Infant mortality in the Chinese health system has been an area of concern for many years.  The current trend shows that a lot of work has been done over the past twenty years, but there is still a long way to go.  An article published by Reuters in March of 2010 discusses a drop in infant mortality by 71%, 64.6 infant deaths per 1,000 livebirths to 18.5, from 1990 to 2008.  In a Wall Street Journal article from September 2011 that produces similar data, they reported a 62% drop from 1996 to 2008, they state the reason is because more mothers are choosing to have their babies born in a hospital setting, rather than at home.  The Wall Street Journal article attributes this to country wide effort in 2000 by China’s Ministry of Health to encourage hospital births and to do this they created a subsidy that allowed for rural residents to afford the trip to hospitals.
Reuters points out that the reason the mortality rate hasn’t dropped further is because of the wide gap in health care between the rich and poor.  The Chinese government’s hope to shorten this gap can be seen with their 2009 reform that put $123 billion into
providing affordable health care to its 1.3 billion person population.

An anthropologist that is working on this issue is Igor Rudan from the Croatian Center for Global Health in Split, Croatia.  He published a paper in March 2010 that looked
at information from obtained from the Chinese Ministry of Health and various other Chinese databases to determine the causes of death in Chinese children younger than 5.  His research showed that there were significant drops in the mortality rates of neonates, postneonatal infants, and children from 1990 to 2008.  Also detailed was the leading causes of death, which include pneumonia, birth asphyxia, and preterm birth complications.

References:

Causes of deaths in children younger than 5 years in China in 2008

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60060-8/abstract

Child mortality highlights China’s urban-rural divide

http://www.reuters.com/article/2010/03/26/us-china-child-deaths- idUSTRE62P01G20100326

Report: China See Dramatic Drop in Infant Deaths

http://blogs.wsj.com/chinarealtime/2011/09/19/report-china-sees-dramatic-drop-in-infant-deaths/

The guinea worm is due to inflection usually through ingestion of the nematode called Dracunculus medinensis this disease is extremely painful to those that are affected by the illness. The parasite travels through the body and then tries to pierce the skin often in the lower appendages of the infected person. it is prevalent in Africa and Central Asia. The parasitic worm lives within drinking water of the people in these areas usually the neighboring ponds and lakes. For those living in countries in these areas going to get the day’s water can serve as a social event. It is a chance for the women of the village to get together and walk down to the lake and gather water. This is a similar to how in developed countries like the US mother will grocery shop together to catch up and gossip about things going on in the town. Water is also viewed as a source of life for civilizations. Water is something your body needs to keep going. You use water to cook, bathe, wash clothing, etc. These lakes can also be seen has a lavatory for some villagers which means that the water is not the pure life source the locals view it as. In Ghana, and other West African countries getting access to clean filter drinking water such as that you buy at the grocery store is not an option. It is too expensive and often not store nearby due to the lack of widespread urbanization. In other countries such as India, that have development methods of irrigating water to the rural areas there has been the development of gangs that attempt to regulate the access to the water taking as much money from families as possible. During the Jimmy Carter administration an effort was started to eradicate this water borne parasite and its associated illness.

I decided to take a look at the work the anthropologist Bernhard Bierlich who was studying the belief systems of northern Ghanaians and how that was affecting their inflection with Guinea Worm disease. Most importantly he wanted to know how they people would feel about their water being treated with chemicals to kill the parasite to that they would be able to ingest the water. He found that the people believed the water was not the source of their sickness but in fact it was something that was a part of the human body and that getting the illness was not something that you could easily avoid. Which I thought was interested because it showed just how common the disease was in the area that they felt they were bound to get it.

Sources:

http://www.sciencedirect.com.proxy2.cl.msu.edu/science/article/pii/0277953694003754

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC118073/

In the country of Somalia more than  29,000 children have died last year in 2011. These children deaths were due to malnutrition and a drought according to the news article by Tammie Fields. Children who were under the age of five years old were mostly the targeted group who died. I am not surprised that the famine and drought outbreak mostly affected young children under the age of five because young children have very weak and unstable immune systems. This makes it really hard for young children and babies to fight off diseases and infections without having the proper nutrients. The famine and drought outbreak in Somalia took a harmful and deadly toll on the young children and this outbreak took the lives of many young children. Since Somalia is an extremely poor third world country. They have very limited and little access to medical and food resources. Somalia in essence has no industry and no agricultural system in their country and this makes the production of food hard to come by. Thus, this results in the malnutrition, famine outbreaks and the death of young children n their country.

