Female Genital Mutilation in Sudan

The topic I chose is female genital mutilation in Sudan.  FGM is the term that refers to a variety of procedures that result in the complete or partial removal of the external female genitals.  FGM is also a manner in which men have control over women’s sexual lives. As stated in the article from Landinfo, it is estimated that 89% of North Sudanese women between the ages of 15-49 have been subject to genital mutilation.  Most women are subject to infibulation, which is the most severe.  This involves complete or partial removal of all external sexual organs.  Infibulation only leaves a small hole for urine and menstrual flow.

The origins of FGM are not really known but go back as far as 5th century B.C in Egypt.  Today FGM is a cultural issue.  Some consider it as a rite of passage.  The reasons behind FGM today are to maintain cleanliness of sexual organs, decreasing vaginal secretions that contaminate the female body, abolish sexual desire, and to maintain virginity and prevent promiscuity. Although in America we view FGM as inhumane, many women are in favor of upholding the custom.  In a survey of more than 5,000 women, 79% between the ages of 15-49 were in favor of upholding the custom.

In 1946, Sudan was the first African country to induce legislation against genital mutilation.  The current penal code, however, does not cover genital mutilation.  Its’ provisions on physical injury might cover genital mutilation.  Since this, girls who have not undergone circumcision tend to be ridiculed and looked down upon.  Although there was legislation against genital mutilation, not much enforcement has occurred.  There are only a few examples of practitioners being arrested but that is all the information that is known.

Ellen Gruenbaum is an anthropologist who spent five years in Sudan.  She learned that female circumcision is a strong cultural tradition.  In her book, The Female Circumcision Controversy, she talks about how there is an acceptance and resistance to change.  With the help of Islamic activists, Sudanese health educators, and educated African women there has been social and economic developments.

http://www.upenn.edu/pennpress/book/13443.html

http://www.english.emory.edu/Bahri/FGM.html

www.landinfo.no/asset/764/1/764_1.pdf

 

Clinical Medical Anthropology

The topic I chose is clinical medical anthropology.  The reason I chose this topic is because I want to go to medical school to become a physician.  I think this topic is very interesting.  America has so many different types of cultures.  I think it’s important to have an anthropological view when treating patients because not everyone has the same set of beliefs when it comes to healing.

In the readings this week there was a very good example of why it is important to have an anthropological view in a clinical setting.  The example comes from the article by Kleinman and Benson.  The case scenario is about a 24-year old exchange student from China.  She was having symptoms of palpitations, shortness of breath, dizziness, fatigue and headaches.  They couldn’t find an explanation for her symptoms.  There was, however, a psychiatric diagnosis of a mixed depressive-anxiety disorder.  She was put on meds and went through therapy.  Her symptoms improved but did not fully go away.  The student drops out of treatment.  After an anthropologic consultation it was found that her cousin in China is hospitalized for a mental disorder and that the stigma associated with this is so strong that the student’s family cannot even begin to think that their daughter has a mental disorder.  The student refuses to deal with her American doctors and that in China they use different terms to describe her condition.  After speaking with the anthropologist, they use different labels to describe the student’s condition and she decides to work with her American doctors again.

This is why it is important to have an anthropological view when dealing with different cultures.  As seen in the case scenario, western medical terms can sometimes be scary to people from other cultures.  Cultural factors are very important during the entire diagnosis and treatment process.  Not everyone from the same background has the same culture though.  As talked about in the Kleinman and Benson article, culture today is not homogenous or static. This is why it is important to have an anthropological view because America has such a mixture of cultures.  It will help create a better physician-patient atmosphere.

