Sexual Health in India: AIDS and HIV

India, currently being one of the most populous countries in the world is currently struggling with the vast spread of HIV and AIDS. This spread of this disease is of major concern since there are currently around 2.5 million HIV positive Indians and the spread has not slowed down. There are several problems that make this epidemic particularly hard to stop. The first is that there is simply not enough sexual education and aids awareness in the poverty stricken districts. This combined with the lack of condom use has resulted in the rapid spread of infections, especially among high risk groups such as sex workers, their customers and intravenous drug users. Another issue is the transmission of HIV from mothers to their infants. While this transference is preventable, it often occurs when the mother lacks knowledge of the disease, lacks funds to receive the anti-retroviral treatment, or is pressured not to take this action. A third major issue that interferes with the prevention of the transmission of aids is the culture itself. Many people see it as taboo to talk about sex related issues, and many are not willing to admit that sex occurs outside of marriages. Some of the organizations that are trying to help are the National AIDS Control Organization, which is a government run aids prevention program and UNAIDS, the Joint United Nations Program on HIV/AIDS. Both of these groups have attempted to raise AIDS awareness by increasing education and promoting safe sex habits (condoms).

An Anthropologist currently working in the field of AIDS and HIV study, particularly of that concerning childbirth transmission, is Cecilia Van Hollen of Syracuse University. She looks at the experiences of mothers throughout pregnancy, childbirth and nursing and how this is altered by HIV and AIDS. She also analyzes the transmission rates of HIV in India and how it often how negative cultural effects on the low class women.

 

http://www.avert.org/aidsindia.htm

http://www.unicef.org/india/hiv_aids.html

http://www.maxwell.syr.edu/faculty.aspx?id=6442451310

Global Health and Medical Anthropology

I choose Global Health and Medical Anthropology because it is a subject that interests me and one that I feel needs more attention. This type of medical anthropology focuses on the cultural, political and socioeconomic factors that revolve around health and healthcare around the world in both industrialized and developing countries. I have always been interested in why some cultures are able to provide a large degree health care to their citizens, while others in similar situations are unable to do the same. The cultural and political factors are of particular interest to me, since they shape the countries entire perception of health care and thus how the medical system is utilized. And although a biomedical approach might be considered best by most westernized people, these factors can either steer the population to embrace this approach or to find a different one that suits them.

In working for a non-anthropologist healthcare provider, there are several ways that an anthropological approach could benefit the patients. The most important way is by helping the patient and the provider to understand one another. By understanding the cultural, political and socioeconomic factors that affect the patient, the provider much more likely to be able to foster trust between himself and the patient, and to be able to develop a treatment plan suitable for the patient. A good example of where this could help was mentioned in the lectures concerning Malaria and how the nets meant to keep out mosquitos were be being ignored or improperly used. If anthropological skills had been put in use, the healthcare providers may have foreseen the problems of the nets and attempted to come up with a more viable solution. The patient’s entire lifestyle, not just their bodily health, needed to be considered, since it was being affected. This type of approach would also help the provider discern whether the patient is likely to comply with a treatment, what subjects are taboo and what factors might prevent the restoration of good health.

Erectile Dysfunction

I choose to analyze the illness of erectile dysfunction in our culture and why it is a biomedical approached is considered to be necessary to treat it. In our culture, the inability to get an erection is seen to lessen the masculinity of a man and as a result people are desperate to prevent this. The social effects from this illness could be devastating and make one the subject of ridicule or quite possibly hurt their station in the workplace. On a political level, erectile dysfunction is not really considered to be a pressing issue; however the drug companies who make money from ED medication do have a political influence and seek support in their endeavors to keep ED as a medical condition. This has a large economic impact as there is a lot of money to be made from selling this medication and men in our culture are willing to pay quite a bit to be rid of this condition. This diagnosis of ED as an illness influences the sufferers to seek treatment, which is usually pharmaceutical, and alters their perception of the condition. It also puts more stress on the patient since they now have another issue that can lead to potential problems if not treated.

http://www.youtube.com/watch?v=k05S4C5XZc8

Like many people in our culture, when I think of erectile dysfunction I immediately remember a Viagra commercial. The commercial itself uses the metaphor of things getting in the way of two peoples relationship and likens erectile dysfunction as one of those. The people then choose to throw all of these things, such as the television remote and magazines out the window before starting to dance. While listing the warnings and side effects it shows the two people going into a room and shutting the door with an obvious allusion to sex. This plays on our cultures ideas about sex and that every man should be able to have sex as the situation arises. The social roles shown are an older man still being able to have fun and enjoy life (successful), if he can still have sex. It presents medial information in the sense that it tell the side effects and warning in while it builds up the commercial. This commercial portrays doctor patient interactions by suggesting you consult a doctor to see if Viagra is a viable way to treat your erectile dysfunction.

