The intersection that I chose is Public Health and Medical Anthropology.  The reason that I chose this intersection is because I am currently working on my Masters in Public
Health as I finish my undergraduate degree.  Before taking this course I had no idea how similar the two fields are to each other or how much they can influence one another.  This became clear to me during some of the activity and reflection assignments when I was able to draw from material that was presented in my Public Health courses to help answer my posts.  Public health works with the mindset of
preventative medicine and medical anthropology can help with in that effort by
providing examples of methods that have or have not worked in the past.  Medical anthropology can also help, as stated in this week’s lecture, by providing data on populations that can be used to formulate health policies and strategies.

Taking an anthropological view as a heath care provider in the field of public health can play a role in helping make a number of decisions.  As mentioned above and discussed in this week’s lecture, medical anthropology plays an important part within health care.  A public health provider working on a health policy or strategy can look back on anthropological studies on the target area.  This can allow the public health provider to see if there is a factor that can prevent the plan from being successful, such as with controversial topics like sex education in India.  A good example of this of a
failed public health plan is the bed nets for residents in malaria infected regions.  Having better data prior to the plan being put into place could have saved billions in donated dollars that could have go to a more effective effort to help stop the spread of the
disease.

Clinical Medical Anthropology is the intersection of applied medical anthropology that coincides with my personal interests due to my degrees in Human Biology and Psychology and my specializations in Bioethics, Humanities, and Society and Health Promotion. This sub-field appeals to me since clinical anthropologists operate as a facet of an interdisciplinary health care team in a hospital, health program, or health agency to improve quality of health care (Pui, 2003). In addition, clinical medical anthropologists are flexible in that the setting in which they work ranges from the developing world to domestic rural and urban locations.

If I were working for a healthcare practitioner, I would explain that hiring a clinical anthropologist is useful in that they contextualize ethnomedical health care beliefs and practices, emphasize experiential aspects of illness in cultural terms, and enhance the cultural sensitivity of physicians, nurses, medical technicians, and hospital administrators. For example, the World Health Organization and UNESCO declared 1996 the Year of Culture and Health, underscoring the paramount role that cultural explanatory models and cultural norms play in international health initiatives (Helman, 2007). In essence, clinical anthropologists can raise awareness about sociocultural barriers to health seeking behavior and compliance, act as advocates for patients of diverse cultural backgrounds, and improve physician-patient communication and satisfaction alike.

For example, in the YouTube video “Medical Anthropology,” it is described how a well-intentioned woman who tried to educate Peruvian villagers about water contamination was unsuccessful due to her failure to recognize the cultural belief that boiling water destroys the spirit of the earth. As Taz mentioned, clinical anthropologists can “act as cultural mediators to develop strategies for individual patients” tailored to cultural values and ideology (Karim, 2012). For example, the significance of employing culturally appropriate terms is demonstrated by Miss Lin, who dropped out of cognitive behavioral psychotherapy due to the providers’ use of technical jargon such as “anxiety disorder” and “depressive disorder” (Kleinman & Benson, 2006). In this case, the Chinese stigmatization of mental illness precluded her pursuit of further medical care; a clinical anthropologist was valuable in this instance since “neurasthenia” carried more culturally-appropriate connotations.

Conversely, clinical anthropologists can also facilitate cultural competence on the part of health care practitioners via “reflexivity…the ability to honestly examine their own cultural ‘baggage’, such as prejudices or particular beliefs, that may interfere with the successful and humane delivery of health care” (Helman, 2007). This mission is central to the US government’s Office of Minority Health (OMH), whose objective is to design culturally targeted health services, ensure informed consent, and reduce cultural health inequities (Helman, 2007). As Kleinman and Benson (2006) purport, suspension of ethnocentrism on the part of the health professional is fundamental since, “The culture of biomedicine is now seen as key to the transmission of stigma, the incorporation and maintenance of racial bias in institutions, and the development of health disparities across minority groups”.

References

Helman, Cecil G. (2007). Culture, Health, and Illness (5^th ed.). UK: Hodder Arnold.

Karim, Taz. Medical Anthropology. Michigan State University. 10 August 2012.

Kleinman, A. & Benson, P. (October 2006). Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It. PLOS Medicine, 3(10): 1673-1376.

