Malnutrition in Nepal

Malnutrition is one of, if not the largest health problem in the world.  It is directly linked to disease, whether as a result or a contributing factor (quite significantly).   There are two main types of malnutrition: protein-energy based malnutrition, which is a lack of enough protein & energy providing food (all basic food groups); and micronutrient deficiency, which is lacking in vitamins & minerals.  Though debated, there is thought to be a third as well: Obesity, because malnutrition is a lack of nutritional value rather than food.  Malnutrition can reduce physical and mental development in children, causing stunting in growth & weight gain, mental retardation & brain damage, and even sight problems (including blindness).  It can also pose danger to women pre & post natal: babies may be low birth-weight (starting out malnourished), a mother may have hard time producing breast milk & it may not have health content if she does, or the mother may not survive. These things are particularly true in developing countries, such as Nepal, given the poverty stricken communities and their lack of adequate water supply and/or food, combined with a lack of education.  Many government programs and NGOs are dedicated to helping with this problem.  For instance, UNICEF, WFP, WHO, and Helen Keller International, all have major programs just in Nepal (some elsewhere as well).  Helen Keller International has set up the Action Against Malnutrition through Agriculture (AAMA) project, to help educate people about proper nutrition and how to provide for this themselves (1).  The United Nations Childrens Fund (UNICEF) and similar aid programs are setting up outposts to reduce travel time for receiving care, educating parents on malnutrition, and are providing people with ‘high-protein packages of food’ for malnourished children.(2) Simillarly, the World Food Programme (WFP), is providing micronutrient powders & fortified blended foods to provide or supplement nutrition in diets.(3)

I found information on several anthropologists that have worked in Nepal, many as medical anthropologists.   However, the research itself was harder to come by.  The research I found to best fit my chosen global issue is from Dr. Linda Stone, a cultural anthropologist, and professor emeritus at Washington State University.  Her research focuses on traditional medicine and religion in Nepal.  She has worked on “development projects in Nepal concerned with the introduction of modern medical options and their integration with local cultural understandings of health and illness.”  She also has worked as a consultant to the World Health Organization, as well as the Food and Agriculture Organization of the United Nations in Nepal. (4)

 

 Sources:

http://www.wfp.org/hunger/malnutrition

http://www.worldhunger.org/articles/Learn/world%20hunger%20facts%202002.htm

1)  http://one.org/blog/2012/05/08/take-action-against-malnutrition-in-nepal/

2)  http://www.soschildrensvillages.org.uk/charity-news/archive/2011/07/fighting-malnutrition-in-nepal

3)  http://www.wfp.org/nutrition/how-wfp-fights-malnutrition

4)   http://libarts.wsu.edu/anthro/Faculty/stone.html

Public Health and Medical Anthropology

Although I plan on becoming a Physicians Assistant, and will probably end up working in a clinical setting, I chose to look at Public Health (have considered studying this instead and would actually love to work with the CDC &/or in another country).  Public Health focuses on improving ‘health and quality of life through the prevention and treatment of disease and other physical and mental health conditions.’  Not only do I find this area very interesting, but I also feel its an immensely important part of health care.  It’s important that society understand how to keep themselves healthy, and how to prevent disease, illness, and/or injury.  Prevention, although not always enforced in our society, is crucial to a long healthy life.  With proper knowledge of preventative measures many health issues could be avoided, and life sustained.  As health care professionals, it should be our job to educate and help patients accomplish this.

When working as, or with, a healthcare provider, prevention and therefore public health is one of the most useful tools available.   Anthropology, or the use of an anthropological view, is another one of these tools that can prove very useful, and important, within the health care system.  An anthropological view allows for a better understanding of ones community, surroundings, beliefs, varying ideas on dichotomies, etc.  It provides an overall better understanding of ones patient(s).  This is particularly important when working with those less fortunate, or when working to educate and prevent disease & illness, especially among those of other cultures & beliefs.   These things may be a major reason for a person, or society, behaving the way they do, and/or seemingly turning away medical help.  For example, as discussed in course materials, people in Africa were given bed nets to help fight malaria via mosquitoes, but are refusing to use them because the nets are viewed as dirty or poisonous.  Or (also from course materials) in a case of contaminated water in Peru: despite being told boiling would clean the water thus improve health, the people refused to do so, because boiling would also destroy the spirits they consume with the water, connecting them to the earth.  These are perfect examples of how understanding other cultures and beliefs are necessary when trying to help prevent and cure people of illness or disease, and why, even non-anthropologists should use this understanding to better their skills and practice.  It’s important that everyone keep an open mind, especially when working with people of differing views and beliefs (not necessarily always from different cultures or societies).

