Global health and Medical Anthropology

Years and years back, I checked out a book from the public library about the use of forensic anthropology to identify the bones that are still being found in areas like Vietnam and Korea and how those soldiers are being identified and returned to their families. Seeing as my grandmother had been permanently affected by how her cousin was declared POW/MIA in Vietnam, this sparked my interest in anthropology. Though I am an avid fan of the show Bones, unlike most people assume, I am not in this business to “work with a hot guy”. Or dig things up in Egypt (though I would like to dig things up here). I went into college at Oakland University as an anthropology major not really understanding what I was getting into. Especially since coming to MSU, I have gained countless knowledge about what it means to be an anthropologist: everything. Anthropology will invade your field of practice and completely turn your way of thinking around, as we have seen here in the medical field. I often wonder what would be the result of having an anthropologist for president – someone who understands global health from a medical anthropological perspective, that culture is a bit more complicated than “Somalia is starving, we have extra corn, let’s give them corn”.

Something that got my attention in previous anthropology courses is the concept of “volunteer tourism”, where people volunteer on a two week or so trip to do things like fly to Africa and help starving children. Or, similarly, the fact that first year medical students are being flown to Africa to practice on third world patients. From an anthropological perspective this is very, very damaging and if I were working for an NGO or similar institution that basically exported “medical care”  I would definitely work to shed light on these issues. As explained in the reading, though it may not always be the case, culture plays a huge role in biomedicine and these factors need to be taken into account on a global perspective.

Clinical Medical Anthropology

I chose clinical anthropology because I feel that it is very important as far as management and improving the healthcare system. It is something that is very near and dear to my heart. For example, some people have medicaid or medicare, which is the “government” type of insurance. Therefore, there are a lot of doctors that do not take that type of insurance. It makes it a bit harder on the patient to have to search for doctors that take that particular type of insurance.

Sometimes it is also difficult for a patient to even go see a doctor because of clinical hours interfering with their job schedules. These are all problems that medical anthropologists take into consideration when practicing clinical medical anthropology. Their job is to try to make solutions to the problems or even make the problem better in certain aspects of it.

If I was a working provider, such as a doctor, it would be good to have these certain anthropological perspective on some of these situations. For example, if a doctor prescribes medicine to a patient for Diabetes, the patient may or may not take the medicine that the doctor has prescribed.

A good anthropological approach to see why the patient is doing this would be considering their insurance situation. Does the patient’s insurance cover this? Does the patient have transportation to get to the pharmacy to get the medicine that they need? The situation could also be psychological. What if the patient does not like poking themselves with needles?

There was an example in lecture that was also used. In Africa, there is a net that they use to protect them from mosquitos and Africans will have less of a chance to get malaria. However, many of them do not use the net because it is uncomfortable to sleep in. Some of them even use it for other things such as coverings for the windows. This is also a big issue and it could be adding to the problem more than being a solution. Clinical anthropology is very interesting to me because they are the ones that get to look at all of these factors and weight out the situation to make it better. Clinical Anthropologists change lives and the paradigms of medicine.

Sources

Lecture 6.1

http://www.medanthro.net/definition.html. August 10, 2012.

Public Health and Medical Anthropology

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

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

 

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

http://www.whatispublichealth.org/

 

 

Global Health and Medical Anthropology

 

The area of intersection of applied medical anthropology I have chosen to investigate further is Global Health and Medical Anthropology.  I picked this intersection because I feel there is no worthier or more important world wide concern or disparity than Global Health. Personally I feel Global Health is of worldwide concern, we are all in one world and the world’s problems are our problems.  I would like to contribute in a meaningful way to alleviate world hunger, it would alleviate so very many problems throughout the world.  One problem leads to another and another. Hunger leads to poor health which in turn leads to disease. 

If I were younger, I would like to serve in the Peace Corps and work right with the needy around the world helping them one on one.  An anthropological approach in this situation would help because if you understand a culture’s ways and values, you can relate to them in a more meaningful and helpful way.