Politically, there is no law of rule that exists within their country. There also no type of democratic government system that exists for the people. America helps aids Somalia by providing resources that feed, medicate, and help the people of Somalia survive in their country. Since Somalia has no working government or legal system it becomes very dangerous to ship food and resources over to their country because gunfights, face bandits, and militiamen try to rob and kill people to steal their resources. An anthropologists working in this area that was mentioned in the news article “29,000 children dead from famine in Somalia” by Tammie Fields, was named Professor David Himmelgreen. Anthropologist Himmelgreen is a professor at the department of Anthropology at the University of South Florida. Himmelgreen research consists of extensive research in African food production, disease, and nutrition.

Sources

Fields, Tammie. “29,000 Children Dead from Famine in Somalia.” Wtsp.com. N.p., 6 Aug. 2011. Web. 10 Aug. 2012. http://www.wtsp.com/news/national/article/204731/81/29000-children-dead-from-famine-in-Somalia

Malaria is still currently a major epidemic in sub-Saharan Africa, and it is reported that a child dies in Africa from Malaria every 60 seconds. Malaria is a disease that is spread to humans from the bite of a mosquito that is infected with the malaria parasite. This disease has been around for centuries and has a very low rate in the western world, but it is an infectious disease that still plagues the continent of Africa, in particular sub-Saharan countries. This disease has a major impact not only on those who are infected, but the communities, countries, and economies that surround the affected areas are also devastated by the spread of malaria. Current statistics state that 350-500 million people in Africa are infected every year by malaria and that 700,000 to a million people die each year from the disease. Of these deaths, one in five are children, and the children living with malaria are commonly suffering from anemia, which leads to poor growth and development. The economic factors surrounding malaria are quite obvious; it is a disease that primarily affects poor people, in poor communities, in mostly poor countries. This economic factor is an unfortunate circular cycle, malaria mainly affects the poor and those who suffer from malaria are unable to provide, so they remain poor and their children are therefore locked into poverty. There are also major world politics involved with combating malaria. NGO’s like UNICEF, the World Health Organization, and organizations like the Roll Back Malaria Partnership work with the local governments and invest billions of dollars into malaria prevention and treatment. One of the major campaigns that have shown some results is the deployment of millions of bug nets. Some of these nets are treated with insecticides and they are widely promoted for malaria prevention to stop mosquito bites. But, as what was mentioned in this week’s lecture, the campaign was not as successful as expected when it was first employed. There were cultural barriers, and the lack of communication between the NGO’s and the local communities led to improper, inconsistent, or complete lack of use of the bug nets in the local residents’ homes. But the campaign had increased in success, along with other prevention and treatment programs, and the occurrence of malaria in sub-Saharan Africa has been cut by 1/3 in the past decade. Although, this is a major win, malaria continued to infect and kill at an alarming rate. Right now there is a move to find a preventative vaccine, that is widely effective and safe for mass use. Hopefully, malaria will go the way of other once deadly diseases, like polio, and be almost non-existent with a simple vaccine.

Many anthropologists and social scientists are studying the varying factors and impacts of malaria. Some are studying the behavioral impacts that dealing with being infected with malaria have caused, others are more focused on the economic impact that malaria plays on sub-Saharan Africa. One article, by Wendy P. O’Meara, breaks down the individual burdens of malaria based on regions and specific countries in Africa. This study shows that while some countries have seen a marked improvement on the burden of malaria, not all countries have been so lucky; some have not seen the amount or intensity of the malaria burden improved in their countries at all. The trend, however, is toward improvement, and I think as long as malaria affects so many people, it will be a topic research and discussed by anthropologists for a long time to come.

