Malaria in Sub-Saharan Africa

Malaria is a disease carried by mosquitoes. It is a protozoan, which basically means that it is not a bacteria or a virus but worse; it’s like a real live animal, only very small. The mosquito bites someone with malaria, lives long enough for it to develop, and then passes it on through another bite. In the region I have researched, Sub-Saharan Africa, the mosquitos are plentiful and love to feed off of humans, making it a very malaria-prone place. Once bitten, the infectious cycle takes only two days to full develop and is exhibited through uncomfortable chills and fever.

From the anthropologic perspective, malaria has more than just biomedical factors. For example, socioeconomic status plays a role. The level of healthcare in Sub-Saharan Africa is not at its prime. Poverty is widespread and access to doctors is very limited, especially in rural areas. Other cultural factors, such as the popularity of folk traditions and a slight resistance to biomedical science make treatment less probable. I read an article titled The Social Burden of Malaria that was extemely informational. It discusses how the situation has steadily been improving thanks to the valuable role anthropologists have played in devising a successful way of decreasing the number of malaria cases. By taking into account how the people react to western medicine practices, they have lessened the resistance to treatment, helping the doctors and the medicine do their jobs successfully.

I included a link to notes from a symposium in which Bob Gwadz lectured on Malaria. He worked on research in Sub-Saharan Africa and helped devised ways to help the problem. BY using anthropological techniques, he was working to improve the situation. I value his opinion and knowledge and really enjoyed the lecture. I think that an anthropological view is crucial in any situation related to this.

Sources:

http://www.ncbi.nlm.nih.gov/books/NBK3746/

http://www.aaas.org/international/africa/malaria/gwadz.html

W6 Activity Post: HIV/AIDs in Malawi

HIV/AIDs in Malawi

AIDs is the leading cause of death for adults in Malawi (Avert). Malawi’s first AIDS case was reported in 1985 (Avert). The government at the time implemented only a “short term response” which included blood screening and HIV education programs. Between 1964 and 1994 Malawi was under the rule of President Hastings Banda, who paid little attention to HIV/AIDS. “His puritanical beliefs made it very difficult for AIDS education and prevention schemes to be carried out, as public discussion of sexual matters was generally banned or censored, and HIV and AIDS were considered taboo subjects” (Avert). During his “presidency” from the first reported case to a year before he relinquished power the HIV prevalence among women tested at urban clinics increased from 2% to 30% (Avert).

In 1994, Banda stepped down following many protests and international condemnation allowing Malawi to become a multiparty-democracy. Malwai then elected President Bakili Muluzi who made a speech in which he acknowledged that the country was undergoing a very severe epidemic and stressed the need for a unified response. By this point AIDS had already “damaged Malawi’s social and economic infrastructure” (Avert). Farmers couldn’t farm to provide food, children could not attend school, workers couldn’t work to support their families. The epidemic was a large factor that contributed to Malawi’s worst famine in 50 years in 2002. A report during that famine said that 70 percent of hospital deaths at the time were AIDS related (UN Aids 2002).

An anthropologist working on the HIV/AIDs crisis in Malawi is Anat Rosenthal. She researches the affects of HIV/AIDs in poorer countries, rural communities, families, and children in those contexts (Boh). Dr. Rosenthal has participated in over a year of work on the field with nearly 50 personal interviews with those affected by the crisis. She works to strengthen families affected by HIV/AIDs and improve community responses to cases of HIV/AIDs (Boh). Funding for treatment, awareness, and social improvement have been made available by the World Bank, the World health organization, UNaids, and the government of Malawi (Avert).

Avert
HIV & Aids in Malawi
http://www.avert.org/aids-malawi.htm
UN Aids 2002
http://data.unaids.org/Publications/IRC-pub03/epiupdate2002_en.pdf
Boh, Patricia

Medical Anthropologist promotes Aids awareness in Malawi
http://www.smudailycampus.com/news/medical-anthropologist-promotes-aids-awareness-in-malawi-1.1922507

Global Health and Medical Anthropology

One of my required readings for ANP 201 was Paul Farmer’s book “Pathologies of Power: Health, Human Rights, and the New War on the Poor.”  This was where I first began to understand the importance of global health and how anthropology fits within the system.  I loved the book and Paul Farmer became a huge hero to me.  For some reason the fact escaped me that he was a medical anthropologist.  I knew he was a medical doctor and an anthropologists but for some reason I didn’t make to connection to medical anthropology.  Maybe I didn’t know what medical anthropology was at the time and therefore it eluded me.