 

http://en.wikipedia.org/wiki/Public_health

http://www.whatispublichealth.org/

 

 

Obesity

I chose obesity because it is a significant problem all over the world, but especially in the U.S.  It is becoming increasingly biomedicalized within society.  The Conrad article states, “Most medicalization studies focus on how nonmedical problems become defined as medical problems, usually as illness or disorders.”  This is evident in that obesity is no longer just about being overweight.  The condition itself is not considered an illness, but is commonly linked with other concerns such as diabetes, heart problems and other serious health issues.  These obvious health issues combined with societies ever growing obsession with being thin (and finding an easy fix to get there) are main reasons why obesity has become so biomedicalized.  Add to this the increase in portion sizes and decrease in exercise & general activity that has occurred throughout society over the past decades.  Also factoring in that it is far cheaper to eat processed food than healthy, and often times easier, faster, & cheaper to eat fast food.  Most people, unless provided with access to fitness & meal plans(typically common among upper class individuals), are thus unable to compete with what society says is normal/healthy and seek the easiest most attainable way of achieving this – because looking like celebrities is seen as healthy and therefore symbolizing wealth (seemingly gives higher socioeconomic status), and vice versa. The fact that insurance companies cover such quick fixes as surgery and diet pills, and that advertisers make a profit off of these ideals & desires cemented in our culture have helped to catapult obesity to its biomedicalized status in society.

Nowadays, there are so many things that one can do to aid in weight loss, from surgeries, to medication, to diets & nutrition supplements. And so many different types of weight loss supplements out there, with so many different celebrity sponsorships, its hard to go five minutes without somehow being bombarded with information on how to loose weight and/or get the perfect body (preferably with minimal work or change in routine).  I managed to find a couple advertisements, one from Nutrisystem, the other from Weight Watchers (I know there are many more out there). Both use celebrities, Janet Jackson & Jennifer Hudson (both symbolize strong female role models/idols), as spokespeople, talking about their weight struggles and how they’ve overcome them.  This is done to show that even celebrities, seen as perfect, who we idolize are human, and have their imperfections. These imperfections, which they have ‘struggled’ with allows for a connection to the intended audience, suggesting ‘if I can loose weight so can you’.  Also, both suggest no need to change eating habits or daily routines, which is key in selling diet aids in our culture, filled with busy & lazy people.  Another key point used in both these ads, is that although both women are popular among many, they are both symbols for black women to relate to, expanding audiences, and opening doors for the advertisers to make even more money.  Another example of this expansion of audiences are the recent Weight Watchers commercials starring Charles Barkley, relating to & advertising for mens weight loss (even when dressed in drag – http://youtu.be/Vs57GZYHtdM )

These mention nothing of doctor patient interactions, or any other medical information, but are more focused on self improvement.  This is to be expected with the way obesity is viewed, particularly in our society. Also with our cultural obsession of thinness, which should ideally be on health instead, no matter what size you may be.

 

 

Life and Death

The ‘culture of biomedicine’, the culture within the biomedical system, the most prominent and relied on of the western society, is a combination of three things: History – how medicine and theories have evolved over time shaping what the culture of biomedicine is today and how we feel about it; The language of biomedicine – how we incorporate social values into medicine (illness narratives, etc); And the rituals or symbols of biomedicine – the sterilization, techniques, & uniforms used in hospitals/operating rooms, or the hospital being seen as a place for healing, a prison, factory, school, and/or a mini village.  These things disprove the common misconception that culture does not exist within, or influence biomedicine. The critical approach is used to do this and to show how biomedicine is a ‘part’ of western culture, rather than the whole.  One of the biggest of these misconceptions is the belief that biomedicine is an objective science autonomous from culture, when in fact it is one of the most influential institutions in western society.

I believe cultural influences play an important role in dichotomies.  Also a major contributor is, one’s education (the level, type, area, etc). Both influence the way one thinks, and views the world, and therefore how they may classify or analyze certain dichotomies.  In my opinion, being someone who sees the world in various shades of grey (nothing is black or white!) many dichotomies are hard to analyze and may be seen as controversial.  Most things do not belong in one category or another, and often there is need for a little wiggle room when dealing with such issues.  Also, these are typically based on an individual belief rather than some universal definition. Trying to convince someone to believe another way is often quite difficult.