Sources:

1-      Williams, Holly A., and Caroline O.H. Jones. “A critical review of behavioral issues related to malaria control in sub-Saharan Africa: what contributions have social scientists made?.” Social Science and Medicine. 59. (2004): 501-523. http://ac.els-cdn.com/S0277953603005951/1-s2.0-S0277953603005951-main.pdf?_tid=9ccaaddcb01590c3c7a2a3fbb5e59f19&acdnat=1344654571_031b9dd8d2f2cbc88e240ed8f4373224 (accessed August 10, 2012).

2-      Prudhhomme O’Meara, Wendy. “Changes in the burden of malaria in sub-Saharan Africa.” Lancet on Infectious Disease. 3099. no. 10 (2010): 545-555. http://ac.els-cdn.com/S1473309910700967/1-s2.0-S1473309910700967-main.pdf?_tid=35e3d50564516efd5b1e2f215464c460&acdnat=1344654651_29e7704bde88c49bfa6ce9b1e708e825 (accessed August 10, 2012).

3-      Chima, R.I., C.A. Goodman, and A. Mills. “The economic impact of malaria in Africa: a critical review of the evidence.” Health Policy. 63. (2003): 17-36. http://ac.els-cdn.com/S0168851002000362/1-s2.0-S0168851002000362-main.pdf?_tid=d2bebfc66a3d9e2fa1a7e869a3651622&acdnat=1344654167_325bbd0ff29c58898357803b6451e90e (accessed August 10, 2012).

4-      World Health Organization, “World Health Organization- Malaria.” Last modified June 2012. Accessed August 10, 2012. http://www.who.int/malaria/en/.

5-      UNICEF, “UNICEF- Health- Malaria.” Last modified August 2, 2012. Accessed August 10, 2012. http://www.unicef.org/health/index_malaria.html.

6-      Roll Back Malaria Partnership, “Roll Back Malaria.” Last modified August 8, 2012. Accessed August 10, 2012. http://www.rbm.who.int/.

     According to the World Health Organization (WHO), as of now, 140 million girls and women are living with the consequences of the cultural practice termed female genital mutilation/cutting (FGM/C). The WHO defines FGM/C as the “partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other non-therapeutic reasons.” It is usually carried out on girls ranging from a few days old to 15 years old. It is most prominent in Africa where an estimated 92 million girls, 10 years of age and older have been subjected to FGM/C. It is not only practiced in 28 African countries, but also in the Middle and South East Asia. (1)
      In most countries, including Sudan, where FGM/C is performed it is viewed as a way to protect the woman’s virginity, and to discourage “female promiscuity” thus ultimately preserving and protecting the family’s reputation or honor. Some other cultural reasons are aimed towards promoting femininity. For example, if the clitoris is not removed via FGM/C t is believed that it will grow longer between the legs to resemble a penis. Therefore, by removing the clitoris which is viewed as a feature of masculinity the woman is ultimately achieving femininity; this is also why this procedure is viewed as a rite of passage into womanhood for the women in these cultures. Many of the pro FGM/C groups have stated that there are also religious regions backing this procedure, but as of now one common statement from the religious leaders in Sudan has still not been attained. (1)

      Some of the attempts of advocacy for the women who suffer physically and psychologically have come from NGOS or other national organizations. Some of the different advocacy efforts have involved “the combination of health-based approach and behavioral change strategies; including peer education, use of positive deviants, and community conversation” (1). After evaluation of the success of the different approaches taken to reduce FGM/C, one of the most successful approaches seemed to be introducing alternative rights of passages, while the least successful approach was the traditional medicalization of FGM/C. (1)
      One major national attempt to end FGM/C came from the National Council of Child Welfare (NCCW) which included the coordination of different groups at a local level such as Sudanese Network for Abolition of FGM/C (SUNAF) which is made up of NGOs and academic institutions, line ministries, and legal experts. One of the major successes of this advocacy movement was the passing of the Child Act Bill in 2009 which includes an article to make FGM/C illegal based on health and social reasons. So far in Sudan, this law has been ratified in the State of South Kordofan in 2008 and in Gadaref State in 2009(1).
      Not everyone views this procedure as an unnecessary act of torture both physically and socially. Some people really do feel this is an act of empowerment of woman, a launch into her femininity. One of these individuals is an anthropologist from Sierra Leonean, Dr. Ahmadu, who actually underwent this cultural procedure herself. She aims to break down the surrounding negative perceptions about FGM/C by sharing her own experience. As illustrated in one of her articles, Dr. Ahmadu feels that countries of the West look at this African cultural practice with an ethnocentric point of view. She also demonstrates how in the U.S. state of California women are choosing to undergo a similar type of procedure as a form plastic surgery to enhance the physical appearance of the vagina (2). Which brings forward some critical anthropological questions. Why is this procedure viewed as inhumane in some countries, but not in others?” Is it really only  a matter of cultural perception?

