Showing papers in "Medical Anthropology Quarterly in 1989"
TL;DR: The ready availability and extreme popularity of Western pharmaceuticals in developing countries poses important general issues for medical anthropology as mentioned in this paper, and they facilitate particular social and symbolic processes that facilitate communication about experiences that may be difficult to express.
Abstract: The ready availability and extreme popularity of Western pharmaceuticals in developing countries poses important general issues for medical anthropology. In attempting to explain why medicines are so attractive in so many different cultures, this article suggests that they facilitate particular social and symbolic processes. The key to their charm is their con-creteness; in them healing is objectified. As things, they allow therapy to be disengagedfrom its social entanglements. Medicines are commodities which pass from one context of meaning to another. As substances, they are “good to think with” in both metaphoric and metonymic senses. They enhance the perception of illness as something tangible, and they facilitate communication about experiences that may be difficult to express. In the course of their transaction, they bear with them associations to authoritative professionals and the potency and potential of other cultural contexts of which they once were a part.
237 citations
TL;DR: The relationship between patient satisfaction and clinical communication is investigated and political and ideological barriers inherent in a colonial medical system were found to constrain Inuit medical interpreters from advocating for their patients' interests and thereby increasing satisfaction with the care.
Abstract: In 1986 patient dissatisfaction with medical services in some Canadian Inuit communities reached alarming proportions. Many observers attributed the problem to poor communication. Through an analysis of the process of interpretation in the clinic from a historical and sociopolitical perspective, I investigated the relationship between patient satisfaction and clinical communication. Political and ideological barriers inherent in a colonial medical system were found to constrain Inuit medical interpreters from advocating for their patients' interests and thereby increasing satisfaction with the care. Enhancing Inuit interpreters' capacity to act as advocates may be possible only through changes in administrative priorities that result from macropolitical change.
81 citations
TL;DR: The authors published a review article on the subject by a linguistic anthropologist, and asked Joel Kuipers if he would consider preparing such a review, and he agreed to do so, because he knew that his work on recorded texts of Weyewa healing rituals was leading him to think more broadly and deeply about medical discourse.
Abstract: Editor's Note: Just a year ago, in MAQ 2(2), we published a set of articles by authors who in one way or another used the concept of "discourse" in their analysis. In my introduction to that issue I promised some time in the future to publish a review article on the subject by a linguistic anthropologist. From my own reading of people like Shuy, Cassell, Labov, Cicourel, and Foucault, it was obvious that though these authors were all analyzing some form of "discourse, " the purposes and methods of their work were sufficiently different to make me wonder if there was any common ground among them and whether some fruitful research ideas, theoretical and/or applied, might not emerge from considering them comparatively (along with other relevant authors and trends). This notion led me to ask Joel Kuipers if he would consider preparing such a review. I picked Joel, a Yale-trained linguistic anthropologist, for the task because I knew that his work on recorded texts of Weyewa healing rituals was leading him to think more broadly and deeply about medical discourse. I commend and thank him for the following article, which I think many willfind useful.
74 citations
TL;DR: In contrast to feminist models of birth that advocate parental control of decision making and limited technological intervention, the overriding goal during delivery of the Dallas women the authors interviewed was to remain alert yet pain free.
Abstract: Childbirth education classes represent a formal means of information transmission to prospective parents regarding the birth process. Assessment of the impact of medical messages communicated in two sets of childbirth classes suggests that the structure and orientation of the class affected the particular messages conveyed. Hospital-based classes familiarized prospective patients with hospital procedures, while private classes encouraged self-advocacy and parental participation. Yet childbirth classes were found to influence women's reactions to delivery less than preexisting beliefs, values, and expectations derived from people in their personal networks. Discussions regarding pain and anesthesia most clearly revealed kin and friends to be the main sources of influence on these matters. In contrast to feminist models of birth that advocate parental control of decision making and limited technological intervention, the overriding goal during delivery of the Dallas women we interviewed was to remain alert yet pain free.
45 citations
TL;DR: In this article, the authors describe interpretations of parenthood that emerge in the context of an in vitro fertilization (IVF) program in an urban hospital, where patients and physicians negotiated a "high-tech" fertilization, issues of medical expertise and authority, and the status of the patient's knowledge and experience of her own body.