Kleinman and Benson – Anthropology and the Clinic

Life/Death

Biomedicine plays a huge role in our society.  Even though it is the norm for us it still has a culture of its own.  As seen in the lecture the cultural areas of biomedicine are- the institutional history of biomedicine, the language of biomedical facts and the rituals of biomedicine.  As we saw in the article this week about surgical room procedures, our culture is how the surgeon gets dressed and how the tools are used and taken out of the sterile packaging.   I think this is very important because it helps to make the patient feel safe.  Although this is the culture for us it make not be for other cultures.  As we have seen in earlier materials there are a lot of religious and spiritual rituals in other cultures.

The dichotomy I chose to talk about is life and death.  Most people would think those are two very straightforward topics but they are not.  There are many grey areas involved with life and death.  Depending on the person, life can be described very differently.  Some think that life begins at time of conception.  Others believe it is around 24 weeks in the womb or after the mother has given birth.  Death can be described in different ways also depending on the person.  Death can be when you take your last breath.  Death can also be if you are brain-dead or on life support.  I think that life begins at the time of conception and that death is when you take your last breath.  My views on life and death came from how I was raised religiously.

I think this dichotomy is accepted as logical because in our society everyone knows the difference between life and death, even if there are different views of when life starts and when death occurs.  It is seen as natural because everyone that is born is eventually going to die.  This is something everyone knows. It is a natural part of life.  This is seen as true because there is no in-between with life and death.  You are either dead or alive.

Obesity

The condition I chose is Obesity.  This condition has become medicalized because of the high increase and the other problems that come along with obesity.  It’s no longer just about being overweight.  There’s the high risk of diabetes, heart problems and other health issues. In the Conrad article, it talks about how nonmedical problems turn into medical problems such as illness or disorders. Our culture is very focused on being thin.  Thin is the norm. This is why I think obesity has become an illness because it is not the norm. Over the past few decades, our portion sizes have increased along with the decrease in the amount of exercise.  Americans eat more and more fast food and spend more time in front of the television. This has led to an increase in the amount of overweight individuals.  Also, our culture is so focused on celebrities and what we see in the media.  We try to look exactly like celebrities.  Celebrities are wealthy.  There is an economic tie between health and socioeconomic status.  Wealthier individuals tend to be healthier.  If we aren’t rich and can’t look like celebrities then we say we have an illness and therefore need medical intervention.

The ad I found was for Sensa on their website. The ad shows a reporter that lost 20 pounds by sprinkling Sensa on her food and that numerous people lost an average of 30 pounds in a 6 month clinical trial.  One of the advertising strategies used in this ad was that the spokesperson was a reporter.  Our culture is so focused on celebrities that using someone famous makes it more relatable to the consumer.  The other strategies they used were saying how the reporter was skeptical also before she used Sensa.  They also offer a 30-day free trial trying to convince people that this product will absolutely work.  The cultural values and ideologies used in this ad were that when using this product your diet and exercise plan didn’t change.  Americans are lazy and like instant gratification without hard work.  The fact that you can still eat unhealthy and not exercise but lose weight makes the product very appealing.  The only presentation of medical information is that it states the product is clinically proven in the ad.  The product is also available without seeing a doctor and without a prescription.

http://dm.trysensa.com/dms2904/index.cfm?action=page.home

I have Narcolepsy

I watched the True Life episode about two girls that are living with Narcolepsy and cataplexy.  The episode follows Julie and Katy.  Julie was recently diagnosed with Narcolepsy and cataplexy.  Katy has been living with Narcolepsy and cataplexy for a decade.  They both follow a chaos and quest narrative.  It is a chaos narrative at first because they are all of a sudden hit with the excessive daytime sleepiness and the cataplexy.  The cataplexy is a sudden loss of muscle control that often occurs with strong emotion such as laughing. This is also a quest narrative because they see the illness as a journey.  Both Julie and Katy find a good balance with the medication, which greatly improves their lifestyles.