SOURCES:
( 1.) Bedri, Nafisa M. “Ending FGM/C through Evidence Based Advocacy in Sudan .” (March 2012). http://unstats.un.org/unsd/gender/Jordan_Mar2012/Presentations/Panel 3/Panel 3_6_paper_Sudan_Ending FGM.pdf (accessed).

(2.) Ahmadu, Fuambai. “Rites and Wrongs: An Insider/Outsider Reflects on Power and Excision.” African Holocaust. (2000). http://www.africanholocaust.net/fgm.html (accessed).

According to AVERT, a humanitarian foundation based in the United Kingdom, AIDS is the leading cause of adult mortality in Malawi, where one in fifteen people have HIV. Social variables that represent greater risk include urban residency, being female, and age between 13 and 24 (AVERT, 2011).  Gender stratification has magnified the epidemic since the subjugation of women translates into sexual abuse, sexual coercion, and inability of women to advocate for condom use. Although the government has discouraged wife inheritance, this cultural practice also manifests as AIDS transmission in some cases. Certain occupations, such as those in the sex industry, policewomen, and male primary school teachers represent disproportionately afflicted populations.

Historically, the reign of Malawi President Banda from 1964 to 1994 resulted in escalating HIV incidence, due to his moral objection to sexual discourse. Hence, social conduct dictated that HIV/AIDS discussion was taboo, derailing preventative measures. Public dissent and international pressure resulted in Banda’s surrendering of power, the inauguration of democratic President Muluzi, and the introduction of a more liberal political climate that enabled AIDS education without political persecution. However, the intolerance fostered by the Banda era had already reaped devastation to Malawi’s socioeconomic infrastructure, culminating in a severe impoverishment and a 2002 famine.

The National AIDS Commission (NAC) was established in 2001 to implement AIDS prevention, testing, and treatment.  These efforts were amplified and supplemented with support services by a multi-sectoral National AIDS Policy put into operation by President Mutharika, elected in 2004.   Moreover, the NGO Malawi AIDS Counseling Resource Organization (MACRO) began providing voluntary counseling and testing (VCT) in 1995. Also, NGOs such as PSI and Banja La Tsogolo and a 2008 UN project have facilitated modest success in promotion of condom use.  In particular, they have used beauty salons to distribute female condoms to circumvent cultural norms whereby it is seen as a traditional male domain. Collaboration of the Malawi government with the Global Fund and civil society organizations such as the World Health Organization, UNAIDS, and The President’s Emergency Plan for AIDS Relief (PEPFAR) has also resulted a dramatic increase in dissemination of antiretroviral drugs.

But, efficacy of campaigns has been limited due to financial shortcoming, in particular due to withdrawal of support by the UK Department for International Development (DFID) and other donors due to suspected political corruption and mismanagement. Additional impediments include deficient human resources, training, and equipment, drug stock-outs, and failure to target health messages to culture or language. Especially problematic is lack of human resources resulting from migration, unsatisfactory education, and loss of health care workers due to AIDS. Although access to rapid screening has increased, only 1% of adults employed this service up until 2003, due to lack of transportation and the cultural stigma of accessing VCT clinics or being diagnosed as HIV-positive, especially for married women (AVERT, 2011).  Furthermore, because homosexuality is illegal, prevalence rates among gay men have not been collected, impeding intervention efforts.  Community leaders have made some progress in changing attitudes toward AIDS, however, as evidenced by Chief Mudwa’s claim: “We have made it policy that whoever discriminates against people living with HIV and AIDS shall be heavily fined or expelled from our kraals (villages)” (AVERT, 2011). In addition, prevention of mother-to-child transmission of HIV (PMTCT) efforts have been hindered by excess demand for tests and inadequate staff, which compromises test quality.

