For my final project in this class, I have decided to look at the health issue of Tuberculosis and how it is impacts the people in Cambodia. Tuberculosis is defined as “an airborne bacterial infection that is caused by the organism Mycobacterium tuberculosisthat primarily affects the lungs but can also affect surrounding organs and tissues” (American Heart Association). TB affects the body by weakening the immune system and spreading to attack the rest of the body. Common side effects are cough, chest pain and bloody mucus, loss of appetite, fever, chills and even death (AHA). Cambodia is one of the poorest countries in the world and many of the people that reside there are exposed to unhealthy living conditions, dirty water, minimal food and resources and lack of transportation to be able to access health care. As you can imagine, many people become sick and get disease due to the conditions of their surrounding environment and culture they are living in.
To put this into perspective, there are 437 cases per 100,000 that are affected by this disease which results in 66 deaths per year. When compared to other countries in East Asia, the average number of cases each year is 117 out of every 100,000 (Chen, 2015). Out of their entire population of 14 million, that means 61,000 people each year fall ill from TB (Khann, Sokhan, et al). What I found most interesting while doing this research, was that men actually have a higher chance of getting TB than women. The reason for this is because of things like HIV, undernutrition, crowded conditions, and tobacco are things that attribute to weakening the immune system. Having HIV alone increases the chance of TB by 26-31 times the average number (Chen, 2015). The reason that I bring this up, is because society is starting to become more accepting of same sex relationships which puts more of a risk on those that are a part of this community, especially with the already pre-existing health issues.
Luckily for women that are pregnant, TB can be treated, and the disease can be stopped from passing down to the baby. If untreated, the baby can have a lower birth rate and in rare cases can even be born with TB (CDC). In order to prevent getting TB there is a shot that can be given that helps protect the body from the infection. If a person already has the infection, TB can be a lengthy process to get rid of, but antibiotics can be given to help get rid of it. Luckily, Cambodia has implemented programs that aid in the prevention of contracting TB, provide treatment to those infected, as well as educational opportunities to inform the public on the severity of the infection. These programs are provided to deter the continued spread of this disease.
The reason it is so important to address this issue is that so many people are put at risk because they don’t get the proper healthcare required to protect themselves. This may be as simple as receiving a vaccination or obtaining the proper antibiotics. TB is something that is preventable and there are many resources to help stop the spread of it however, the lack of knowledge and understanding may put more people at risk. From a public health standpoint, this is actually a huge problem especially in low income, high-poverty areas of the world-such as Cambodia. The reason it is so difficult to get it under control in developing countries is because there is not an effective surveillance system to monitor those who do have it and those who do not, there is not an efficient way in identifying the case of TB, and the program that is helping administer vaccines, promote information and health, and treatment for the issue, is sometimes difficult to get in places that do not have the resources (Zaman, 2010).
Another aspect that plays a role in modeling what the people in Cambodia are living in/going through is by the social determinants that are present.Social determinants are the “condition in the places where people live, learn, work, and play in which affect a wide range of health risks and outcomes” (CDC 2018). Depending on where a person lives in the world, depends on what will impact their lives. Whether this be the culture they grew up in, the religion they were raised with, how developed or underdeveloped their country is/where they live and how accessible health care/fresh water/food is in their area. These are all examples of what social determinants are. When you think about the actual health problems that are currently an issue for the people of Cambodia, those are actually a result of their social determinants. For example, the reason why Tuberculosis is so prevalent in Cambodia is due to where they live and how difficult it is to see a real doctor for regular medical attention and checkups.
In the first week of this class we learned about the five theoretical models in determining how different people are affected by various things in the realm ofhealth. The model I want to discuss is the critical medical anthropological theory. This theorylooks at all the circumstances for a person and decides whether or not those things impact the person or a group of people. This looks at the political, economic, or social power that is in place during that specific time (ANP 270 Week 1 Lecture 4). All these factors play an important role in determining the health of humans. The reason I think this theory fits best for the issue of Tuberculosis in Cambodia is because different parts of the world have access to different technology and resources. While some countries can have amazing health care that is very affordable, easy to get to, and is very beneficial for the entire population, other parts of the world may not have the same options. Bouncing back to the paragraph before this, you can see that the critical medical anthropology theory and social determinants actually are very similar and have an impact on each other.
For Cambodia, health care services are varied depending on where in the country one resides. In the mountainous places, getting health care is very difficult and often can take a while to get to the facility, while if one lives in the city, it is a lot easier to get to. A quote by the department of Epidemiology in Phonm Penh states that “prevention is better than treatment” (Health Care in Cambodia). It is easier to help prevent certain diseases and infections than it is to treat them, and this is mainly because primary health care is very limited in Cambodia. They tend to focus on curative medicine which is the intention of fully getting rid of the health problem in the hopes that it doesn’t come back. Instead of for example, getting the proper vaccines and regularly being seen by a physician to help prevent such health issues from happening that are completely preventable to begin with.