Life/death

When we talk about the culture of biomedicine, we are talking about the fact that while most people claim biomedicine is separate from culture and is universal to all people, it is actually heavily influenced by culture. From our lectures we learned that it is constantly influenced by culture, and changes over time with our culture (western culture). It also has a noticeable effect on western culture, as it help us determine what and how is an illness and how most medical situations should be handled. The examples of germ theory and antibiotics were mentioned to show of how it played an enormous part in changing our culture since both germ theory and antibiotics revolutionized the our knowledge of medicine and what was possible with modern science.

I like the dichotomy of life and death, because it is one that we usually consider to be concrete, when in reality the two can sometimes be hard to separate. In western society, we either view people as alive, or dead, but not somewhere in between. There are certain cases, such as when a person is declared brain dead, where even though we see the body as alive, we see the mind as dead, and thus some people see the person is dead while others consider this person to be alive. I am of the belief that if the person is no longer to control their actions, and they are not able to make thoughts or provide responses due to no brain activity, then they are dead. I also would put this standard to newborns, where if they can be shown to have brain activity, then they are alive. I think I have adopted this view because of my belief system, how I was taught to view life and death and my trust of modern biomedicine. As for this dichotomy being accepted in western society, I believe that this is fairly evident. The society see’s a person as alive and able to have some type if impact in the world or the people around them, or dead when they stop breathing and cease to live. They do not really think that there could be anything else rather than alive or dead. You are either alive or you’re not.

True Life: I Have Diabetes

This episode is basically the story of three younger people who have diabetes. One is forced to move back in with her mother when her medical bills pile up, another is having troubles adjusting to college life and drinking with diabetes, and the third is diagnosed with diabetes during pregnancy. What ends up happening, is that the first has to work long hours to ensure that she is able to pay her bills, and conflicts with her mother before finally becoming financially stable. The college student must balance his drinking with his illness, and although he becomes sick on occasion from drinking, he continues to do so, while monitoring his blood sugar. The pregnant woman has complications in birth due to her diabetes, which compels her to induce a forced labor to have her child early. All of these individuals have aspects of the three types of narratives, but they mainly fall in the restitution and chaos categories. They see diabetes as an affliction that they can never be cured of, but something that they can manage with careful monitoring. The first two are able to deal with their illnesses, and recover normalcy in their lives, making them fit into the restitution category, even though they can never fully recover. The third however, is show to be unable to deal with this illness and is brought back to the emergency room multiple times.

There is no real stigma attached to people with diabetes, due to it mainly being manageable and non-noticeable in everyday life. These people are expected to monitor their blood sugar, keep track of what they eat and to give themselves shots of insulin if necessary.  They all experience medical professionals in a similar manner. The doctors basically tell them how they are doing with their diabetes and what they could do better. While the illness narratives help these three people put their illness in perspective, it does not play the same type of role that narratives for alcoholics or cancer patients might play. Whereas these the alcoholics and cancer patients might form support groups as mentioned in the lectures, diabetes patients don’t see their illness to the same degree, they see it as more of an irritation and annoyance that could hurt them, rather than something directly against their health.

Restless Leg Syndrome

Restless Leg Syndrome, as explained in the lecture, is the inability to keep your limbs still, since they develop extremely irritating, or uncomfortable sensations when not in motion. This illness is pretty much thought of as a joke in our culture because people have trouble believing that this sensation actually exists and that it can have such a tremendous impact on the afflicted’s life. Since it is often laughed at, many people will try to suffer through it, or be embarrassed to consult a doctor about it, which can lead to needless suffering.  Another issue with RLS is that it is hard to rate how much pain or suffering a person actually experiences from it. Our societies biomedical approach is not very well suited to rating pain of an illness that does not have readily apparent (visible) effect. As shown in the lectures, the scale to rate pain would not be of much use, and the actually symptoms are fairly hard to describe.

