics at the pool I work at, with plenty of seniors well into their nineties. I guess I didn’t consider that this is coming from a stable middle class population. I wasn’t surprised that Japan has the highest life expectancy, based on the limited knowledge I have of their culture.

In “Bad Sugars”, the alarming prevalence of Type II Diabetes among the O’odham and Pima Native Americans of Arizona is discussed. Research has found that diabetes rates are almost double in minority populations that historically have been ripped from their roots and caused excessive stress. Stress hormones increase blood sugar, and elevated glucose levels can block small blood vessels resulting in blindness, kidney failure, and amputation. The damming of Arizona rivers in the 1920s, such as the Gila, depleted the water source that these communities relied on, forcing them into poverty and a diet devastating for diabetes. Living below the poverty line has shown to be a major cause of diabetes, but luckily a new water preservation act is giving them their livelihood back.

Diabetes is a good example of how politics, economics, environment, culture, biology and individual choice influence the development, spread and treatment of illness. Political actions such as the damming of rivers (and likewise the effect of the environment) can determine the economic status of an individual and if they are more likely to live in poverty. Under these pressures, cultures may transition from a healthy diet to a poor diet as a result of their new limited means. Regardless of this, individuals may also be genetically predisposed for a disease or simply choose not to take care of themselves. Economic status and personal choice also plays a large role in whether or not a disease is treated. Culturally, diseases like Type II Diabetes may be regarded as simply “bad sugars” and a way of life, further impeding effective treatment. There are many factors involving Type II Diabetes, but those groups exposed to high stress and low income are the most susceptible.

Atrial fibrillation among white populations

My mother is a registered nurse working in the emergency room, so I asked her opinion of what she found to be the most common disease among people of typically European (white) background. Cardiovascular disease and atrial fibrillation were her suggestions, but cardiovascular disease is actually most prevalent among those who identify themselves as African-American. Atrial fibrillation, however, is the most prevalent among white populations.

Prevalence of Atrial Fibrillation by Race and Age

 (source: National Stroke Association, http://www.stroke.org/site/PageServer?pagename=afib_main)

Atrial Fibrillation is a condition the electrical signals or pathways occurring in the atria (top of the heart) are abnormal and erratic, resulting in an irregular heartbeat. When an irregular heartbeat occurs, the atria cannot contract correctly and as a result blood flow is reduced by their quivering. In 15 to 20 percent of strokes, atrial fibrillation is the cause. (source: Center for Heart Rhythm Disorders, http://www.nmh.org/nm/program-for-atrial-fibrillation?gclid=CLfEqtqzl7ECFYao4Aodyw3ofA)

In interesting aspect of Atrial Fibrillation is that while the disorder is consistently most prevalent among white populations, those of African-American ethnicity are still less likely to be diagnosed or treat the disorder even when they have it. In 2010, the American Stroke Association conducted a study called REGARDS thought found that “Electrocardiograms [ECG] done at the start of the REGARDS study showed 432 people (88 black and 344 white) in the study group had atrial fibrillation”, however, “blacks were approximately one third as likely to be aware that they had AF as whites”. This seems to indicate that the prevalence of AF among whites is largely genetic, but differences in diagnosis and treatment favoring white populations increases the disparity. (source: American Stroke Association, http://www.stopafib.org/newsitem.cfm/NEWSID/251/African%20Americans%20and%20atrial%20fibrillation/stroke%20incidence%20in%20blacks%20in%20southeast%20US)

Race, genetics, and health are intertwined in an intricate way, and this is especially true considering the debate over the existence of race. When drugs such as Bidil seem to be more beneficial to groups who identify themselves as African-American, race seems to exist. However, one has to identify as such, it is not the result of a medical test. The cultural complications of economic gain and past influences such as the eugenics project further complicate the issue. Genetically, health can be affected both positively and negatively. This is especially visible among African populations at constant risk of malaria. Those carrying a single sickle-cell gene are protected from the disease, however, two protected parents may produce a child with crippling sickle cell anemia. Consistently, race (social factors) and genetics weigh heavily upon one’s health.