Clinical Medical Anthropology

I chose clinical medical anthropology as my area to investigate further. I chose this because I am considering going to medical school after graduation. If I do choose to enter the field of medicine I think a good foundation in clinical medical anthropology would help me to be a better physician.

I think taking an anthropological approach in a hospital setting when surrounded by doctors and nurses is very important. The doctors and nurses hired by the hospital were only trained to heal with science and facts of the biomedicine world. Their training does not include cultural complexities we are facing in today’s world now that globalization is happening more rapidly. In the article this week, Anthropology in the Clinic, it states that cultural processes include the embodiment of meaning in psychophysiological reaction, the development of interpersonal attachments, the serious performance of religious practices, common-sense interpretation, and the cultivation of collective and individual identity. Doctors and nurses are unequipped with the knowledge of each culture and how a patient will react to each treatment option provided to them. If an anthologist gets involved then the different situations are better understood and a patient can receive the best treatment for their individual needs related to their culture and self-identity. Also I think it is important for NGOs and other aid that may be provided to be looked at with an anthropological approach. Like in the lecture when bed nets were given to protect people from disease carrying mosquitoes that could infect people with malaria. The providers of the bed nets did not understand why the intended users where not using them or were doing so incorrectly. When they took a step back and view the situation as an anthropologist then they got their answer and with an answer come an understanding in how to fix the situation. With a fix like the bed nets more lives can be saved. There are many more examples and more many more reasons why one should take an anthropological approach in a hospital setting or when talking with NGOs.

Clinical Medical Anthropologist

If I were to further investigate an area of applied medical
anthropology it would be Clinical medical anthropology because of my
own person fascination with the health. I also would find this area
most helpful in my pursuit to be a physical therapist. I believe that
ones culture and beliefs can make a difference on whether they truly
feel healed or can recover from an injury. With further
investigation, we can combine the culture with medical practices and
have the greatest benefits for the patient.

Working for a doctor as a clinical medical anthropologist could be
very beneficial for the doctor. The language used in translating what
is occurring in their bodies could be better understood by the
patient.  It would also allow the doctor to treat the patient in a
way that does not conflict with their cultural values. Very similar
to how a priest may come to visit the sick in the hospital and pray
for the patient, the same could be done with other cultures. It is
much like how we learned of  shamans being allowed in hospitals to
perform various rituals for the sake of the patients. Being a
clinical medical anthropologist would allow us to use the
ethnomedical approach and  explain why a patient did not initially
consult a physician when the first symptoms occurred. This would help
with what treatment options would be best for the patient because the
doctor would know how their culture feels about medications, therapy,
and so forth.

In providing services to the doctor, the patient benefits from
having complete understanding of how to go about the situation with
their culture taken into consideration. The patient will also be able
to tell their illness narratives without feeling stereotyped and
someone realizing why this is considered an illness to them. If a
doctor was to encounter Kuru in America and was unaware of the
cultural ritual of eating the flesh of a recently deceased family
member,  he would not know the meaning behind the action or how it
came about.  They may even consider it to be an epidemic of some
sort. Clinical Medical anthropologist would cause the blurred lines
between patient and physician to be clear so that there is no longer
misunderstandings.

 

Public Health/Med Anthro

I picked the intersection of Public health and Medical Anthropology because they work off each other in order to solve world problems. Outside the United States, health care and culture are practiced drastically different. It is important to use anthropology to learn about the people and the culture, and then use Public health knowledge to make significant improvements. Although one method may work for Americans, that method may not be possible in another country or against their beliefs. When I switched my major from human biology to health and society in social science, my interest and knowledge of anthropology, culture, and public health greatly increased. I had been studying everything on a biological level and did not realize the complexity of health and well-being. I want to pursue a career in nursing, but lately I have had a strong interest in getting my master of public health. I think that public health policy really can alter how health care is carried out. I feel understanding these issues would help my nursing career.

In the article Unique Opportunities: Medical Anthropologist that we were to read this week they said, “ Medical Anthropology encompasses every aspect of medicine, and it encourages an understanding of self, along with empathy for the strengths, weaknesses, rights, and needs of others, as well as the ability to relate to others with greater human understanding.” I feel this quote perfectly describes what we have learned in this class so far, and it demonstrates the importance Medical Anthropology brings to Public Health.