“Medical Anthropology” –Tribal Jazzman Scholar, Episode #26 [Video File]. August 10, 2012. Retrieved from http://www.youtube.com/watch?v=NjDPwF9uV58

Pui, Jasmine. (September/October 2003). Medical Anthropology. Unique Opportunities: The Physician’s Resource.

Mercy Ships

The 60 minute
piece with Doctor Farmer and his alternative delivery methods of medical care
in Haiti and countries in sub Saharan Africa motivated me to write about mercy
ships. Mercy Ships is an organization founded in 1978, describes its self as “the
world’s leading non-governmental ship-based medical organization”.  Operating its current hospital ship the m/v (motor
vessel) Africa Mercy, the organization’s vessel with its 400 volunteers (both
medical and technical)  operate primarily
in western Africa.

In these “cruises”, the ship provides clinical services, public health, community
health, epidemiology, and health education.
This ship is a full service (and obviously) very mobile hospital. These comprehensive
hospitals have full diagnostic facilities including eye clinics and dental
facilities and a pharmacy.

One great
thing that this organization does is its shore side work. This includes dental hygienist
visiting primary schools to education African children on the importance of
oral hygiene as well as providing basic preventative care for themselves. Expanding
shore side missions and in the pattern of Dr. Farmer is what Mercy Ships calls “capacity
building” working with indigenous medical professionals.

Another reason
I picked this topic is because of my future career. I am going to be a marine
engineer. I was attending the Great Lakes Maritime Academy, in their marine
engineering program. I ran into some economic problems at the school, so I had
to take a year leave of absence to get my money situation in order; so I can
back to Michigan State University to knock out my last few credits (to get my mandatory
bachelor’s degree). When I complete the program at the Great Lakes Maritime
Academy and am a licensed marine engineer, I could see myself volunteering some
of my off time (which is one of the great things about the marine
transportation industry there is lots of time off) to help people in the third
world.

Since I will
not be a medical professional, I could explain to them to look at the children
that they are providing preventive care education and address them in a culturally
sensitive meathod method. http://www.youtube.com/watch?v=f4YvViOLKA8&list=UUeyq3MDtsasdCX4MYrnNzfA&index=10&feature=plcp

This course has opened my eyes to just how important and functional the field of medical anthropology is. I previously was most intrigued by the field of archaeology but have slowly switched my focus over to this subject. There are currently an abundance of medical jobs in the United States which definitely has an influence on its attractiveness. Also the advancement in technology is soaring right now, making western medicine even more dependable and efficient. On the other hand, our country has admitted that the healthcare system we currently have is not so good at all. Even countries rated below us in terms of wealth, technology, etc., have longer average life spans. The reason for this may be the existence of universal healthcare systems, in which no citizen has to worry about not having access to sufficient health services.

After watching a video on the subject of healthcare systems earlier in the semester, I have drawn up a little dream scenario in my head. I wish I could come up with a solution to our country’s problem. It isn’t fair that a portion of our population is denied healthcare due to poverty, lack of insurance, and other hardships. And it isn’t just poor families suffering. I have friends who don’t have insurance because their parents’ plans have dropped them and they are unable to work a job that provides benefits or can’t afford to pay for another type of insurance and don’t qualify for governmental assistance.

In order to come up with a new medical situation for this country, I think that well-educated and passionate anthropologists are a vital part of the research team. They bring a culture-analyzing view. As professionals, they are able to take on an objective perspective, pointing out the important qualities of our culture that would affect a proposed system. Coming up with a new healthcare system isn’t just about developing one that seems good but shaping it so that it fits into our lives easily and naturally, ensuring its success. We may need economists, politicians, doctors, and other professionals to create a system but the anthropologists would be able to predict its success rate before it is even put into action.