The main problem with incorporating this into society is that the hospitals and medical facilities are geared more towards certain specialties. Meaning one can be podiatry, another could be pediatrics, or geriatrics and so on. There aren’t many that are primary care so many have to travel far to see someone. Fortunately, they do have a National Tuberculosis Institution that has been established to help treat and prevent others from getting TB. This is a huge step in getting the proper care for the general population in Cambodia. The critical medical anthropology has been used to introduce and advocate places like this. It is an effective way in introducing policies and solutions in the public health area of the country (Witeska, 2015). This is really important for patients to understand the issue of Tuberculosis and helps inform them of what the health benefits are in preventing TB. Tuberculosis has been slowly declining, and this is all due to programs that help treat, prevent, and inform the people on the severity of it. “Dr. Mao Tan Eang, national TB program manager in the Cambodian Ministry of Health, says that the TB program owes its success to a clear evidence-based policy and plan, strong technical expertise, government commitment and leadership, as well as sustained support from international donors and partners” (WHO, 2014).
Due to the critical medical anthropology theory, global health is significantly getting better. I found an article specifically about this topic that included how it connected with health disparities and TB. “The flow of international aid from wealthier to poorer countries has increased dramatically over the last decade. This is attributed in part to the efforts of health activists, including medical anthropologists, who have rendered bare the realities of health disparities and human suffering. We are now facing an unprecedented moment in the history of global health, in which infectious diseases such as HIV/AIDS, malaria, and Tuberculosis are no longer peripheral concerns but primarily targets of bilateral aid programs, philanthropy, and research” (Pfeiffer/ Nichter. 2008). This goes to show when other people get involved on a global level, more change can be brought about than if it is just locally. Sometimes it can be hard and also frustrating at times, but in the end, it is worth taking all the help that is being offered.
Tuberculosis is one of the major health issues for Cambodia. This is due to the lack of knowledge, access to health care, along with affordability of health care, current living conditions among several other factors that make up the social health disparities in that country. Fortunately, it is a health issue that is highly preventable as well as treatable if a person does get it. I think more people need to make the effort to see physicians regularly as well as their families. Even here in the US where vaccines and treatments are easily accessible, there are still many cases of people with TB. Due to my current job, I actually see people that have this nasty health issue and they do suffer. The treatment is weeks/months long and the patient always have to wear a mask, including all the medical staff that enter the room to see the patient. Most of the patients that I see that have this are elderly folks and that was because they didn’t have the vaccination available to them when they were younger. If there was one thing that I could do to make an impact on global health, it would be to educate. I think too many people are so caught up in this vaccine dispute about how they think it causes autism or other health disabilities, that they think their words are going to protect themselves and their children. I personally feel as though it is messed up for those to have access to these vaccines and treatments to not take it and then get sick and go see a doctor because they are sick. Hopefully in the near future we can end this debate and make vaccines mandatory for all those who reside in an area and prevent TB along with many other diseases.
Works Cited:
“Medical Anthropology and the World System: Critical Perspectives, 3rd Edition.” Google Books, books.google.com/books?hl=en&lr=&id=lZNxDwAAQBAJ&oi=fnd&pg=PP1&dq=critical medical anthropological theory tuberculosis in cambodia&ots=TdmQf8Uzf7&sig=6pShqirzwR826nDnm8_DAoQW0DA#v=onepage&q&f=false.
Witeska-Młynarczyk, Anna. “Critical Medical Anthropology–a Voice for Just and Equitable Healthcare.” Annals of Agricultural and Environmental Medicine : AAEM, U.S. National Library of Medicine, 2015, www.ncbi.nlm.nih.gov/pubmed/26094543.
Pfeiffer, James. Nichter, Mark. Medical Anthropology Quarterly.New Series. Vol 22, No. 4 (Dec. 2008), pp. 410-415. https://www.jstor.org/stable/25487843?seq=1#page_scan_tab_contents
“WPRO | Tuberculosis.” World Health Organization, World Health Organization, 21 Oct. 2017, www.wpro.who.int/cambodia/areas/tuberculosis/en/.
Khann, Sokhan, et al. “Linkage of Presumptive Multidrug Resistant Tuberculosis (MDR-TB) Patients to Diagnostic and Treatment Services in Cambodia.” PLOS ONE, Public Library of Science, journals.plos.org/plosone/article?id=10.1371/journal.pone.0059903.
“TB Treatment & Pregnancy | Treatment | TB | CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/tb/topic/treatment/pregnancy.htm.
Zaman, K. “Tuberculosis: a Global Health Problem.” Journal of Health, Population, and Nutrition, International Centre for Diarrheal Disease Research, Bangladesh, Apr. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2980871/.
“Learn About Tuberculosis.” American Lung Association, www.lung.org/lung-health-and-diseases/lung-disease-lookup/tuberculosis/learn-about-tuberculosis.html.
Chen, Kevin. “Southeast Asia: Regional Incidence of Tuberculosis in Cambodia.” Yale Global Health Review, 11 Sept. 2015, yaleglobalhealthreview.com/2015/04/26/southeast-asia-regional-incidence-of-tuberculosis-in-cambodia/.
“Treatment of Tuberculosis Guidelines 4thEdition.” “World Health Organization, World Health Organization.https://books.google.com/books?hl=en&lr=&id=pK0fqlkjFGsC&oi=fnd&pg=PP2&dq=tuberculosis&ots=ZidEASU0rA&sig=5R2fKufqUow2MWVzNUIDXDlE9qw#v=onepage&q&f=false
“Cambodia Turns a TB Health Crisis into an Opportunity.” World Health Organization, World Health Organization, 19 Mar. 2014, www.who.int/features/2012/tb_cambodia/en/.
“Health Care in Cambodia.” Cultural Survival, www.culturalsurvival.org/publications/cultural-survival-quarterly/health-care-cambodia.