In the article I have cited, What Can Critical Medical Anthropology Contribute to Global Health, anthropologists have shown the “realities of health disparities and human suffering”.  It points out a very important point in regards to medical anthropologists and global health–they have made the wealthier nations aware of the need to help poorer nations in this regard.  Medical anthropologists take into consideration the cultural practices of people of different ethnicities when recommending treatments and ways of treating people of different cultures from our own.

Certain diseases mentioned in this week’s lecture such as malaria and HIV are global problems that need to be addressed by health professionals all over the world.  Other global health issue’s that were mentioned in the lecture include reproductive health, malnutrition, and infection.  These are everyones concern, globally and here at home. Medical professionals need anthropological training to understand different cultures and the most effective way of treating people of different ethnicities.

 

 

 

 

http://onlinelibrary.wiley.com/doi/10.1111/j.1548-1387.2008.00041.x/abstract

 

Global Health and Medical Anthropology

I chose this intersection because I feel that global health is not up to par. Especially when you consider what technologies are available to us, as well as how easy it is to have a global presence, we are not helping out the needy as much as we could be. It seems to me that the saddest bit is that politics and personal interests play the most into this, rather than selflessness. As we saw in the class video about the medical anthropologists Dr. Farmer, many called him crazy for trying to help the poor population of Haiti. I found this sad, because rather than encouraging him, people seemed to discourage him and felt that the Haitians were a lost cause. I believe that no one should be considered that, and that everyone should have a chance at a healthy life. Hence my interest in global health and medical anthropology. It wouldn’t be about making the most money for a corporation, but rather helping fellow humans enjoy life to their fullest. After all, that is what being an anthropologist is about: respecting fellow humans.

I would use some of what I had mentioned previously if I were working for someone that isn’t an anthropologist. Again, I feel that it’s about corporations making many, especially in western medicine. I feel this is morally wrong, as we are trying to treat fellow human beings, not put money into the pockets of corporations. Through anthropology, we can gain an understanding of various human cultures and their behavior, and use that to aid them and make them healthier. One specific method of treatment does not work for everybody, and this is very apparent when you are traveling around the globe, and observing how other cultures and people view medicine. We need to keep a worldview, or holistic approach, if we have any hope of increasing global health.

Clinical Medical Anthropology

The application of medical anthropology to a clinical setting is relevant to me and my goal of becoming a primary care physician.  Medical workers who strive to understand the cultures of the biomedical health system and the individual patients it serves can use this context to provide the most effective healing.  Acknowledging the unique ways in which patients view their health and their lifestyle can help avoid miscommunication and non-compliance, both of which can interfere with treatment.

Even seemingly small issues, like putting medical terminology into lay terms that are more comprehensible or emotionally acceptable for patients, can make a big difference.  For example, the Anthropology in the Clinic article we read this week explained a case study where a young Chinese woman felt alienated by the American medical system when she was diagnosed with a depressive, anxiety disorder.  Mental illness was very stigmatized within her family, and the terminology her doctors used in her diagnosis and treatment made her uncomfortable.  After her doctors were able to understand this, they were better able to communicate with her without using the Western, biomedical terminology that made it difficult for her to accept her condition.

That same article made a powerful case for doctors educating themselves to develop an anthropological background, rather than falling into the current trend of gaining “cultural competency.”  This practice of describing cultural sensitivity as a technical skill that can then be applied to patient cases is often ridden with stereotypes and builds the false expectation that addressing cultural factors can single-handedly solve clinical problems.  Instead, clinicians should train in the principles of ethnography, a much more relevant practice of engaging individuals to empathize with their personal values and viewpoints.  Through this, doctors can strengthen their interpersonal skills to reach out to patients and find out how they experience an illness, what matters most to them, and what stresses weigh down on them.  This can complement doctors’ biomedical training, which can lead to an unintended superior attitude that places technical knowledge above the actual human experience of health and disease.  In a health care system that prides itself on objective and scientific treatment, medical workers need to focus on each patient as a person with individual thoughts, beliefs, and cultural practices.  A healthy doctor-patient relationship with mutual trust and respect can then lead to the truly best healthcare.