Abstract: In this article I describe interpretations of parenthood that emerge in the context of an in vitro fertilization (IVF) program in an urban hospital. Through the notion of “odds,” which is used to communicate the likelihood of a successful pregnancy, patients and physicians negotiated a “high-tech” fertilization, issues of medical expertise and authority, and the status of the patient's knowledge and experience of her own body. I suggest that while in vitro fertilization may be technologically innovative, it is conceptually conservative in upholding existing cultural assumptions about parenthood, sex, and marriage. In melding a cultural approach to kinship with an examination of the “contexts of meaning” in a medical setting, I seek to illuminate the cultural effects of medical technology, the rhetorical determinants of social relationships, and ideas about kinship in the United States.
29 citations
TL;DR: Comparison of the patterns of use of Poaceae, Ro-saceae, and Caprifoliaceae suggests why some plants are of medicinal value and some are not and how people were able to gain this knowledge.
Abstract: Statistical analyses of a very large sample of uses of medicinal plants by Native Americans demonstrate a method by which we can determine which sorts of plants they were most or least likely to select for use as medicines. Comparison of the patterns of use of Poaceae (grasses), Ro-saceae (apples and others), and Caprifoliaceae (honeysuckles) suggests why some plants are of medicinal value and some are not and how people were able to gain this knowledge.
28 citations
TL;DR: The authors examined the ways in which patients discussed illnesses and injuries as life events in structured, open-ended interviews and showed how explanation and interpretation were brought together, linking mechanism with morality, rather than merely juxtaposing or contrasting mechanism and morality, joined them by using a psychologized view of human beings centering on the notion of stress.
Abstract: In this article I examine the ways in which patients discussed illnesses and injuries as life events in structured, open-ended interviews. I show how explanation (identifying cause) and interpretation (identifying reason) were brought together, linking mechanism with morality. Respondents, rather than merely juxtaposing or contrasting mechanism and morality, joined them by using a psychologized view of human beings centering on the notion of “stress.” I claim that “stress” as a coupling element is now a culturally available medico-moral concept in the United States that allows “fact” and “value” to interpenetrate. Although some physicians and stress researchers use “stress” as a medico-moral term, they appear to desocialize it, whereas the study's respondents implicated “stress” in actions and interactions evaluated as undesirable or wrong. As a bridge-symbol, “stress” parallels multivocal ritual and sacred symbols.
26 citations
TL;DR: The results suggest that males with Prader-Labhart-Willi Syndrome have three times the fatness scores of other males their age, while scores for PLWS females average only twice those of normals.
Abstract: A multidisciplinary study involving cytogenetic, clinical, and anthropometric assessments of Prader-Labhart-Willi Syndrome (PLWS) has focused on improving diagnosis and prognosis in this complex condition. Since one of the major features of PLWS is obesity, 7 of the 26 measurements in the anthropometric evaluation were skinfold thicknesses at different body sites. Forty individuals with PLWS have been assessed. Z-scores were computed for skinfold measurements to examine quantitative differences for fatness at different sites. Data on PLWS individuals, grouped by age, sex, and chromosome type, were compared with normative data for skinfolds. The results suggest that males with PLWS have three times the fatness scores of other males their age, while scores for PLWS females average only twice those of normals. Our research illustrates the utility of anthropometry in the evaluation of patients in clinical genetics and offers a comprehensive approach to the heterogeneity observed in PLWS.
25 citations
TL;DR: In this paper, a book that is provided in a better way and utterance will be expected by many peoples, even if they are a good reader or not, feeling to read this book will always appear when you find it, but when you feel hard to find it as yours, what to do? Borrow to your friends and don't know when to give back it to her or him.
Abstract: Interestingly, shamanism colonialism and the wild man a study in terror and healing that you really wait for now is coming. It's significant to wait for the representative and beneficial books to read. Every book that is provided in better way and utterance will be expected by many peoples. Even you are a good reader or not, feeling to read this book will always appear when you find it. But, when you feel hard to find it as yours, what to do? Borrow to your friends and don't know when to give back it to her or him.
24 citations
TL;DR: It is concluded that international health organizations can play an important role in the consolidation of popular democracy in developing nations, especially when this is part of the political agenda of the host country.
Abstract: Recent studies have noted a new conservatism among international health organizations as they shift from policies of comprehensive primary health care to more vertical programs of disease control in the Third World. Health care efforts in Nicaragua since 1979 offer an arena in which to analyze the role of the World Health Organization (WHO), the Pan American Health Organization (PAHO), and the United Nations International Children's Emergency Fund (UNICEF) in the elaboration of Nicaragua's health development policy and practice over time. I conclude that international health organizations can play an important role in the consolidation of popular democracy in developing nations, especially when this is part of the political agenda of the host country.