According to lecture video on “Applied Medical Anthropology” clinical anthropologists work with medical professionals and patients in clinical settings on ways to improve healthcare and management. Just like in global health arena these anthropologists apply the same theoretical and methodological training to address barriers to health. One of the primary goals of clinical anthropologists is to emphasize the cultural context of an illness experience. This especially important when clinicians are treating patients from other cultures who understand health through different ethnomedical systems and explanatory models.Anthropologists are important because according to the lecture video “Applied Medical Anthropology, they “recognize that neither of the clinician nor the patient is a blank slate and that the only way to come up with a workable treatment program is to consider the complete cultural, biological, psychological and social circumstances.” In essence I  would say that this a more affective approach because the treatment program considers a persons biological, cultural, psychological and social factors in creating a workable treatmentl. All these factors are important in creating a treatment for a person because they act as a cultural mediator to develop the best possible strategies to achieve health for individual patients

I picked this intersection because I believe clinical medical anthropology is essential and important in treating patients more affectively by providing a recovery plan that reflects their cultural and social needs. Medical clinicians are essential because they provide a link and communication between the patient and the medical world. According to the article Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It, “clinicians are grounded in the world of the patient, in their own personal network, and in the professional world of biomedicine and institutions. Clinicians serve as social and cultural links that connect the patients to the social world of the medical field. If I was working with a provider in the area of clinical medical anthropology who is not an anthropologists I would explain to the provider that taking an anthropological approach is useful in this particular area because “culture factors are crucial to diagnosis, treatment, and care”(Kleinman & Benson 1673). These factors help shape beliefs, values, and behaviors that reflects a patients culture. This is invaluable because it allows the clinicians to understand and formulate a treatment that will help their patient recover base on their cultural needs. Clinical medical anthropologist are for the patients and the serve as communicators for their patients to the medical world.

Sources

Kleinman and Benson – Anthropology and the Clinic

http://anthropology.msu.edu/anp204-us12/files/2012/06/6.-Kleinman-and-Benson-Anthropology-in-the-clinic.pdf

Lecture: 6.1- “Applied Medical Anthropology”

According to the World Health Organization (WHO), Epidemiology is the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems. I picked the intersection of these two fields because Epidemiology is something that I have been interested in for a long time. I am currently in the undergraduate program here at Michigan State and this summer I had my first experience with Epidemiological research that I shall continue in the fall. I think that Epidemiology is an interesting field because it in itself is an interdisciplinary field and then combining the viewpoint of an medical anthropologist add an additional layer of understanding the group one is studying. Taking into account medical anthropology will cause you to think more about the culture of the area. Because often Epidemiologist find themselves asking why do we see the distribution that we have. It will be difficult to understand why people are still be infected with cholera in a small village. That is until you realize that the people of the village believe that the fluorine and chlorine compounds you provided to clean the water are seen as toxins and therefore they do not add them to the water source. It is the job of the anthropologist to learn more about the culture so that the team can come up with other methods of providing safe sustainable drinking water for the village without offending them. Another great example would be from the youtube video in this week’s lesson. It is a recording made by a medical anthropologist who mentions some of the possible ways of applying medical anthropology. The one I found very interesting was the women who of the village who during their period where been essential kicked out during those few days. This might they did not have access to things that others in the village had like water, food, and other resources. So when they starting giving women the IUD devices to decrease the rate of pregnancy they we causing the women to be isolated from the village for a longer period of time which is not going to be helpful when you think about the fact that many of the women have quite a few children to care for. This is a great example of where the anthropologist taking the time not only to learn the language but the culture and why they do the things they do can come in handy. It will allow for a level of care that may not be high but may end up being a program that individuals will follow because it goes along with their beliefs.

Sources
1. http://www.who.int/topics/epidemiology/en/
2. Tribal Jazzman Medical Anthropologist http://www.youtube.com/watch?v=NjDPwF9uV58

I decided to write about the increasingly common practice of combining medical anthropology and epidemiology to use interdisciplinary methods in solving important global health issues. I am personally very interested in the epidemiology as a field of study because the cause and spread of disease can be affected by so many factors, from huge macro-level events, to the most microscopic of organisms. Epidemiology is defined as “the study of the distribution and determinants of disease” (Trostle et al. 1996), and the reasons behind the distributions and the biological, social, and cultural determinants also factor in heavily to fields of study that are of interest in applied medical anthropology. I hope to one day be a geriatric primary physician, and although I may not be on the front lines collecting the data with the epidemiologists and anthropologists, it will be very important to me to know about what disease are currently being spread and who is at risk because the geriatric population typically is the most infected and least able to fight off general infectious diseases. The geriatric population, along with children and the chronically ill are part of the most vulnerable subgroup of the population when it comes to contracting diseases, and this is true in almost all areas of the world.