Information from: Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It, Arthur Kleinman and Peter Benson

Clinical Medical Anthropology

The topic I chose is clinical medical anthropology.  The reason I chose this topic is because I want to go to medical school to become a physician.  I think this topic is very interesting.  America has so many different types of cultures.  I think it’s important to have an anthropological view when treating patients because not everyone has the same set of beliefs when it comes to healing.

In the readings this week there was a very good example of why it is important to have an anthropological view in a clinical setting.  The example comes from the article by Kleinman and Benson.  The case scenario is about a 24-year old exchange student from China.  She was having symptoms of palpitations, shortness of breath, dizziness, fatigue and headaches.  They couldn’t find an explanation for her symptoms.  There was, however, a psychiatric diagnosis of a mixed depressive-anxiety disorder.  She was put on meds and went through therapy.  Her symptoms improved but did not fully go away.  The student drops out of treatment.  After an anthropologic consultation it was found that her cousin in China is hospitalized for a mental disorder and that the stigma associated with this is so strong that the student’s family cannot even begin to think that their daughter has a mental disorder.  The student refuses to deal with her American doctors and that in China they use different terms to describe her condition.  After speaking with the anthropologist, they use different labels to describe the student’s condition and she decides to work with her American doctors again.

This is why it is important to have an anthropological view when dealing with different cultures.  As seen in the case scenario, western medical terms can sometimes be scary to people from other cultures.  Cultural factors are very important during the entire diagnosis and treatment process.  Not everyone from the same background has the same culture though.  As talked about in the Kleinman and Benson article, culture today is not homogenous or static. This is why it is important to have an anthropological view because America has such a mixture of cultures.  It will help create a better physician-patient atmosphere.

Kleinman and Benson – Anthropology and the Clinic

Clinical Medical Anthropology

 

I’ve chosen this area, clinical medical anthropology, since I overall find it quite interesting. My mother was a nurse and my sister is in the process of becoming a physician’s assistant, so I have always grown up with slight medical knowledge. I have a degree in Sociology and have also taken classes on Public Health, from which I have gained knowledge on our health care system and how Westernized medicine, especially with the American health care system vastly differs from other sorts. I feel as though have some sort of Anthropological background as a doctor, since there are people from several different countries and backgrounds. It is incredibly important to respect other individuals that have different values and mindsets than that of the Westernized American. While I don’t believe I’ll be doing anything regarding the medical profession, from the classes I have taken and the knowledge I have gained, I’ve come to learn how our health care system in America is a money game; while we have one of the most expensive systems in the country, we have one of the highest child mortality rates out of any developed nation. In my mind, this is a complete travesty, and all individuals should have access to health care, and be able to afford it. Medical anthropologists advocate for the community and push for greater equality for all and how politics and force of globalizations affect different social institutions. Medical anthropology helps to improve cultural sensitivity. In order to fully understand your patients, you should be sensitive to differences in religion, cultural background, local worlds, and country origin. 

 Cultural factors are incredibly important in order to diagnosis, treat, and care properly for a patient.  An example that was a case scenario listed was about a graduate student from China, in which she developed symptoms of palpitations, shortness of breath, dizziness, and fatigue.  When she went to receive treatment, tthey diagnosed her with depressive-anxiety disorder, and received antidepressants. While her symptoms got better, they never disappeared and then she dropped out of treatment. After an anthropologist discovered that Lin’s cousin is hospitalized with a  mental illness, she can’t even imagine being stigmatized with the disorder. By the anthropologist discussing with Lin abotu how this is considered a stress related condition, the individual decides to receive treatment once again.