24 citations
TL;DR: Though ideal standards of German biomedicine devalue traditional treatments like the Kur, a variety of cultural, economic, and political factors support its persistence.
Abstract: Variations within Western biomedicine reveal different cultural styles of therapy, particularly for medical conditions either of uncertain etiology or with diverse and diffuse symptoms. The West German biomedical system consists of an eclectic set of therapies, all offered under physicians' care. The Kur, spa treatments that are part of rehabilitation medicine, exemplifies a form of biomedical care that reflects a distinct cultural style. Though ideal standards of German biomedicine devalue traditional treatments like the Kur, a variety of cultural, economic, and political factors support its persistence.
TL;DR: In this paper, the authors analyze Costa Rica's experience with community participation in health between 1973 and 1985 and identify three problems with the concept of political will: (1) by focusing on individual countries, it shifts attention from the international health agencies that so often determine poor countries' health policies; (2) it implies that states are monolithic entities, comprised of unified coalitions, rather than competing groups involved in a constant struggle over policy; and (3) it diverts the analytic gaze from global inequalities and relations of international dependency that contribute to poverty and ill health.
Abstract: This article criticizes the concept of “political will” by analyzing Costa Rica's experience with community participation in health between 1973 and 1985. Despite a long-standing state commitment to social welfare programs, Costa Rica has been unable to achieve active, sustained participation in the government's rural health programs, partly because of partisan conflicts over implementation. It is unlikely that “political will” can succeed in countries where the state's commitment to social welfare is less obvious than in stable, democratic Costa Rica. This article identifies three problems with the concept of “political will”: (1) by focusing on individual countries, it shifts attention from the international health agencies that so often determine poor countries' health policies; (2) it implies that states are monolithic entities, comprised of unified coalitions, rather than competing groups involved in a constant struggle over policy; and (3) it diverts the analytic gaze from global inequalities and relations of international dependency that contribute to poverty and ill health. Rather than blaming poor countries for their supposed “lack of political will,” international health organizations should examine what factors led them to rescind their commitment to community participation in health.
TL;DR: The authors examines the relationship between capitalist development processes, the state, and the peasantry in Guatemala in order to demonstrate another consequence of PHC interventions: that they ultimately operated as an inherent part of this relationship and bolstered legitimacy for the existing social and economic order.
Abstract: During the 1970s international and bilateral development agencies actively began promoting and financing comprehensive primary health care (PHC) programs in underdeveloped countries. The stated goal of these activities was to provide rural peoples with a modicum of basic health services, and access to health care did increase as a consequence of the PHC effort. However, this article examines the relationship between capitalist development processes, the state, and the peasantry in Guatemala in order to demonstrate another consequence of PHC interventions: that they ultimately operated as an inherent part of this relationship and bolstered legitimacy for the existing social and economic order. Although the delicate balance between the state's need to garner consensus and its potential for resorting to coercion to establish its legitimacy is clearly highlighted in an extreme example like Guatemala, the same relationship between processes of capitalist accumulation and social legitimation pertains to other settings.
TL;DR: It is suggested that the tenacity of home-based therapy is a product of its receptivity to innovations that complement core health care values.
Abstract: Qualitative and quantitative data collected over a period of 11 years indicate that Saraguro Indians in the southern Ecuadorian highlands rely almost exclusively on mothers as family healers despite access to a range of specialized traditional and biomedical services. However, the home-based health care system has begun to change in recent years as mothers increasingly integrate selected features of biomedicine into family curing. I suggest that the tenacity of home-based therapy is a product of its receptivity to innovations that complement core health care values.
TL;DR: It is postulate that uvulectomy, a procedure recognized by Africans to be therapeutic rather than religious, may have been beneficial when modern health services were unavailable and may has been the treatment of choice in pre-antibiotic days.
Abstract: The partial or complete removal of the uvula is a procedure considered almost obsolete by cosmopolitan physicians. Antibiotic therapy is now accepted as the treatment of choice for most enlarged, infected uvulae, and modern medical evaluation is considered essential to rule out the possibility of life-threatening conditions such as tuberculosis or cancer as the underlying cause of symptoms. However, traditional African practitioners continue to perform uvulectomies at the request of their patients and to claim safe alleviation of symptoms, despite severe complications noted by physicians. I postulate that uvulectomy, a procedure recognized by Africans to be therapeutic rather than religious, may have been beneficial when modern health services were unavailable and may have been the treatment of choice in pre-antibiotic days.