I took an anthropology course last semester called sociocultural diversity and we learned the importance of culture and the identification of race. We did an activity on PBS where we had to look at a picture and determine the race of the person. I personally did horrible with the activity. I got most of the questions wrong. I think having an anthropologist help and educate doctors and nurses is immensely valuable. Having the ability to recognize the race and culture of the patient will start the process of the explanatory model. We have learned about this throughout the course, but this week specifically in the article Anthropology in the Clinic. Following the steps of the explanatory model will contribute to better health care for the patient. The six steps are Ethnic Identity, What is at stake, illness narrative, psychosocial stresses, influence on clinical relationships, and the problem of cultural competency approach (Kleinman, Benson). If the health care provider can use the anthropologist these steps can be more effective. Knowing what is at stake for the patient and knowing their illness narrative will help in the diagnosis and then psychosocial stresses can be accounted for. Once the health care provider feels they know the best course of treatment an anthropologist can let them know if the care can be carried out and accepted by the person and their culture.

I think our health care providers are very focused on treating symptoms and not the cause of the disease. We do have doctors with D.O who focus more on the health of the person versus the symptoms of the disease, but I feel anthropologists would allow for better public health and individual health.

Sources

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

http://anthropology.msu.edu/anp204-us12/files/2012/06/6.-Unique-Opportunities-Medical-Anthropology.pdf

 

Global Health

I picked global health because it has to do with the worldwide well-being. It’s the best way to make sure everyone can have the access to healthcare when every need. In lecture 1 its say global permits individuals to connect about health across great distances and this very important. I remember when I was younger to want to be a doctor and being a part of Doctors without borders. Even though I no longer want to be a doctor I still want to travel to different counties and help out any way that I can. Watching the video Dr. Farmer’s Remedy was very inspiring and yet heartbreaking. I am Haitian American and watching the video shows how important global health is.

If I was working for a healthcare provider who is not anthropologist it would be very useful if they did. It’s a great way to know how different cultures understand their bodies and their beliefs. For example the Medical Anthropology” -Tribal Jazzman Scholar, Episode #26 TribalJazzman  in  he talks about a woman from Peru who try stop the spreading of parasites to tribes through water way. She came to the villages and told them to boil their water to kill the parasites in the water and they said yes. Months later many people were still dying because they don’t believe in boiling the water; it had the spirit of the earth in it. Another example is about exchange student from China who came to USA and had been experiencing dizziness, fatigue, and etc. She later diagnosed with   depressive-anxiety disorder and takes her antidepressants for a while the symptoms are under control. She suddenly stops an anthropological consultation finds out why , in china her illness is considered stress related instead of an illness. So they change the name of her illness so she would start taking her medication again.

In the first scenario if an anthropological approach was taken; when the woman had come back it would be good news instead of bad. The second scenario is a great example of how anthropological approach worked.   If a healthcare provider took the   anthropological approach it’s a great way to build doctor and patient relationship.

Public Health and Medical Anthropology

I chose public health because it is what I want to do with my life. I have always been driven to work in some area where I could help people, and for the longest time I thought that was by becoming a doctor. That was until I read the biography of Dr. Paul Farmer, the same that the 60 Minute video was about. I read his story, Mountains Beyond Mountains, around my Freshman year of college, ever since then I’ve know that I want to work in public health. I am looking to go to graduate school and get my Masters in Public Health, and I would eventually like to set up clinics that can provide medical care to those who may not regularly have access to it. I have thought about working over seas, and I am not necessarily opposed to it, but I also know that there is just as much need for better access to health care right here in the United States. There is some need in a lot of inner city areas here, like Detroit for instance, but I also know from personal experience that there is just as much need for better access to health care in a lot of rural areas. The closest hospital to my home town was 30 minutes away, and if it was anything serious or urgent you’d have to go to a hospital that was almost an hour away, so there is definitely need there.

 

I can definitely imagine working in that kind of situation. I’m originally from Ohio, and my town sits right in the center of Ohio’s “Amish Country”. There are a lot of doctors, who are definitely not anthropologists, who work with the Amish but don’t really understand them too much. An Anthropological approach would be very useful in the area of public health because it would allow doctors like these to understand the cultures of the patients that they are working with and better provide care for them. Much like Paul Farmer looked at the culture of the Haitians and made a system of care that works with their culture, anthropologists working in public health could do the same for cultures around the world.