Although it may be the obvious choice, I chose to discuss the dichotomy of Life & Death.  At first glance, it seems very simple and straightforward.  Either you’re dead or you are alive, right?  But, as discussed earlier, nothing is black or white, and our society seems to have a particular obsession with this dichotomy.  It is so ingrained in our culture, it causes major controversies, and is even part of our politics.  With all the new technology and research constantly being done, it’s easy to see why that is. The lines between life and death seem to become messier by the minute.  In my opinion, life is much easier to define than death is.  Life, as debatable as this may be, begins when a fetus can survive outside its mother’s womb (somewhere around 24wks).  Death, on the other hand, is often measured as when someone needs life support to survive, but I think I lean more towards once they are brain dead. I honestly don’t know, it’s so hard to tell and is really dependent on personal opinion and experiences.  Because of these differing opinions and definitions, the varying ways of analyzing, and other discrepancies, this dichotomy as well as others are accepted by western society as logical, natural, and true, even when contradicting each other.

Fibromyalgia

Fibromyalgia as defined by the Mayo Clinic “is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.” This is extensively minor in comparison to what was described in the blog we read for class, written by a woman who suffers from Fibromyalgia.  The symptoms she described were heavy on the pain (chronically) and were a range of anything (& everything) from severe and concerning to bizarre and stressful, and everything in between. Even more confusing, is trying to find accurate information about it (most sites are either very scarce or overly detailed). The symptoms can vary so much from patient to patient, & from day to day, that no one is even really sure what it is, how its caused, or how to treat it. It is incredibly hard to diagnose, is often misdiagnosed, and in order to be diagnosed one must experience the chronically widespread pain for at least three months.  Once diagnosed, its often treated with a myriad of pain medications, sleeping pills, therapies, and/or at home remedies.  Living with Fibromyalgia, as with most chronic conditions, makes it difficult to function normally.  This is made even more difficult by the inability of others to fully understand what you are going through, and how you can look or seem so normal yet be so sick.  It’s an incredibly frustrating experience.  Its certainly not for the weak of heart. At least not in a society such as this.

Most of the treatment regimens used for Fibromyalgia are medications or other biomedical treatments typical of western medicine, as discussed previously (one of the medications prescribed to help treat Fibromyalgia is also used to help treat seizures b/c it focuses on the neuropathways & was suggested to me as an add on at one point, which shows the span of theories & treatments used). These don’t necessarily work because, there is no actual set of symptoms to be treated. Which is why most patients treat each individual symptom as it occurs, and simply learn to manage or deal with the untreatable.  I would like to see a more holistic approach to this condition.  It would be interesting to see a shaman’s approach.  Or how a placebo would fare?

I found the Placebo video really interesting.  I’m a firm believer of ‘mind over matter’ & that the brain is an amazing organism, capable of even more amazing things.  But placebo surgery still plagues me.  It made me wonder if it would work for conditions other than pain.  But the example that completely got me was ‘the elephant boy’. He was born with an incurable skin disease, and was hypnotized to have his skin clear.  coincidence or fluke? Either way, its pretty amazing that his incurable disease was cured!  These, along with the depressed lady who felt so much better she was sure she got real medication not placebo, are all perfect examples of the connection between belief and healing.  Not that I needed to watch a video, or learn about placebos to know this. From my own personal experiences, I know that if you have a positive mental attitude, going into surgery or when dealing with a medical issue, your outcome is always that much better!

 

Mayo Clinic: http://www.mayoclinic.com/health/fibromyalgia/DS00079/

PubMed: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001463/

webMD: http://www.webmd.com/fibromyalgia/default.htm

I’m Allergic To Everything

This episode of True Life follows two teenagers, Raelyn and Zeke, whose diets are so limited due to food allergies that it effects not only their health but their daily lives.

  • Raelyn, diagnosed with idiopathic anaphylaxis, is seemingly allergic to nothing in particular.  She is required to take caution with everything she ingests, for fear that she may have a reaction of some degree.  She keeps benedryl & epi-pens on hand at all times. Some reactions are so bad, she goes into anaphalactic shock, has a seizure, and / or requires a trip to the hospital.  Eventually, after unsuccessfully trying everything with traditional biomedicine, she goes to a homeopathic physician, where she is able to find results. Her goal is to be able to function at a degree that she can attend college like a normal person her age.
  • Zeke, has so many food allergies, that he is required to drink a nutrient rich formula (42oz.) on a daily basis in order to supplement what he is unable to gain from such a limited diet.  With hopes of at least decreasing his amount of formula, he is constantly running food tests, in drs. offices (scratch tests on arms) or at home (trying eating), so as to add so more foods to his diet.  Some of these tests work with great success, while others with little to no success at all.  He also has to have biopsies done of his throat to make sure, everything is alright (which it is).

