Anth 215 Lectures 9/25/14-10/9/14
Anth 215 Lectures 9/25/14-10/9/14 215
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Mrs. Allen Torphy
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Date Created: 11/08/14
Anth 215 92514 Uncovered Question Why is this story relevant for an introductory course on Medical Anthropology Which lessons to take away from it Relevance 0 Mental disabilities 0 No insurance big company scheming people 0 Families similar to this are in same situation has to do with ability to pay 0 Showing those of all ethnicities are at risk 0 Ethical responsibility now coming down to them insurance dumping blaming others to avoid suing who is to be sued here third party involved 0 Value of life 0 Who is Worthy of life 0 Problem of bureaucracy of healthcare Lessons 0 Ability to qualify and pay for insurance is life changing 0 Many families left Without medical care 0 Privilege to have health insurance 0 How health is financed and how much it actually is to pay out of your pocket 0 Access should be a human right 0 Healthcare is a right health insurance is a business 0 Problem solved through affordable care act 93014 Anth 215 Learning objectives 0 Being able to describe What is medical anthropology 0 Being able to identify the four subfields in anthropology 0 Understand events that shaped development of medical anthropology as a field Health Illness and equality 0 Is inequality making us sick PBS series Unnatural Causes 0 2 trillion used on medical health care in US Shorter sicker lives 30th in life expectancy Higher percentage of babies die in US than Cuba 47 million US residents don t have health insurance American diet Personal health behaviors Who will be sicker Who will die sooner OOOOO Medical Anthropology is about how people in different cultures and social groups explain the causes of ill health the types of treatment they believe in and to whom they turn if they do get ill It is also the study of how these beliefs and practices relate to biological psychological and social changes in human organism in both health and disease It is the study of human suffering and the steps that people take to explain and relieve that suffering Cecil Helman 2006 Culture Health and Illness fifth edition Pp 1 What Medical Anthropologists study 0 What it means and feels like to be sick 0 Who gets sick and why or why a person is duped sick 0 Which treatment options people have access to or not and how they make decisions about which treatments to choose 0 Folk illnesses in different societies 0 Cultural knowledge to the actual treatment of diseases 0 A starting premise of medical anthropology is that health related issues including disease and treatment how and why one gets sick and the nature of recovery are far narrower biological phenomenon These processes are al heavily in uenced by cultural and social factors as well Anthropology in action 0 Talking observing connecting aspects of social and cultural life process of trying to get information being there as much as possible to get a glimpse of inner lives 0 Observe participate get own experience participant observation helps to ask better questions 0 Long term field work living the lifestyle of those you are trying to understand 0 Local practices and customs working with people local community Four Subfields in Anthropology American view 0 Biocultural anthropology 0 Exploration of the relationship between human biology and culture 0 UW focuses on ecological and physiological and demographic aspects of human biocultural variation within the frameworks of human adaptability and evolution 0 Archaeology 0 Study of human culture through investigation of material traces and their relationships in space and time combined with other forms of historical information when available 0 Sociocultural anthropology 0 Studies the social dimensions of human life and the systems symbols and meanings that comprise a culture and of which social organization is an expression 0 Studying the ways people organize themselves and the ways they view the world they inhabit kinship religion sexuality law 0 Linguistic anthropology 0 Studies how language patterns and modes of communication shapes social life individual identities and patterns of meaning making Culture Beliefs influences traditions and systems that have and give meaning to the Way We live our lives Medical Anthropology 0 Where does medical anthropology fit in Why did Medical Anthropology develop as a field of study 0 Society of Medical Anthropology Branch of American Anthropological Association est 1968 Why then 0 Cambridge Anthropological Expedition to the Torres Straits 0 1898 Development 0 1950 1960 Broadening of nonWestern setting in Anthropology growing interest in aspects of healing 0 1960s some ThirdWorld countries achieving independence anthropologists marshaled to teach methods to improve health 0 1970s shift in disease emergence and understanding from single cause to complex disease phenomenon 0 1980s focus culturally sensitive care and patientdoctor interactions and scrutinizing biomedicine as culture 0 1990s technologization of care 10214 Anth 215 Objectives Cultural Sensitivity 0 Being able to describe the dangers of a single story and the importance of having multiple stories instead 0 Able to describe medical anthropology s unique approachcharacteristics compared to other social science disciplines able to identify the different methods medical anthropologists use 0 Understand how medical anthropologists methods are particularly Well suited to studying health and illness is a culturally sensitive Way Cultural sensitivity Why 0 People come from different cultures have different understandings cannot treat the same 0 Important for anthropologists 0 Remember medical anthropology is about how people in different cultures and social groups explain the causes of ill health the types of treatment they believe in and to whom they turn if they do get ill 0 How to study culture How to become culturally sensitive I Long term fieldwork I Bottom up approach Working with people involved Doing research in cultural setting Guatemala among Mexican farm workers Papua New Guinea Alaska China US hospital Conducting interviews asking people about their ideas definitions and perceptions of health and illness Leaning local language and customs Writing ethnographies 0 What is ethnography O Sobo and Loustaunau US is a multicultural country