Our culture isn’t very familiar with Narcolepsy.  There’s kind of a stigma related with it because most people aren’t familiar with the disorder and there is no cure.  The reason I chose this episode is because I have Narcolepsy.  I am fortunate enough to not have cataplexy and not as severe as Julie and Katy do.  I just have the excessive daytime sleepiness.  Most people don’t understand how you can be so tired all the time.  I experienced the same situation where I can’t fully function and be totally alert without the help of some medication.

The experience that Julie had with her doctor was a very scary experience for her.  She didn’t want to be put on medication.  Katy, on the other hand, was taking too much medication.  Julie eventually found a good balance with medication and going to a chiropractor.  Katy eventually took less Adderall.

The sick role for both of them eventually became unbearable.  They both knew their health is abnormal.  They both sought out the care of professionals and they were excused from regular responsibilities. They, however, found that they could not continue not going about a regular day.  Julie found she could not continue not doing things just because of her cataplexy.  Katy found she not continue sleeping in bed all day and not depending on her boyfriend for everything.

They both were apart of the complicating action of the illness narrative.  They both saw in increase in suffering.  Julie’s condition got worse because she didn’t want to be on medication.  Katy’s condition got worse because she stopped taking her medication.  They both went through the evaluation and resolution stage.  They were both suffering, decided to they were going to change how their life was going, and they both came out stronger because of it.

Sources: http://www.mtv.com/videos/true-life-i-have-narcolepsy/1672872/playlist.jhtml

Lecture 4.1 and 4.2

 

Post-traumatic stress disorder

According to PubMed Health, post-traumatic stress disorder (PTSD) is a type of anxiety disorder.  It can occur after any traumatic event that involved the threat of injury or death.  Usually when I think of PTSD I think of soldiers returning from war.  PTSD can, however, occur at any age and after many different types of events.  PTSD might be the result of assault, domestic abuse, prison and rape.  These are just a few events.  There are many others that can trigger PTSD.  The same event may trigger PTSD in one person but not in another. From a biomedicine approach, there is no test to prove whether someone has PTSD or not.  This is exactly the same for post-partum depression, which was discussed in the lecture.  In our culture, these disorders tend to have stigmas attached to them.  As talked about in the lecture, a mother with post-partum depression may be seen as being a bad mother.  Soldiers with PTSD may be seen as being weak.

Since there is a social stigma attached with PTSD and soldiers, they may not seek out treatment. In our eyes, soldiers are seen as very strong people and may be too embarrassed to seek treatment.  Since PTSD is such a common thing in soldiers, they may think they have PTSD without actually having it.  That would be the placebo effect, which was also talked about in this week’s materials.  For those that do seek treatment, therapy is usually the first step.  Support groups are also helpful.  In some cases, PTSD can cause depression.  In this case, anti-depressants or SSRI’s would be prescribed.

I think there is a strong connection between belief and healing.  There were some good examples of this in this week’s video on the placebo effect.  One example was the use of placebo surgery.  The video talked about two army veterans who needed knee surgery.  The study involved three different groups: Draining of the knee, draining of the knee and scraping of bad cartilage, and the placebo surgery.  Both veterans had the placebo surgery in which just the incisions were made on the knee.  All three groups had almost the same results.  No result was greater than the placebo effect.  I think that the mind is a powerful thing and has the ability to perform miracles.

Sources: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001923/

http://www.youtube.com/watch?v=QvbQnMvhQFw

Lecture 4.1

Taijin kyofusho in Japan and South Korea

The CBS I chose to research is Taijin kyofusho. Taijin kyofusho or TKS, is a cultural variation of social anxiety.  TKS is a clinical syndrome that is most prevalent in Japan and South Korea.  The syndrome, which translates as “fear of interpersonal relations”, can be divided into two subtypes.  The first is the neurotic subtype and the second is the offensive subtype. The first subtype can be divided into a classical type and an avoidant type.  The classical type is the fear of being negatively judged due to physical signs of anxiety and feelings of shame due to anxiety.  The physical signs that they fear of being judged for can include sweating and tremors.