I do not see global health or even medical anthropology being a part of my future career, although I do have a very strong interest in global health and my heart breaks whenever I hear about the many disparities people are forced to suffer through in developing countries and certain parts of our own country.  I, like Paul Farmer and most other developed countries, believe that medical care is a basic human right and should be available equally to all people.  The fact that the majority of my anthropology education has been focused on archaeology, and not medical anthropology, and I graduate after next semester may prevent me from obtaining a job in this field due to my lack of knowledge.  Maybe if MSU had offered this class sooner I could have focused my energy in this field of study.

I believe understanding a patient’s culture, worldview, and beliefs about science and medicine is extremely important in the medical system.  Anthropologists have the knowledge and ability to moderate between doctors and patients through the use of ethnography and other methods.  An example of a situation where anthropologists intervened was that of Ms. Lin who was from China but moved to America in order to attend school.[1]  After refusing to take her medications for anxiety, an anthropologist became involved to find out why.  The anthropologist found that China has a very strong stigma associated with mental illness and by the doctors describing her condition as an anxiety disorder, and the stigma associated with a mental disorder in her culture, she refused to participate in that role.  The anthropologist discovered that the Chinese call this condition neurasthenia which is considered a stress-related condition and not a mental disorder.  After discovering this about the Chinese culture medical staff began to call her condition neurasthenia instead of anxiety disorder and Ms. Lin began to take her medicine.  This may not have been discovered unless there was a person set in place in the medical system who had the knowledge to ask the right questions.  In this way acting as mediator between doctor and patient an anthropologist role is invaluable.

 


[1] Arthur Kleinman, Peter Benson, “Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It,” Plos Medicine, http://anthropology.msu.edu/anp204-us12/files/2012/06/6.-Kleinman-and-Benson-Anthropology-in-the-clinic.pdf.

Life/Death

So often in western culture, I feel like we fall into the problem of treating our customs and rituals as what should be “normal” and that anything outside of that is taboo or odd. Biomedicine is no different. Biomedicine is treated as the best way to solve illness and western culture is so quick to prescribe pharmaceuticals for issues instead of looking at alternatives. This can be seen clearly in how many M.D.s that we have in our country compared to D.O.s. Osteopathic medicine is still science based but it looks at the body more as a holistic unit, and works to make the body as a whole work, not just to fix problems in individual units. We as a culture very much buy into the culture of biomedicine. This can be seen with how many prescriptions drugs are available for so many things, and so many over the counter drugs for colds and coughs, when little things like that can honestly be taken care of with chicken noodle soup. Understanding this culture is important because it can help us not only understand some issues in our society, like drug abuse and hypochondria, but also help us understand how other cultures view us and our customs.

 

I think that the life/death dichotomy is very interesting. Mostly because I had never thought of it until now. I had always thought of the lines between life and death pretty clear, but the points brought up in the lectures made me think. I personally believe that human life begins when a fetus is to the point in development that they can live without the mother, but I respect that people may disagree. Death is a bit harder for me to define, and I think that’s a pretty normal thing. I think that humans are reluctant to declare something as dead because we don’t want to let go. That’s why we have people kept in vegetative states. I understand why people would want to keep their loved ones alive, but also there needs to be a point where it’s healthiest to let go.

Alcoholism

I think that today Alcoholism is now seen as an illness
because of the vast amount of people who face this problem. I also think that
our lifestyles today make it seem like it is a bigger issue to be a heavy
drinker. Many years ago it was typical for someone to drink daily but with
today’s standards of living it is more often frowned upon. You need to be
dependable in order to get a good job and make money to support yourself and
your family, and if you are known as being a heavy drinker then people are not
going to want to hire you for fear of you being drunk during a time that they
are depending on you to do your job to the best of your ability.

As the Conrad article says “these diagnoses have been
promoted actively by sufferers and their advocates” which I agree with. The start
of groups like AA has made alcoholism really aware to the public. I think
people actively stating that they have a problem and showing how difficult it
is to overcome this illness has also proven to the general public that this
really is an actual sickness and should be treated like one.

http://www.drinklessnow.com/
alcoholism cure

The strategies of this advertisement are to make it seem
like a quick fix to your problem which all Americans appreciate. It says no
meetings and no side effects just by adding this drop of medication to your
water. It claims to stop cravings for alcohol. One of our values in society is
time, and to have the ability to save time and just take this medication it
makes life so much easier which I think is the ultimate goal of this drug. Also
if you don’t have to go see a doctor to order it then it saves you a trip to
the doctor and possibly the embarrassment of telling your doctor you have a
problem. This medication claims to be completely anonymous. The website shows
results to be 84% successful which makes you believe that it could definitely
work. I think that a lot of Americans would turn to this medication in hopes of
a quick cure.