clinicians should be able to accommodate people with varied cultural background 0 Why Spend time in their communities Translators Taking more time don t assume you know them ask lots of questions about their views etc Paying more attention to nonverbal communicationlanguage 0 Silence 0 Nodding 0 Agreeing 0 People on staff from actual community 0 Etc To learn and understand that the ways people perceive and interpret health and illness and seek and deliver care are inextricably bound up with cultural norms social structures and environment To learn that what is illness pain healing health and care is NOT self evident but shaped by cultural ideas and practices and individual perceptions The dangers of a single story 0 What do you think upon hearing the title of the TED talk What is or are the dangers of a single story 0 How one person gives one perspective biases cannot just take one person and make them the representative of the entire population 0 One point of view tunnelvision or blinders 0 Lack of perspective lead to biased views can lead to worse biases and assumptions leading to racism sexist views etc 0 TED Talk danger of a single story 0 We are extremely impressionable as children 0 single story of Africans Africans had no possibility of being the same as other cultures OOOOO Africa portrayed as country needed to be saved by a white foreign country Tradition of telling that Africa is a place of darkness African authenticity Single story of Mexicans Multiple versions of the same single story from one cultural view O Portraying an entire culture as less than the ones telling the stories Creates stereotypes not that they are not true but instead incomplete that become the representation of the entire population being talked about Robs people of dignity Emphasizes difference rather than similarity Important to get perspectives from both sides Respect other cultures and views do not form an opinion until you know the complete story Single stories create stereotypes Shows people as one thing only African migrant poor starving oppressed etc People and societies reduced to one aspect only O 0000 Multiple stories important for Medical Anthropology To get a more holistic view of health and illness need to incorporate multiple voices To understand the decisions people make in care need to know their reasoning and motives Multiple people multiple perspectives doctors nurses local healers patients family members care givers etc 10714 Anth 215 What is it when people talk about culture Today s objective Being able to give a workable definition of culture Being able to identify the advantages and disadvantages or dangers of using culture as analytic category Being about to define ethnocentrism and cultural relativism Culture 1 A society s shared learned knowledge base and behavior patterns that guide how people live what they generally believe and value how they communicate and what are their habits customs and tastes yes 2 A complex whole which includes knowledge belief art morals law custom and any other capabilities and habits acquired by man as a member of society yes 1871 3 The performances of ceremonial acts prescribed by profane or sacred decree though which complex settings are negotiated shared and individual and social significance established 3 layers of culture Artifacts and objects 0 Symbols or things O Eg chairs hazard signs 0 Values 0 Why do they do this or think this Way 0 Underlying assumptions also called orthodoXies 0 Things in a society considered natural What is the advantage for medical anthropologist students for using culture as an analytic category of study 0 Want multiple stories to understand decision making 0 What are orthodoxies that cause this behavior What are dangers of using culture as object of study explanatory force 0 Misunderstand another culture 0 Lead to biases in opinions cultural bias 0 Point out more differences than similarities Female genital surgeries 0 As of the end of 1970s 0 International debate on female genital surgeries O NGO intervention attempting to eradicating the practices 0 International support again continuation of practices 0 Economic barriers and threatened with boycotts 0 Also shift in terminology 0 Female genital cutting 0 Female circumcision 0 Female genital mutilation 0 Female genital surgeries Why female genital surgeries 0 Cultural relativism versus ethnocentrism What about moral relativism 0 Contesting or defending of cultural differences What is culture What is tradition 0 Ethical questions regarding true consent bodily integrity human rights children and young adolescents sexuality and black bodies What do We know 0 Prevalence practiced in East and West African countries among particular ethnic groups in other regions of Africa and in some parts of Southeast Asia Malaysia and the Middle East 0 Age ranging from infancy to late adolescence 0 Meaning and methods vary across ethnic and religious groups 0 Style and degree of surgery vary greatly Makhlouf Obermeyer 1999 0 Prevalence difficult to measure incomplete correspondence between biomedical categories and local terminology pg 84 0 Not all countries report on genital surgeries 0 Number taken from small samples and made to be representative of a country 0 Yet often great differences across regions and ethnicreligious groups O Statisticsnumbers are a point of entry I What are motivations behind practice I Which local terminology used I How does terminology refer and correlate to different practices I How do practices change over the course of time I Who carries them out I How do economic political and religious factors shape prevalence and practice carried out 0 For instance Arabic generic term for fm circumcision khitan but commonly used in Egypt and Sudan tahara Debate in 1990s international character should practice be eradicated condemned legally forbidden or values as cultural difference and cultural minorities been given specific cultural rights Ethnocentrism or cultural relativist 0 Ethnocentrism using one s own standards values and beliefs to make judgments about someone else These standards against which others are measured are understood to be superior true or morally correct while those being evaluated and not measuring up are inferior or Wrong Sobo 0 Cultural relativist Cultural perceptions in clinical setting how to act 0 Attempts to provide culturally sensitive care turned into cultural silence and