Although deaths due to AIDs have declined in Malawi, numbers of new infection have increased.  This necessitates a strategy where AIDS is combated on multiple fronts in concert with promotion of HIV nutrition, treatment of opportunistic pathogens, and confronting socioeconomic barriers. An anthropologist working in this area is Dr. Anat Rosenthal, who has examined the means by which local and global health organizations affect AIDS in Malawi communities, the sociocultural effects of AIDS-related health policy, and the more general objectives of evaluating and preventing HIV/AIDS outbreaks (Boh, 2011). For example, she conducted participant observation to discern community perception of the Malawi Diffusion and Ideational Change Project (MDICP), whose mission was to elucidate how social networks act in shaping attitudes to family planning and HIV/AIDS (Rosenthal, 2005).  Through ethnographic research, Rosenthal studied the role this survey enacted in day-to-day Malawi lives. In essence, her intention was to uncover the impact of this project and provide recommendations for improving its design, ethics, and the community cooperation (Rosenthal, 2005).

References

Boh, Patricia. (January 27, 2011). Medical anthropologist promotes AIDS awareness in Malawi. The Daily Campus. Retrieved from http://www.smudailycampus.com/news/medical-anthropologist-promotes-aids-awareness-in-malawi-1.1922507#.UCXM2qNSQ-0

HIV & AIDS in Malawi. (2011). Retrieved August 10, 2012 from http://www.avert.org/aids-malawi.htm

Rosenthal, Anat. (September 26, 2005). MDICP-3 Ethnographic Project: Assessing Community Reaction to a Large Scale Survey. Social Network Project Working Papers, 1-18.

Malaria, a disease that has been mentioned several times throughout this course, can be effectively cured by medication, but it still remains prevalent in Sub-Saharan Africa, where it kills 3,000 African children a day.  This parasitic disease is transmitted by mosquitoes. Once inside the body, the parasite destroys red blood cells and can clog cerebral arteries.  Without treatment, the initial flu-like symptoms from infection can progress to life-threatening illness.

Malaria is a major public health issue in the poor countries of Africa, where it is tied to poverty in a grim cycle: the disease is a consequence of poverty, and at the same time further impoverishes the communities it affects.  By preventing infected people from working, causing immeasurable human suffering from the loss of loved ones, leaving children with lasting neurological damage, requiring costly medication, and negatively impacting the economic decisions of households and entire nations, malaria has a devastating effect wherever it strikes.  The governments of the countries where malaria has a high incidence are generally poor to begin with, and this lack of funding for treatment and prevention is a major barrier to controlling the disease.  People with HIV or AIDS, which are also a major health concern in Africa, are particularly vulnerable to malaria.  As malaria is such a large-scale global health problem, multiple health organizations like WHO and the World Bank, as well as the UN, donor governments, and various charitable organizations are focused on addressing it.

One medical anthropologist studying malaria in Africa is Dr. Vinay Kamat, a professor at the University of British Columbia who has focused his research on how recent changes in malaria medication and control strategies are affecting those afflicted with the disease.  In a 2009 study, he researched how the Tanzanian government implemented new treatment guidelines that included the large-scale deployment of an artemether/lumefantrine-based combination therapy (ACT) medication commonly known as ALu.  This medication is regarded as an effective treatment and a “key weapon” against malaria, but its high cost is unsustainable in the long-term for Tanzania without a significant donor.  Dr. Kamat studied the public’s perspective on ALu as public health facilities began distributing it within the new policy.  He found that the majority of mothers of children with malaria do not rush to the hospital within the initial onset of the disease; rather they rely on store-bought fever medications.  Despite this, once at a health care facility, the mothers were satisfied with the efficacy of ALu, as well as its affordability due to the government subsidy.  This study prompted further questioning of how to encourage early treatment of malaria, to avoid the delay between the onset of symptoms and proper treatment.