If I was working with an epidemiologist on trying to come up with answers to why a particular disease is spreading and behaving in a certain manner, the knowledge and methods used by applied medical anthropologists would be indispensible in coming up with ways to combat a disease and answering the major questions about how to solve that particular health problem. The anthropological theories could help to assess what macro-level structures could be contributing to the rate a disease is spreading and why it is spreading in a particular pattern. They could look at the ecological systems, transportation patterns, and the culture’s ethnomedical systems in order to present a complete picture to the epidemiologists to help determine the distribution pattern of a disease and more importantly, why the disease is spreading in that specific manner. Applied medical anthropologists could also help epidemiologists, by using anthropological methods to collect data that could look at individuals with the disease they are studying and collect enough qualitative data to help identify the determinants of the disease and who is most at risk. This interdisciplinary approach could help treat and then move to prevent the further spread of that specific disease. The overlap of interests and fields of study between epidemiology and applied medical anthropology have led to a great increase in scientific studies that utilize areas of both professions, which then join together to help solve important health issues.

Sources:

1-      Janes, Craig R. Anthropology and Epidemiology. Dordrecht, Holland: D. Reidel Publishing Company, 1986. http://books.google.com/books?hl=en&lr=&id=ggn-VgZceYAC&oi=fnd&pg=PR7&ots=BLo4530f_y&sig=pAEnIq_cFfQDZP7HrKlRcs5klJg

2-      Trostle, James, and Johannes Sommerfeld. “Medical Anthropology and Epidemiology.” Annual Review of Anthropology. 25. no. 1 (1996): 253-274. http://www.annualreviews.org/doi/pdf/10.1146/annurev.anthro.25.1.253 (accessed August 10, 2012).

The area of applied medical anthropology I chose was clinical medical anthropology. I chose this because my degree deals with the health field so I have learned a lot about the subject and it interests me. Taking an anthropological view in a clinical setting is important because it covers topics and situations that doctors, nurses, specialists, etc. were not taught. Physicians are taught to take care of a patient and make sure they get better, and basically treat them like they are the disease they have. They don’t really find out much personal information, or any cultural information. This is where a medical anthropologist would come in. They would look at other things other than the science behind the disease, and actually take into account the cultural morals and values that one may possess. It would be a lot more personable and could definitely make someone feel a lot more comfortable in a clinical setting, especially if they are from a different cultural background than their physician. A clinician and a medical anthropologist could work together to decide the best way to treat a patient that would cure the illness all while taking into consideration the needs of the patient. Medical anthropologists could also talk to patients to find out their perceptions of the care they are getting and how they interpret it to better the environment in which the patient is in. This could help the clinician to ease the process of healing and be more comfortable with a patient. I think an important part of medical anthropology is asking questions and interviewing people. This way you get to know the person and how they feel in certain situations, what they like, what they don’t like, and you don’t have to guess. This makes it very personable for the patient because every person is different and reacts to things in different ways.

For this week’s blog I chose to investigate Clinical Medical Anthropology as an intersection of applied medical anthropology. The field I hope to end up in some day is sports management, so none of this really relates to that. Most of the topics do not directly apply to my major of economics either, but the one that interested me the most was Clinical Medical Anthropology. I found an article that discusses the intersection of the clinical world and the anthropological world and the problems that may arise. As the lecture states, “Clinical Anthropologists are anthropologists who work with medical professionals and patients in clinical settings on ways to improve health care and management.”  They must emphasize the cultural context of an illness experience. In order to determine how to help/treat a patient a Clinical Medical Anthropologist must get to know each individual patient and not make assumptions. The article I read made gave examples on the differences of how doctors and anthropologists might think.  In one example given is a case that involves a man and his four year old son who are both HIV positive. The man’s wife died of AIDS a year earlier. Though the boy is HIV positive, his father has not brought him in for regular care. The author of the article said that while a doctor or clinician assumed “that the problem turned on a radically different cultural understanding.” On the other hand, the anthropologist determined that the issue was not due to cultural differences but rather the man’s socioeconomic situation. Through talking to him, the anthropologist was able to learn about his understanding of HIV, his low-paying job, and his late night shifts that prevented him from taking his son to get treatment. This is why it is important to take an anthropological approach to situations like this. While it is extremely important to try to learn how different cultures treat different diseases and illnesses, it is also important for them not to generalize.

http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030294

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.