Since there is no definitive answer on what causes Restless Leg Syndrome, or any consensus about a biomedical explanation, it is hard to successfully cure. In the US, doctors may suggest lifestyle changes to help combat the effects, or they may turn to pharmaceutical solutions, but since they do not understand the root cause of the illness, they cannot truly cure it. All the doctors can do is treat it, which may help, but will not eliminate the underlying causes of RLS.

I happen to believe that there is an important connection between belief and healing. When someone believes in something enough, their desire to make it become reality can effect most aspects of their life, and even cause their body to jumpstart its healing process. This is shown multiple times in the Placebo film, for both observable medical conditions such as a wounded knee that have been traditionally treated with surgery, and with mental disorders such as depression, that are usually treated by pharmaceutical means. Overall, I would say that the mind can cause psychosomatic illness, that manifest physical symptoms and it can create psychosomatic cures to alleviate or cure physical conditions.

Hwabyung of Korea

 The article that I read, Hwabyung in Korea: Culture and Dynamic Analysis, by Sung Kil Min was a look at Anger (fire) disease which is known as Hwabyung in Korean culture. What the disease basically entails is a strong feeling of anger with related behavioral and bodily symptoms. The anger is seen as a reaction to being the put in an unfair situation, usually social in nature and must be suppresses so as not to interfere with familial or social relationships. This suppressed anger continues to build till it finally causes Hwabyung, which can show itself through heat sensations (hot flashes redness of the face), somatization, respiratory oppression, insomnia, anorexia, depression, anxiety, and behavioral symptoms such as sighing, tearing, and an impulse to open doors or go out from closed situations. An interesting aspect of this is that even though patients become very depressed, they are still extremely talkative. Hwabyung symptoms are thought to symbolize the nature of fire, and other symptoms such as the open of doors are seen as the release of anger. Culturally, there is a unique sentiment known as Haan, which signifies the mixed mood of missing, sadness, suppressed anger and feeling of unfairness that results from societally tragic history, as well as from traumatic personal trials. This could be a product from any number of things including a failed romantic relationship to lower family class, to being swindled. An accumulation of feeling of haan and the inability to deal with such has been reported to be a major reason behind Hwabyung. While the disease has mostly been known for effecting women, it is also recognized for effecting people in the lower social class.

Treatment of this disease is varied from person to person. Often sufferers will go to physicians, pharmacists, traditional herb physicians, Christian faith healing, shaman rituals and psychiatrists looking for treatment. The methods used to combat this disease can be psychotherapy, drug treatment, family therapy, community approaches, often integrated with traditional and religious healing methods or through the use of haan-puri, which is basically the sentiment of resolving, loosening, unraveling and appeasing negative emotions with positive ones. An example that Min gives of this is if the haan of a mother was caused by poverty, and a violent husband, the haan-puri might be a result of the success of her son, for which she endured the hardships for.

Sung Kil Min. Hwabyung in Korea: Culture and Dynamic Analysis. World Cultural Psychiatry Research Review, Jan 2009 accessed 7/20/12

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

Shamans In Hospitals

The article A Doctor for Disease, a Shaman for the Soul written by Patricia Leigh Brown, is a look at how the Mercy Medical Center in Merced, CA employs shamans such as Va Meng Lee to help care for patients. They are allowed in the hospital and allowed access to patients, similar to priests. The doctors have chosen to incorporate these shamans into the system of care because they feel that these shamans help the patients with spiritual concerns, which in turn allow them to better recover from illnesses. The cultural role of these shamans is rapidly becoming more apparent, as many patients feel that they need spiritual healing as well as physical. This also helps creating trust between the communities and the doctors that can be invaluable in dealing with sick individuals. The shamans are first entered into a training program, where they learn aspects of western medicine, and are upon completion given badges that allow them recognition by the hospital. Shamans such as Mr. Lee are allowed to preform ceremonies of healing (spiritual inoculation) to safeguard the patient’s soul form wandering on its own or being effected by malevolent spirits. Even if the rituals are not the cause of healing, the social support and belief aspects has a positive effect on how well the patient recovers from his or her illness.