Both teenagers are required to be responsible (more than the average of their age) about what they eat, how they feel, and what might trigger an ‘episode’.  Its not an easy way to grow up, especially when others may not understand.  Dealing with something like that often causes one to grow up much faster, and be more responsible & mature than average.

I would categorize this as a quest narrative, because they are learning to cope with what is wrong with them. Although they are looking for a cure, as most ill people are, they really just want a way to live a normal life while dealing with their medical issue.  And taking part of this narrative is a way for them to do that, it shows others as well as themselves that they can be normal even with a debilitating medical issue.  The narrative itself, is used as an informative, as well as entertainment piece (thanks to mtv & reality television).

I believe illness narratives are important and useful in all aspects, and to all involved.  It helps the patient, family and friends to deal with what they have been through, or are going through.  It allows the healthcare providers a sense of understanding for the patient that they maybe wouldn’t have had otherwise. It also, allows for a feeling of connectivity, belonging, and even respect, among the patient and others of similar situations.

 

ADD/ADHD in America

I chose to ADD, or ADHD because the majority of my family has it, including myself.  Most of my family is either on, or has at one time tried, medication for it. The exceptions would be myself, being epileptic it’s not something I’m able to do and have learned to make do, my grandfather, who used it to his advantage running his own dental practice, and the few who have not experienced any problems due to it.  However, as prevalent and obvious as it is in my own family, I believe its often over diagnosed and even more often over medicated.  With a CBS, as with any, so prevalent among society as ADD (affect up to 1 in 20 children in the USA) its difficult to take a step back however. ADD is actually just shorthand for ADHD, which is a behavioral disorder characterized by symptoms of inattention and/or impulsivity and hyperactivity.  These can significantly impact on many aspects of behavior and performance of ones life, and can do so throughout childhood and well into adult life.   I read an article that suggested ADHD may not be as predominanetly american as it seems, it merely caught on quicker here & we’ve done more research. It argues both sides, arguing social & cultural stresses are causation.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525089/

Clown Doctors: Shaman Healers of Western Medicine

The article Clown Doctors: Shaman Healers of Western Medicine, made the comparison of clowns, in western society, to healers from traditional societies, particularly shaman.  It did this both with physical similarities (costumes, make-up, props, music, ventriloquism, ‘magic’ or sleight of hand, puppets, etc.) and with their cultural defying performances, used to employ social healing.  They use suggestion, and manipulation of cultural symbols used in society’s medical system in an attempt to alleviate the patients distress.  The Clown Doctors of The Big Apple Circus Clown Care Unit (CCU), not really doctors but clowns, are a perfect example of a complementary therapy used to enhance the efficacy of medical treatments in developed nations, particularly with children.  The clowns help alleviate stress from the hospital environment, helping not only the children, but their parents, and the staff as well.

The healers of this article are the clowns, in emotional or psychological regards as opposed to the typical biological aspect, both of which are extremely important to proper healing.  I think one could argue about the social status of the clown doctors.  Many are properly educated and probably of middle class outside the hospital.  However inside the hospital setting, its hard to say where exactly they would rank, but I would guess fairly high.  They are allowed to boisterously wander around the hospital, joking with & poking fun at anyone they feel like, including doctors & other staff. And although they have to check at the front desks they are allowed into some pretty specialized areas of the hospital to visit with the young patients there.  Many of their ‘performances’ or props used also poke fun at the hospital or its procedures.  All of this joking and fun having is done, with patients, their parents, and hospital staff, in order to alleviate stress, lighten the mood, and distract from the reality of their surroundings (& illness).  Its a great way to supplement treatments; I’ve seen dogs allowed in the hospital as a way of doing this but not a clown (would be interesting).

The clowns are quite heavily part of the folk sector, but they are working within the professional sector.  This seems a little odd, and even out of place in western society, but it does make sense and in fact works perfectly well.  The folk sector involves the use of healers which treat patients using holistic methods extending beyond physiological symptoms, allowing patients more comfort through their illness.  The professional sector uses biomedical methods of understanding & treating the body, its illnesses, & symptoms. Some of these illnesses, or injuries are much more severe than others, and even hard for the clown doctors to witness.  These  offer perfect times for the clown doctors to do what they do best, their job. They may not perform any biological medical treatments, but distract and console the patients and families from procedures and illness with humor and laughter.