The second subtype, the offensive subtype, is what distinguishes TKS from the typical social anxiety disorder (SAD).  The offensive subtype is comprised of two factors.  As stated in the article I read, the factors are “a belief that one’s self or one’s behavior is flawed, inappropriate or offensive in someway and a fear that these flawed social presentations will offend others”.  The symptoms that are associated with this subtype further distinguish this disorder.  Individuals within this subtype report symptoms that are considered delusional according to the DSM system.  These symptoms are all fears.  They include fear of body odor and intestinal gas, fear of having stiff facial expression, fear of staring at and making eye contact with others, fear of a deformed body and fear of blushing.

Culturally speaking, this offensive subtype of TKS is mostly present in Asian cultures but studies have shown other cultures as having symptoms associated with the offensive subtype.  It was reported that there was an African-American women who had a fear of offending others by staring at their genital region in social situations.

Treatment of TKS can be done through Morita Therapy.  Morita Therapy was developed in the 1910s.  The goal of this therapy is to restore the mind to before the patient was caught up in their social fears.  Morita Therapy was originally characterized by rest and discipline.  It is now, however, done on an outpatient basis and in groups.

Sources:

Marques, L and Robinaugh,D. Cross-Cultural Variations in the Prevalence and Presentation of Anxiety Disorders.  Expert Review of Neurotherapeutics.  Pp 313-322.  Feb 2011.

http://search.proquest.com.proxy1.cl.msu.edu/docview/850590512/abstract/1380AF0462730A5EA8F/10?accountid=12598

Maeda, F and Nathan, J. Understanding Taijin Kyofusho, Through its Treatment, Morita Therapy. Journal of Psychosomatic Research, Vol. 46, No. 6.  Pp 525–530. 1999

www.stanford.edu/~fumiko/…files/Maeda_1999JPsychosomRes.pdf

 

“A Doctor for Disease, a Shaman for the Soul”

The article I am summarizing is “A Doctor for Disease, a Shaman for the Soul”.  This article was about the increasing presence of Hmong shamans in Mercy Medical Center in Merced, California.  Approximately four patients a day are Hmong patients from northern Laos.  Part of the culture of the Hmong, is to have shamans perform ceremonies to help with the healing process.  As Mr. Lee states in the article he says that doctors are good with disease, but the soul is the shaman’s responsibility.  This hospital is the one of the first of many to include cultural beliefs as part of the healing process.

The healers are the shamans. I believe that shamans have a somewhat high social status since they are healers.  In the article, it states that shamans have the same unrestricted access to patients just as clergy members do.  Tame versions of the actual rituals are allowed in the hospital.  They tend to last about 10-15 minutes and they must have the patient’s roommates’ consent first.  Usually ceremonies have shamans go into trances for hours to negotiate with the spirits.  They do this negotiating with live animals sometimes.  During normal ceremonies gongs and finger bells are used to speed up the spiritual process.  The patient in the article had diabetes and hypertension.  Mr. Lee was trying to protect his soul from being kidnapped from the patient’s dead wife.  Mr. Lee interacted with the patient by putting a coiled thread around the patient’s wrist.  Two of the nine approved ceremonies in the hospital include “soul calling” and chanting in a soft voice.

The sectors that these shamans operate in are the folk sector within the professional sector.  They operate in the folk sector because they use healers and they take a holistic approach.  The shamans in this article are also within the professional sector because they are in a hospital setting working alongside doctors as part of the healing process.  The healthcare delivered in this system is delivered by performing any of the nine approved ceremonies. The Hmong believe that their soul is capable of wandering off or being kidnapped.  They perform these ceremonies to help the soul return to the body and keep it there.

Source:

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

http://www.nytimes.com/2009/09/20/us/20shaman.html?_r=3

When the Bough Breaks

I did very poorly on the health equity quiz.  I only got a few of the questions right.  I knew that the United States didn’t rank well on a lot of the topics but I was shocked at how low we ranked on most things.  The statistic that was most shocking to me was that Latino immigrants had the best overall health.  Since Latino immigrants are coming from a lower socioeconomic status you would assume that their overall health would be lower.

