Public Health and Medical Anthropology

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.

Infant Mortality in China

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/

Clinical Medical Anthropology

I think that clinical medical anthropology is essential for helping patients and professional staff understand each other.  The fact that clinical anthropologist act as a cultural mediator not as a whole but from an individual perspective makes treatment much more effective.  I feel that understanding a person’s personal experience with an illness is very important in providing a treatment regimen that will be the most effective.  Of course there are downfalls, such as the tendency to stereotype, but I feel that overall the methods used are necessary to understand cultural beliefs and their impact on medicine.

As a clinician, having a cultural understanding would allow for better communication to the patient.  I think some of the best examples of this were made in the Tribal Jazzman Scholar video.  The examples that he used are great ways to show that knowing more about the culture in an area can make an impact on the approach used to fix an outstanding problem.  Another great example is talked about in the lecture.  The HIV/AIDS epidemic in Africa has had a huge cultural impact. If epidemiologists and doctors could find a better way to communicate to women that breastfeeding is hurting their children and that by not breastfeeding they are being a good parent things may be drastically different.  They also need to find a way for them to provide nutrition for their children that is safer for them.

I remember watching a documentary that talked about how they were able to communicate to different tribes in Africa the importance of family planning.  In these tribes the girls are married very young and the problem is that they become pregnant at too young of an age and it causes major health issues.  The clinicians and anthropologists were able to talk to the men and women about birth control.  The men like the idea because it kept their wives healthy and also allowed them to be able to control the sizes of families so they were better able to support them.  This is just an example of how with the right communication, change can be possible.

The Guinea Worm in Northern Ghana

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/

Clinical Medical Anthropology

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 (5th 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.

 

Famine in Somalia

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 in Sub-Saharan Africa

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

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

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

Sources:

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

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

Malaria in Sub-Saharan Africa

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/.

FGM/C in Sudan

     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).

John Menary

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