 

“Mountains Beyond Mountains” by Tracy Kidder, 2009

Clinical Medical Anthropology

I chose Clinical Medical Anthropology as my area of intersection for anthropology because I plan on working in the clinical setting in the future.  As a pediatrician, which I am working towards becoming, I will be in the clinical setting everyday working with patients and my colleagues.  It is critical to have an understanding of anthropology when working in such a setting because you need to understand the cultural differences in treatment for each culture.  You will run into many different problems as a physician, and the biggest problem is working around these cultural differences.  Once these differences are understood it makes for a much smoother and easier visit.  Some things that cause this are different cultures do not accept certain treatments.  You need to know what is acceptable in what culture and medical anthropology can help with that.  One example of clinics trying to help with this problem is at theMercyMedicalCenterinMercedCalifornia.  During week three in our lectures we talked about what this hospital did to lessen the problem of cultural boundaries.  This hospital took on a new policy which allowed traditional healers, or shamans, to work in the building and make regular rounds just like the doctors.  These shamans would go into the rooms and perform rituals on patients that did not allow traditional medicine because it was not part of their culture.  On top of having unrestricted access to the hospitals like the doctors, they also made house calls, which is something that doctors can not always do because they are so busy.  These shamans were not only there to help heal the patients with cultural boundaries, but are also a base of security for other patients.  The hospital can be a scary place, but the shaman can help patients feel more secure by performing a ritual.  This policy inCaliforniashowed that if you incorporate a cultural understanding in the medical workplace it can have a positive affect on patients.

Source

http://www.nytimes.com/slideshow/2009/09/19/us/20090920-SHAMAN_index.html

Epidemiology and Medical Anthropology

I chose to elaborate on epidemiology and medical anthropology because I am interested in pursuing a public health degree, and epidemiology is an important aspect of public health. It will apply to my future career because I hope to provide health care to underprivileged communities around the globe, and understanding epidemiology and the distribution of illnesses is a vital component of public health. Through epidemiology, risk factors for disease can be identified, allowing for preventive medicine to inhibit the development and spread of diseases in a given community.

An anthropological view on epidemiology, particularly the applied anthropological approach, would be useful because it focuses on research and analysis for a specific problem and client, which is the basis of epidemiology. It would also be helpful so preventive measures can be developed and applied in specific contexts within communities because these solutions may not translate to different populations. As an epidemiologist, it will be of value to incorporate the cultural values of anthropology into medical practices. Culture is a huge factor in how populations will respond to treatments and the Kleinman and Benson article emphasizes that culture is not static but rather dynamic and comprised of multiple variables.

The Youtube video from this weeks materials emphasizes the importance of taking an anthropological approach to medicine and how important culture is in the treatment of illnesses. The video describes how a woman tried to prevent the spread of E. Coli in water from cattle farming in Peru because it was causing intestinal problems such as dysentery and young children were dying of dehydration. She raised money to campaign for boiling water and went through villages to teach women how to boil water to kill the parasites causing the infections. It seemed as though the village was responsive to her efforts, but when she returned to follow up she found people weren’t boiling their water because they believed it held the spirit of the Earth, which would be destroyed when they boiled it. Because cultural context was not taken into consideration in this case, the effort failed. Another example occurred in Ecuador, where intrauterine devices were distributed to women who wanted less pregnancies. However in this culture, menstruating women are secluded and can’t handle food, leaving their children without care. The IUD’s increased the length and severity of menstrual bleeding, which was problematic for this village. These instances emphasize the importance of considering the anthropological approach while administering treatments, as they should be culturally defined within relevance to the context of a culture.

Global Health and Medical Anthropology

Global Health is important in context with medical anthropology as it offers different perspectives and insights of health and well-being to a specific culture and country. Particularly, developing nations that do not have the same political, economic, and social resources that developed nations have are the main focus in global health. As Dr. Paul Farmer has done in co-founding Partners In Health; he gives free treatment to patients that come to his clinic in Cange, Haiti. In return, that he may provide equal and sustainable health care for the Haitians by the Haitians.

The context of understanding people in different cultural environments has always been of interest to me, particularly, in the use of language and the way things are described, communicated and sometimes translated. So when there are health disparities among different countries and cultures it’s interesting to see the different origins and interpretations of illness and health. Ideally, I would one day like to join an organization that can better improve the lives of others so they can better help themselves and live a comfortable day-to-day life.