I chose “When the Bough Breaks”.  This video talked about the high rates of premature births among African American women.  The video talked about how, in general, someone with a higher socioeconomic status and a higher education tend to live longer and have fewer health problems.  Even African American women who had a high socioeconomic status and a higher education still had a higher risk of delivering a premature or low birth weight baby.  They came to the conclusion that racism plays a huge part in African American women delivering premature babies.  There is a two-fold risk of delivering a premature baby from those who experienced life-long racism.  Stress affects pregnancies in many different ways.  Racism is an add-on stressor.  Stress hormones can make labor begin sooner, which increases the risk of delivering a premature baby.  The video talked about a solution to this problem.  They talked about how African American women need to be taken care of from the time they are born so that when they have a baby it won’t have as high of a risk of being delivered prematurely.  The main solution would be to eliminate the life-long stress of racism.

In the video, it was discussed that in the 1980s, the government began cutting back on social programs and that rate is still increasing today.  When we cut back on social programs that affects people with lower socioeconomic status.  People living in the environment of low socioeconomic status already have limited options when it comes to health care.  Taking away these programs eliminates the choice they have when it comes to treating certain health problems and diseases, such as receiving proper care before, during, and after pregnancy.  Not receiving proper health care increases the odds of certain cultures of just becoming another statistic for health problems. Some cultures are just more prone to certain environments and certain socioeconomic statuses, but when the government steps in and takes programs away, the vicious cycle of problems associated with low socioeconomic status will just continue.

Cystic Fibrosis among White Americans

 

The health disparity I chose is Cystic Fibrosis (CF). The reason I chose this topic is because I had learned a little bit about it in my last class.   CF is an autosomal recessive disorder that is the most common lethal inherited disease in white Americans.  CF is a disease of the mucus glands and affects multiple organs systems.  Characteristics of CF include: chronic respiratory infections, pancreatic enzyme insufficiency, and associated complications in untreated patients.  Lung disease is the main cause of death.

The prevalence of CF in Caucasian newborns is 1 in 2,500 to 3,500.  Cystic Fibrosis affects about 1 in 17,000 African Americans and 1 in 31,000 Asian Americans.  The reason why it is so prevalent among white Americans is because the genetic mutation spread throughout Europe during the Stone Age. Approximately 1 in 20 white people have the silent cystic fibrosis trait.   CF, however, is only lethal when the mutation is inherited from both parents.

Preventing CF is not possible at this point because there is no cure.  There are medications and treatments that can extend the life of someone who has CF, which the United States has the highest survival age.  Based on a study it was found that males and people with a higher socioeconomic status have a higher survival age.  People with a higher socioeconomic status have more access to treatments and medications therefore have more opportunity to survive longer than those who don’t have access to treatments and medications.

Race, genetics, and health sometimes all go hand-in-hand but not always.  As we saw in the lecture about Sickle Cell Anemia and Malaria, these two were higher among the African races.  That’s because Malaria occurs highest in African countries.  Genetics obviously plays some part because Sickle Cell Anemia is higher in Africans but environmental factors also affect health.  There isn’t as much access to health care in certain African countries as there is here in the United States.  Therefore, people can’t prevent themselves as much from getting Malaria because they don’t have the same access to medications and treatments.

Picture of the Inheritance of Cystic Fibrosis

Sources: http://emedicine.medscape.com/article/1001602-overview#a0101

http://ghr.nlm.nih.gov/condition/cystic-fibrosis

http://www.nytimes.com/1994/06/01/us/cause-of-cystic-fibrosis-is-traced-to-the-stone-age.html?pagewanted=all&src=pm

http://www.medicinenet.com/cystic_fibrosis/page2.htm