 

http://www.univie.ac.at/ethnomedicine/PDF/Medical%20Anthropologie.pdf

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

 

 

Clinical Medical Anthropology

I’ve picked this area of intersection because foremost, I find it generally interesting. I’m currently in the process of applying to different medical schools in order to fulfill my dream of becoming a physician and I find this area to be interesting because it could potentially involve me working with a clinical medical anthropologist one day. After watching Tribal Jazzman Scholar’s video on YouTube about medical anthropology I realized that there are many things to consider when “helping” individuals in a foreign culture. Taking an anthropological approach is necessary whenever dealing with any culture to which you do not belong or fully understand because otherwise it is likely that you will be applying your own logic, which is shaped by your cultural values, to the situation. For example, in the video, Jazzman talks about how he built a shower for an impoverished family near the Mexican border area. He said that he built it out of wood and came back later to discover that the family had dismantled the shower in order to use the wood for other purposes. He then has a brief diatribe about how he built this shower according to what his western perception of this family’s needs was and hadn’t considered that they would want the wood for other purposes. It is very important to prevent most situations like these from arising because with globalization, they are becoming increasingly more likely.

Especially within the United States’ Western culture, it is very important to take an anthropological approach to health care as a physician, nurse or other health care professional because this nation is so diverse. Americans are made of a diverse lot of unique cultures and individuals with many unique beliefs and because of this diversity, it is important to view patients anthropologically before suggesting a certain treatment.  For example, applied anthropologists are very important in this field because the same health programs implemented in a suburban, mostly white neighborhood are unlikely to be as effective in an urban, predominantly Hispanic neighborhood. Many barriers are beyond language and I think applied anthropologists are very important in that they can help medical professionals to bridge this cultural gap. In a way the world is getting smaller as we experience more and more globalization, but it seems like in many ways the cultural gap is growing as it is common for Westerner’s to enforce their beliefs and mentalities on other cultures.

 

Source:

http://www.youtube.com/watch?v=NjDPwF9uV58

http://www.medanthro.net/research/cama/index.html

Clinical Medical Anthropology

I chose the area of clinical medical anthropology to investigate further because I really believe that this ties in well with what my future career goals area. I would like to pursue a master’s degree in public health but with the concentration of healthcare administration and public policy. Through this concentration I want to incorporate the knowledge I have gained in the area of anthropology to improve the quality of healthcare the patients receive. This would include training for doctors and staff on being more empathetic to cultural beliefs as well as a way to integrate biomedical practices with cultural practices. With America being known as a “melting pot” it is important that Western medicine respects each member within this pot. I am hopeful that through these improvements, better doctor/patient relationships will be established and a greater sense of trust will be placed into the healthcare system.

It would be extremely beneficial to take an anthropological approach when working within a hospital setting alongside doctors and nurses that do not have any anthropological background. By understanding a patient’s culture and religious background, the healthcare provided could be greatly improved. According to the article “Concepts from Medical Anthropology for Clinicians”, it is stated that, “A doctor’s diagnosis, though medically correct from an orthodox point of view, may not be at all representative of the patient’s view of the situation,” (pg. 932). For example, in a case scenario that was done, a 24 year old Chinese exchange student in graduate school was seen by a doctor for experiencing symptoms of palpitations, shortness of breath, dizziness, fatigue and headaches. The doctors diagnosed this as depressive-anxiety disorder and placed her on anti-depressants and routine cognitive-behavioral psychotherapy. The girl drops out of treatment, stops taking the medication and refuses to see the doctor again. IT was discovered that her family was from Beijing and that a strong stigma is put on mental illness so healthcare providers there do not use the word disorder. Instead they use the terms neurasthenia or stress related condition (Kleinman and Benson 2006, pg. 294). Getting a better view of how each patient is experiencing illness instead of just an assessment of the disease and its symptoms can be crucial in establishing trust between the patient and doctor as well as prescribing the right treatment on a per person basis.

References

Benson, Peter and Kleinman, Arthur. Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix it. PLoS Medicine. 2006; 3.10: 294.

Katherine K Perry. Concepts from Medical Anthropology for Clinicians. Phys. Ther. 1984; 64:932.