Having an anthropological background and stance for a biomedical practitioner within global health would be very beneficial. While the healthcare provider can have a better understanding of the illness in biological terms, the anthropologist is the mediator. They bridge the gap between the cultural and scientific knowledge of healing and treatment. For example, TribalJazzman (on youtube) told the story of IUD’s placed in Ecuadorian women as a birth control mechanism. Many doctors would thus predict that women would be able to be more in control of unwanted pregnancies, however, this resulted in adverse effects. Women in this particular Ecuadorian group were not allowed to handle food when menstruating, and the IUD’s would give longer menstruation cycles. This led to longer seclusion periods, and mothers not being able to feed their children and family. A situation like this would not be understood by just the doctor. Without an anthropologist being involved, and observing these finds and cultural ideas and values, the use of biomedicine essentially becomes useless.

Public Health and Medical Anthropology

*I decided to pick public health in medical anthropology because of how easy it is to travel around the world. As we move quicker and easier around it is easier for diseases, bacteria, and viruses to also move around with us. As these diseases spread to areas in which they had not previously inhabited, they can have extreme reactions and can even cause epidemics. Medical anthropologists can help greatly in discovering the best ways in which to fight these epidemics. They can assess the different cultures views and beliefs and incorporate that into the most effective treatment. In fact, there are currently 45-55 medical anthropologists working for the CDC. (Fiske; 2007) I think this type of work would be fun, interesting, and exciting and I hope to one day work for the CDC as a medical anthropologist.

*Taking an anthropological view in any area of healthcare can be extremely helpful. One culture will/can see things extremely differently than another. This can cause persons of one culture to not visit the doctor for medical conditions that may be life threatening whereas a person in another culture with the same condition would not hesitate to see a doctor as soon as they possibly can. It can also affect their probability of taking medications. One culture may see the medication as poison and refuse to take it where as another culture may have individuals that just can’t afford to purchase the medication. Knowing these different reasonings and ideals in the cultures will help medical professionals to better treat individuals.

It can also help in determining if the issue in treatment is due to cultural differences or something else. This is seen in an example from Kleinman and Benson’s essay ‘Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It’. (2006) In their Case Scenario found in box 1 they discuss the affect of a Mexican man’s culture on his son’s HIV treatments. The man had a rather complete understanding in regards to HIV and the treatments for it but had not been bringing his son in for regular care. The doctors working his case believed this was due to the man’s “radically different cultural understanding”. However, the anthropologist helping on this case came to realize through conversations with the man that he did not have the time nor the funds available in which to take his son to the clinics in order to receive his healthcare as needed. In other words, it was not his cultural differences but his socioeconomic situation that altered his treatment routine.

Global Health and Medical Anthropology

I picked the intersection of global health and medical anthropology because it is of the most interest to me.  Last spring I took ANP 320 and my professor talked about her research about medical students treating patients in Malawi.  I thought it was interesting that rather than analyzing a different medical system in a different country, she analyzed and critiqued an American medical system working in a different country.  I majored in History, philosophy, and sociology of science so I find it very interesting to look at how different cultures understand health and the body and especially the incongruencies between western medical systems and others.  Although I find this area interesting, it has nothing to do with future career.  I decided to leave the world of healthcare two years ago and pursue a greater passion, literature.

If I was working as a health care provider such as a doctor, nurse, or in a NGO providing health care to people within a different cultural context, taking an anthropological approach would be helpful to create the most effective treatment plans for patients.  It is important to understand how people understand the body and how it works so that you can treat patients, or even just explain treatment plans, in a way that makes sense in their cultural context and does not violate their beliefs.  One example of this brings me back to a few weeks ago when we read about treating Hmong patients in California.  Because their ideas of illness are more focus on the spirit and not on the body, our biomedical explanation does not seem to correlate well.  Also, many of our treatment plans such as surgery violate body taboos and would not even make sense as a treatment for a spirit problem.  CITE.  A second way that taking an anthropological approach would be helpful is that it can help one learn which topics are all right to talk about and which ones are not.  For example, in the lecture a case was briefly mentioned of birth control and sexual health in India.  Because sexuality and sex outside of marriage are taboo topics, a sexual health discussion like those that are given here in many high schools or simply by doctors to patients of a certain age would not be appropriate and the information may be ignored.  In that case it would be much more beneficial to find a way to discuss safe sex within the context of marriage so as not to offend anyone or presume that one is condoning sex in an inappropriate context.

Fadiman, Anne. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus, and Giroux, 1997. Print.