adverse birth outcomes Need of incisions 0 A central midwife s duty is to evaluate the need for vagina cuts often seen as needed to secure that passage of the child and avoid dangerous ruptures 0 Studies argue that Women who are fully or partially infibulated need defibulation during delivery otherwise increased risk of delayed delivery and uncontrolled tearing 0 Norwegian health care Workers frequently resisted defibulations and resorted to more invasive episiotomies cutting the vagina Problems of Csections I Somalian Woman resistant 0 Motivated by culture not natural 0 Hear of medical abuse and experimentation fatal death in Somali only performed in case with extreme emergency fear of being secretly sterilized In attempts to prevent culturally sensitive care 0 Cultural practices become taboo I Silence 0 Modes of culturalization I Shame of talking about sex 0 Cultural imaginations of What Somali culture is about and What Women Want 0 Black bodies as exotic and closer to nature different pain management Dangers of Culture 0 Homogenization reducing diversity into single units 0 Culturalization members of community become representative of the culture 0 Heriachization of culture ethnocentrism 10914 Anth 215 Making the familiar strange and the strange familiar US Biomedicine as ethno medicine Objective 0 Be able to identify several characteristics of US biomedicine s culture of health and healing BostonMed episode 1 0 Rapid assessment technique 0 What are some of the underlying assumptions that shape the patterns of caregiving and care receiving 0 What are the patterns that are occurring in the hospital 0 Calm attitudes concentrated deeply in the patient looking at it as a job personification can get in the way in times of medical need focus on procedure rather than other things 0 Giving chance to residents mistakes happen goal is to make the patient stable or better 0 Compassion for job compassion of caring of people 0 High energy motivated people enthusiasm for performing 0 Giving comfort to patients and hope for better outcome 0 Causal around coworkers sharing stories different for what is discussed with patients 0 Turning tragedy into something good 0 Surgeries practice of healing mental health good vibes 0 Trust of patients in doctors 0 Bring up hope from previous let downs 0 Companionship with each other talking about comforting things 0 Do not discuss things that will let down people always giving hope 0 Visiting patients trying to get to know patients build relationship with patient don t just care about getting the surgery over with caring about improving health 0 Roles of different positions nurses surgeons residents anesthesiologist 0 Ownership of patients reduction of person into a patient 0 Confidence to disclose mistakes 0 1 person per bed privacy US accessibility not on the floor hygiene 0 Doctors wearing coats use of instruments 0 Patient clothes name and disease person that has issue with lung no info on marriage religion etc 0 Body parts are located and objectified I Not body as a Whole body in parts Making the familiar strange I Some underlying orthodoxies I Ethnomedicine depicted on google biomedicine not considered Ethnomedicine I all medical system be they national guises of biomedicine or indigenous medical system or folk medical systems in complex societies either preindustrial or postindustrial are part and parcel of culture and society 0 Charles Hughes as those beliefs and practices relating to disease which are the products of indigenous cultural development and are not explicitly derived from the conceptual system of modern medicine Biomedicine as ethnomedicine I Medanthropology all medical practices are ethnomedicines all are embedded and emerge from sociocultural systems all healers dentists shamans etc are ethnohealers Some tenacious assumptions 0 Body mind and soul separation I Bodymind duality I US 0 When is someone dead I Dead when heart stops beating I Brain stops functioning I Lifesupport breathing on your own I Quality of life diminished I Head is separated from body 0 1968 I First open heart transplant 0 1964 I Chimp to human transplant patient died in hours but still considered successful surgery I Ventilator help breathing from a machine Can t be too soon in declaring death can be too quick Not a process but an event at a precise moment 0 1981 I Definition to be put into law Uniform determination of death 0 O I Whole brain death irreversible loss of brain function 0 Japan 0000 O 1991 only 17 heart transplants carried out in Japan Preserve Japanese culture but advance technology There s a soul More resistance because of medical abuse Focus on donor misuse of donor bodies thinking about life after death Extend part of yourself to others to enable them to live longer Some underlying assumptions Natural versus supernatural science as magic Power of pharmaceuticals Why do we take a pill 0 Reduce symptoms and get better 0 Locate cure in small pill not just something chemical 0 High expectations from doctors do be prescribed medicine Placebo something that people will give you that looks like a pill drug but is nothing Placebo effect power of mind you think it will make you better you feel better 3 group trial 0 One gets pill one gets different pill one gets placebo control group those given placebo felt better than two other groups Medical Knowledge 0 O Systematized orderly and 0 Patient knowledge 0000000000 0 O Perception of symptoms theory behind symptoms based on empirical observation or experiment Traditional western 0 Procedural knowledge Homeopathic 0 Popular knowledge Psychological 0 Chemical knowledge Technological O Spiritual Medical ethics 0 Herbicidal and cleanse Evidence based 0 Religious Anatomy 0 Nutritional Communicative 0 Environmental Physiology cause of disease 0 Risk benefit assessment Nurturing care 0 Molecular Real Biomedical knowledge 0 O O O O Often based on science Somehow systematized ordered in classifications Often established through empirical observation experiments laboratory research and clinical trials under controlled circumstances Evidencebased Uses generalization that about as fact The rational self O Considered about being able to make your health and medical decisions 0 How healthy am I today What am I going to do in the future how Will that impact my health who will I meet how will that shape my health
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