Sources:

Bio of Vinay Kamat: http://www.anth.ubc.ca/people/anthropology-faculty/vinay-kamat.html

Kamat’s study in Tanzania: http://www.malariajournal.com/content/9/1/61

Basic facts on malaria: http://www.who.int/malaria/en/

http://www.earth.columbia.edu/articles/view/41

As I was doing research on what FGM was, I found some stories of girls that have gone through this “procedure.” It was not by personal choice in their cases. Female Genital Mutilation or FGM is “the partial or total removal of the female genitalia,” as described by path.org. It is also known as female circumcision. Despite being condemned by the United Nations, health professional, and human rights organizations, FGM is practiced all over the world especially in Africa, more specifically the Sudan. It was actually declared illegal in the Sudan in 1941, but has since been legalized.  An article in the Sudanese Tribune claims, almost 90 percent of northern Sudanese women have suffered through this. According to another source, that is about 14 million women and girls. Usually this ordeal is done to girls from age’s six to ten but it has been done to girls younger than that. One of the girls from the story who was forced to undergo this procedure was asked who made her get it done, her answer was her grandmother; “She said that this is something belonging to the traditions and customs and we can’t get away from it. And at that time everyone in the Sudanese society used to have this circumcision,” Aside from just the traditions of the culture, FGM also occurs in the Sudan because some believe it promotes hygiene and Sudanese men prefer women who have been circumcised. Not only does Female Genital Mutilation cause girls excruciating pain but there are also serious side effects that could occur. According to path.org, “The highest maternal infant mortality rates are in FGM- practicing regions.” Though the numbers are not exact, they believe about a third of girls who have been circumcised die due to treatment unavailability. One Non-Governmental Organization (NGO) that has had a big effect on stopping FGM from happening is the Babikar Scientific Studies Association on Women Studies. They were the first NGO to try to help the fight against FGM in Sudan. While there are many who think this practice should be stopped, one Sierra Leonean anthropologist named Fuambi Ahmadu thinks that is not right. Ahmadu does not see circumcision as a barbaric act or a mutilation nor does she believe that it affects a woman’s health. He is working to try and spread his opinion and educate people on what he believes to be true about Female Genital Mutilation.

http://www.path.org/files/FGM-The-Facts.htm

http://www.sudantribune.com/Female-genital-mutilation-still,12647

http://www.wluml.org/node/5575

http://www.antropologi.info/blog/anthropology/2010/female-circumcision

Female genital mutilation “comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.” (Female genital mutilation, Februrary) FGM leads to infertility, bleeding during, pain sexual intercourse, and sometimes causes death. I found different possible origins for Female genital mutilation but it can be date as far back as the 5th century B.C in Egypt.  Nearly 90 percent of Sudanese woman go through this procedure every year. They say encourages hygiene for Sudanese woman, men think highly of women who are circumcised, and it makes the bride price higher.  With the bride price being high it will help poor families with the additional income. Some Sudanese say it also has to do with their religion who Muslims and say the Koran says woman should be circumcised. In 2008 WHO passed a resolution to put end to FGM.UNICEF and the National Organization for Women (NOW) are trying to stop FGM. These are organizations are to make people know the consequences of FGM through support, research, and guidance.

Professor Ellen Gruenbaum did research in Sudan where FGM is way more common. Her research showed that the more western civilization got involve there was more the Sudanese resist to change. “Gruenbaum shows that the practices of female circumcision are deeply embedded in Sudanese cultural traditions – in religious, moral and aesthetic values, and in ideas about class, ethnicity and gender” (PANEL: Medical Anthropologist Speaks on Abolishing Female Circumcision, 2012). Professor Gruenbaum research shows how to take a different approach to stop FGM in Sudan.  She wants to bring to light both the reception and the confrontation to change. Gruenbaum says it happens because of social and financial changes, religion influences, and woman not being educated about FGM. “ Gruenbaum seeks to provide an insightful analysis of the process of changing this complex, highly debated practice”. (PANEL: Medical Anthropologist Speaks on Abolishing Female Circumcision, 2012)

Works Cited

PANEL: Medical Anthropologist Speaks on Abolishing Female Circumcision. (2012, September 29). Retrieved from http://www.peacewomen.org/news_article.php?id=179&type=event

Female genital mutilation. (Februrary, 2012). Retrieved from Who Health Organization: http://www.who.int/mediacentre/factsheets/fs241/en/

http://www.who.int/mediacentre/factsheets/fs241/en/

http://www.sudantribune.com/Female-genital-mutilation-still,12647

http://salsa.wiredforchange.com/o/5996/p/dia/action/public/?action_KEY=1899