In this case the healer is the shaman Va Meng Lee who is considered to be a healer in Hmong culture. Through the use of rituals, he is able to protect the souls of his patients and help them overcome illness. He serves not only a comforting factor, but is directly responsible for how the patients view medicine and healing in a cultural sense. In terms of sectors, shamans are a part of the folk sector, as they share the cultural tendencies of the Hmong people and use a holistic approach. These shamans feel that the body and the soul are intrinsically connected, so what effects one will have an effect on the other.

White Americans and Cystic Fibrosis

The health concern that I choose to research was Cystic Fibrosis in Caucasian Americans. The main reason that I choose this disease was because it has a large rate of occurrence in Caucasians, and because it is difficult to find a disease that more disproportionally occurs white Americans when compared to other groups.  The disease itself is inherited and primarily affects the lungs and digestive systems. It is causes by a defective gene that produces a protein that causes mucus to be abnormally thick and sticky. This can cause a number of symptoms such as salty tasting skin, constant coughing sometimes with increases mucus, shortness of breath, impaired growth,  weight loss, constipation, loss of appetite, bloating, abnormal stool, fatigue, nasal congestion, increased chance of pneumonia, sinus pain, and inflammation of the pancreas.

 http://www.meddean.luc.edu/lumen/MedEd/genetics/diseases/cf_1.jpg

                Although the risk of Cystic Fibrosis is prevalent among many Americans, it is disproportionately found in Caucasian Americans with ancestry from central or northern Europe. This is mainly because of the genetic factors that determine if you will born with Cystic Fibrosis are predominant in Caucasians with European backgrounds. Although there is no cure for Cystic Fibrosis, there are multiple forms of treatment aimed at extending and increasing the quality of life of those afflicted. These treatments include antibiotics, enzyme therapy, pneumonia vaccines, oxygen therapy, special diets, vitamin supplements and lifestyle treatments such as avoiding smoke and dust and drinking more fluids than usual.  The average lifespan on someone with Cystic Fibrosis is about 35 to 40 years, which is a drastic increase as compared to the last 50 years.

                The relationship between race, genetics and health can all become readily apparent for most circumstances if you look for it, but are not present in all situations. A good example of the three relating to each other would be the malaria and sickle cell anemia that we discussed in class, but many illnesses can just as easily be a result of only one factor such as the Chernobyl accident.  In that instance, many people were made ill, but race and genetics had very little to do with the cause and prevalence rates.

http://www.lung.org/assets/documents/publications/solddc-chapters/cf.pdf

http://www.cff.org/AboutCF/

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001167/

http://www.meddean.luc.edu/lumen/MedEd/genetics/diseases/cf.htm

Not Just A Paycheck

I managed to get 7 out of 10 on the Health Equity quiz, which was not much of a surprise.The only question that actually stuck out to me was question regarding recent Latino immigrants. That they have better health than us is not really surprising, but it does point to the larger issue of poor health in a very affluent culture. If people are coming to our country to improve their lives, their health should improve along with other aspects of their life. Our affluence and culture are the very things that are worsening the citizens’ health.

                Not Just a Paycheck was a look at the effects of an event (corporation shutting down a plant) that causes the loss of multitudes of jobs and how the community is effected in regards to their health. This case showed how the town Greensville, MI was adversely affected after the shutdown of the Electrolux plant. The plant was moved down to Juarez, Mexico, and a large portion of the population in Greensville became unemployed. This created tensions that had serious health risks, not only for the unemployed workers, but their families as well. The additional stress causes health issues such as depression, gastrointestinal issues, and cardiac problems. These workers are then compared to the wealthy that live in the surrounding region. These people unsurprisingly show very little of this stress and have access to better health care in general. The workers are also compared to their counter parts in Sweden who have undergone a similar circumstance, but do not show these adverse health effects. The program examines the differences in support that the workers in Sweden gain from the corporation and government programs and eventually suggests that this aid has a tremendous impact on the health of workers. Basically it summarizes that if the population in Greensville, MI had received the same type of aid, they would not have suffered as many health related issues from the closure of the Electrolux plant.

                Politics, economics, environment, culture, biology and individual choice all have an enormous influence on the development, spread and treatment of illness. You culture and politics effect what you perceive as illness, where your environment, political situation, economic situation, cultural ideas, biological issues and individual choices all help to determine how you react to and treat illness. These reactions can determine if an illness spreads or if it is contained and treated.