MTV show

I have diabetes

Subjecting myself to the insipid tripe that is MTV for the
first time in over a decade (Beavis and Butt head on Itunes does not count) I
watched a show I never heard of before True Life.  I picked the episode I Have Diabetes. This episode documents three young diabetics, and
how they cope with the disease.  There is Kristen a formally independent twenty
something that is forced to move home to cope with her medical bills. Mathew a
diabetic college student who binge drinks even though being a diabetic heavy
alcohol use is dangerous, and Jennifer a very young women who is diagnosed with
diabetes when she is pregnant.

In this documentary they three subjects struggle with the
sick role the male subject knows that drinking with his diabetes is very dangerous
but he continues to do it because I wants a “college experience”. One of the
female subject struggles with the strict dietary restrictions.  Another female subject struggles with bills
and move back home with mom and dad to help cover her bills.

I think the narrative type is the chaos narrative I think
this because the three young people seemed to have major difficulties in obeying
well known dietary restrictions (including limiting the amount of alcohol
consumed). The financial difficulties, of one of the subjects adds to this. It appears
that their lives are spiraling out of control.

The interaction of the three characters with the medical system
is primarily with biomedical professionals (probably endocrinologists). This is
a medical system that is modern, and that we all are failure with.  Diabetes is a common common medical condition;
all of us know at least on problem with this condition. With the obesity
epidemic in this country it is also a growing problem.  There is not a stigma with diabetes even
though type two diabetes has a behavior component to it.

Real Life: I’m Obese

This episode dealt with the lives of three individuals who live with one of the most common health issues in the United States, obesity. The first, Corey, approaches obesity with restitution. He realizes that his weight is a problem and resolves to “fix” his illness with gastric bypass surgery. In his mind he sees the surgery as a cure to eating and a cure to gaining weight, overall making him healthier and “normal”. The second, Amy, also realizes her illness but deals with it very differently. Her life is much more chaotic, everything she does is controlled by her weight. It is almost as if she is addicted to eating, because she is unable to stop. She also realizes all of the effects of obesity, like diabetes, heart attack, etc, but this makes her afraid that without surgery she will die. Finally the last individual, Frances, embraces her obesity, saying that her weight is part of who she is. For her she owns what the others see as a disorder. She rejects the cultural need to be thin, and says that she can be perfectly happy the way she is.

 

They use their different narratives to deal with their lives. Each one comes from a different background and sees the obesity as a different thing for them. Corey uses his narrative to come to terms with his obesity and to do something about it. Amy uses the chaos of her situation seek medical help and avoid the negative ramifications of her weight. Frances makes it her quest to show people that obesity may not be a bad thing and that you can be obese and still enjoy life.

 

Obesity is prevalent in our culture and is definitely stigmatized. I can speak from personal experience. Much of my family is overweight, and my mother was obese for most of my life. She face many difficulties. Finally, around the time my brother announced that he and his wife were expecting, she resolved to do something about it. She had struggled with dieting for years, and finally decided on gastric bypass surgery. It was incredible. It made such a change in her life, she is now down to a healthy weight, she is able to do much more around the house, and most of all, she can play with my niece.

 

The two individuals in the show that took the same route as my mom also found that there was a very supportive environment to help them, but its also a very realistic environment, showing the the true consequences of obesity. As far as rights and responsibilities, I believe that obese individuals deserve to be treated like any others, but it is there responsibility to accept or deal with their obesity.

ppd

Post
-partum depression

The baby blues are a known and
historically recorded phenomenon that expresses itself for a few days to a week
after childbirth (passnc.org). Symptoms include trouble sleeping, loss of appetite,
trouble sleeping, and anxiety (passnc.org). A more severe and lingering condition
is post- partum depression. Were as the baby blues are short lasting a benign,
post- partum depression can last for up to a year and includes more menacing symptoms
such as a want to engage in self harm, harm the infant, or neglect the infant (passnc.org).

For many decades  post- partum depression, was believed to be a culturally
bound syndrome restricted to western nations, (rcpsych.org) but more recent studies
“have shown that  post- partum depression seems to be a universal
condition with similar rates in different countries” (rcpsych.org).

However, I do think that it is
far more common in the United States for several reasons. The primary reason
can be simply narrowed down to one source; popular media delivered into the
living rooms of women through the media of television.

There were two tragic incidents
in the last ten years; the first was that of Andrea Yates when in 2001 a thirty
something mother in Houston, Texas drowned her five children in a bathtub. The second
and somewhat less sensationalized case(but still heavily covered by the media),
was when another thirty something mother used a kitchen knife to traumatically
amputate the arms of her infant daughter who died of blood loss.  Both women were found not guilty by reasons of
insanity, and committed to a state hospital.