White Women & Breast Cancer

I researched Breast Cancer in White Women. Although, I don’t know anyone who has actually had breast cancer, I have been effected by cancer in general, and believe it is a terrible thing to have to go through/deal with. The fact that White women are more likely to get breast cancer than anyone else is alittle scary (I guess I’m lucky to not have been effected by it anyway thus far).  Breast Cancer, like any cancer occurs as a result of environmental interaction with a defective gene.  In this case it is from malignant(cancer) cells forming in the tissues of the breast, typically in the ducts.  It is considered a heterogeneous disease, which differs by individual, age group, and even the kinds of cells within the tumors themselves. Also it is not predisposed to just women, but men as well.  Being a geneticcly suceptible disease (more likely to occur if someone in your family has/had it) shows the effect genetics plays in our being more prone to this disease. As does societal/environmental factors (oral contraceptives, etc)

chart provided by: http://www.cdc.gov/cancer/breast/statistics/race.htm

However, the research suggested that white females may be the most likely or to be diagnosed with Breast Cancer each year, but we are far from the highest in mortality from it. The chart below shows disparities between black & white females, but the difference spans more than just the two. These differences are most likely due to societal & cultural norms or pressures, social & economic standing, and availability to proper medical care (screenings,medications, hospitalizations, etc.), as well as differences in genetics & types of tumors/cancer. The disparity between black & white females is so great that while both have declined in average incidents over the years, only whites have declined in mortality, while blacks have increased.

chart provided by:  http://ww5.komen.org/breastcancer/statistics.html

Using the materials we covered in class, its easy to see the influence of things like genetics and environmental factors, on health.  One’s environment can play a huge role, and be a major detriment to ones life.  It determines living conditions, job, income, diet, stress levels, and essentially health. Genetics, are obviously wired into your system & therefore a perminent part of who you are & what your health is like.  However, using race as a determinant is not so easy.  There is no true definition of race, and it is dependent on the individual.  People may concider themselves a race that others may not have, or maybe they concider themselves multiple races.  Its not something that can be pinned down & its all dependent on genetic variants. Because of this, defining or limiting diseases by Race & genetics is a near impossible thing to do.

 

http://www.cdc.gov/cancer/breast/basic_info/

http://ww5.komen.org/Default.aspx

http://www.nationalbreastcancer.org/

 

Collateral Damage

I didn’t do as well as I would have liked on the Health Equity quiz, but it wasn’t terrible. I received a 6/10.  I was surprised (and slightly thrown off at times) by how much of it was based on political economy, however having some history in the area from past classes ended up helping, and made most of the statistics provided seem much more logical and far less shocking.  The statistic that I found most surprising, not to mention interesting (even watched the correlating ‘unnatural causes’ video) was that (new) immigrants are the healthiest of all people in the U.S., at least for the first five years.

The video I picked to discuss was, Collateral Damage, about the Marshallese people.  This episode discussed the people of the Republic of Marshall, their constant relocating/recolonizing throughout history, the inequality of life among the islands as well as throughout the world, and the effects these and other elements have on their health.  The people of these islands, live in a very unique situation; they are susceptable to a full spectrum of diseases & illnesses, such as Diabetes, Tuburculosis, Malnutrition. This is because although they live in poor, overcrowded communities (more densely populated than Manhattan) of developing/third world societies, they are also subjected to the developed ‘middle class’ society through the military base on a neighboring island (many islanders ferry over to work there, or once in awhile some go to do laundry).  The obvious inequalities of social class, development, and wealth prove major factors in peoples health.  Even when islanders are able to escape to a life in the US, their problems, health & otherwise, follow them and their families.

The development, spread, and treatment of illness are influenced by many factors: politics, economics, environment, culture, biology and individual choice all play their own role.  Individual Choice for example, as depicted in this case study, was important because often people didn’t want others to know they were sick and therefore avoided seeking treatment.  Economics was also very important in this study because these people were living in poverty stricken communities with about 20 people per household.  They couldn’t afford medicine or hospital care, and living in such crowded environments creates easy access for the spreading of such diseases (it made me sick, having worked in a hospital & seen patients with TB in huge isolated rooms all to themselves & then to see this). And with the continued effect of TB on the families that moved to the US (still a much higher rate then others), biology comes into play.