The non-stop media coverage after
these tragedies ranging from the evening news to the afternoon talk shows like
Dr. Phil and Oprah, lead to widespread knowledge about post- partum depression.  This media bombardment may have a negative placebo
effect,
known as a nocebo (the weeks class material).

http://www.passnc.org/faq/babybluesvsppdpppsychosis

http://bjp.rcpsych.org/content/184/46/s10.full

I Have Schizophrenia

This episode followed three sufferers of paranoid schizophrenia. One of them is a male who self-medicates using marijiuana in order to cope. Another sufferer is a girl currently going through college who sees a therapist for treatments. Finally, the last person showcased lives at home and is currently dealing with his illness by going to support groups and taking medication.

Firstly, you see the signs of restitution, chaos, and quest within each of these sufferers. Restitution is seen amongst each of them in that a therapist, medicine/pills, or talk of a mental institution is used as methods in order to fix or alleviate each of these peoples’ disorders. Chaos is seen in each as well, perhaps the most. The first person has constant conflicts with his mother about his well-being, and he also has issues about where he my live as he is kicked out of places. The second person, in college, has to take a speech class, and is unsure about whether she should perform in front of a group for fear of her symptoms returning. The last person has a definite chaos narrative: both his father and grandfather suffer from cancer, and his grandfather dies in the course of the episode. His family fears that he’ll fall into a depression and relapse into his condition. Finally, each does have a quest narrative. The first sufferer who has rejected all attempts at help, finally ends up finding a place to live where he’ll get help for his condition. The other two sufferers end up going to or to go to support groups, who help them come to terms with their conditions as well as realize that it is not their fault, and that they do have others they can talk with in order to help them out.

Typically, none of these sufferers have any responsibilities. But it’s interesting in that the latter two end up taking on their own responsibilities. For example, the girl who goes to college does so of her own accord and will, and the last man has plans to go to college when his condition is lessened. They do all experience issues with culture as well. For example, the first man with the condition argues with his mother, who does not seem to be supportive and wants simply to put her son in a mental institution. She almost sees him as “crazy” and doesn’t have much regard for helping or taking care of him herself. The other two have issues being in public, no doubt tied to the social stigma of being in a very socialized culture. This puts a lot of pressure on people who become paranoid in large groups of people. However, part of their quest narratives involve them eventually going out in public and being around large groups of people in an attempt to become comfortable in that situation.

I would say that illness narratives are very supportive to the patients, especially as shown in the sufferers of schizophrenia in this episode. The first man actually did not want to be “cured” because he enjoyed talking to the birds, because he feared that there would be voices if he were totally alone. He preferred talking to something as opposed to nothing, even if he knew it was part of his condition. The second patient would talk to her therapist, often gaining support from her in decisions as to what to do in school. Finally, the last man goes to support groups, as mentioned. However, he is not forced to – he chooses to. He finds it incredibly therapeutic and it shows how a narrative can help a person cope with what condition they may be suffering from.

W4 Reflection Post: Restless Leg Syndrome

Restless leg syndrome (RLS)

This condition “is a disorder in which there is an urge or need to move the legs to stop unpleasant sensations” and occurs most often in middle-aged and older adults (PubMed Health). It is interesting that many of us in America did not know what restless leg syndrome was until we were bombarded by pharmaceutical marketing and soon after that stand ups and parodies which mocked its validity (Week 4: Lecture 1). Biomedicine does not have any specific tests or cures for restless leg syndrome, instead it treats simply treats symptoms (PubMed Health). The fact that doctors must solely rely on patient reported systems makes diagnosis imprecise. It shifts medicine from being a science of pathology into something of a therapy for feeling good. It makes the physician a provider of consumer goods. It is peculiar to healthcare where the provider of a good is also someone trusted to look out for your own good. We understand that the salesperson at your favorite department store is there to make you purchase, their recommendations are biased. But we trust our physician to be our representative when it comes to finding treatments, operations, or biomedical products such as prosthetics.

In my opinion there is definitely a connection between mind and body mostly in the relationship between perception and appraisal. This is seen in medicine between beliefs and healing. When you’re in a negative mindset it’s difficult to appraise things positively. When you are used to certain attributes belonging to a thing you will just recognize it as such even if those attributes are unrelated to that thing but something else entirely; this occurs in medicine with symptoms being attached to a disease when they can be related to any number of other conditions. With restless leg syndrome physicians often make their diagnosis by simply testing against other conditions (PubMed Health). If they rule everything enough conditions besides RLS out they will settle with diagnosing someone with Restless leg syndrome.

PubMed Health; Restless leg syndrome
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001810/

Week 4: Lecture 1
http://anthropology.msu.edu/anp204-us12/week-4-lecture-1/