TL;DR: In this paper, the authors accept the probable influence of calcium levels on the manifestation of certain possession symptoms but argue that stress, with its attendant changes in epinephrine and glucocorticoid levels, significantly reduces the body's ability to retain calcium, irrespective of diet.
Abstract: Kehoe and Giletti (1981) have argued that the preponderance of women as patients in curing ceremonies is best explained by a variety of dietary inadequacies, particularly by a deficiency of calcium, resulting in tetany, convulsions, hallucinations, and other disorders that could easily foster a belief that such individuals are possessed. They also discount the likelihood that psychological and social stress play a meaningful role in the manifestation of such symptoms. In this article we accept the probable influence of calcium levels on the manifestation of certain possession symptoms but argue that stress, with its attendant changes in epinephrine and glucocorticoid levels, significantly reduces the body's ability to retain calcium, irrespective of diet. Indeed, we maintain that the stress model, which emphasizes the role of physiological, psychological, and sociocultural variables, can better account for many of the ethnographic examples cited by Kehoe and Giletti than can their own explanations.
TL;DR: Singer et al. as discussed by the authors analyzed a similar era and strategy in the history of rural health, namely, the primary health care (PHC) movement of the 1970s and 1980s and analyzed the influence of international health agencies such as the World Health Organization (WHO), the United Nations Interational Children's Emergency Fund (UNICEF), and the United States Agency for International Development (USAID) in setting up and carrying out PHC programs within the context of each country's history and political structure.
Abstract: entral America offers an excellent geographic microcosm for examining the relationship between sociopolitical organization, the delivery of health services, and the role of international health agencies. Despite the fact that the Central American countries are geographically contiguous and share a history of conquest and Spanish colonization, today they encompass several extremes of sociopolitical organization, including revolutionary socialist Nicaragua; the recently elected right-wing leadership of El Salvador, which is leading a class war against the peasantry; genocidal military rule under a democratic veneer in Guatemala; Panama's "democracy," also under military control; and the much-cited exception of peaceful, democratic Costa Rica. The countries of Central America also include both ends of the "health status" spectrum: Guatemala and Honduras have among the worst health indicators (e.g., infant mortality rates and life expectancy) in the hemisphere, while Costa Rica and Panama have among the best. Using a political-economic theoretical perspective, this collection brings together case studies of health programs in three of these countries: Costa Rica, Guatemala, and Nicaragua, along with a research report from El Salvador. To maximize the comparative value of this collection, the papers analyze a similar era and strategy in the history of rural health, namely, the primary health care (PHC) movement of the 1970s and 1980s. More specifically, they analyze the influence of international health agencies, such as the World Health Organization (WHO), the United Nations Interational Children's Emergency Fund (UNICEF), and the United States Agency for International Development (USAID) in setting up and carrying out PHC programs within the context of each country's history and political structure. Our goal in bringing these papers together is to develop within anthropology a systematic comparison of the relationship between sociopolitical organization and health care delivery similar to that initiated by Bossert (1983). The papers (with the exception of Meyers's research report) were originally presented as part of a symposium at the American Anthropological Association meetings in 1987. The authors are all working under the rubric of critical medical anthropology, applying Marxist political economic theory to the implementation of primary health care in Central America. This type of endeavor is relatively new in the field of anthropology, but it is by no means unprecedented. Singer
TL;DR: A typology of such speech play forms is presented and it is suggested that biomedical speech play represents an alternative biomedical voice distinct from both that of the lifeworld and that of objective, scientific biomedicine.
Abstract: Play with the professional language of biomedicine is endemic in American hospitals. In this article 1 present a typology of such speech play forms and suggest that biomedical speech play represents an alternative biomedical voice distinct from both that of the lifeworld and that of objective, scientific biomedicine. The voice that speaks through biomedical speech play embodies social and emotional concerns that are devalued in the professional ideology of biomedicine but that cannot be ignored by biomedical practitioners. Biomedical speech play thus presents an alternative (and necessary) reconstruction of biomedical reality.
TL;DR: A campaign stressing sanitation and health education, conducted by village health promoters, and the use of oral rehydration therapy were associated by the health promoters with a decline in diarrheal mortality in children, but Anthropometric measurement of children under five showed an increase in acute undernutrition compared to survey data reported from the region in 1978.
Abstract: A community health assessment was carried out in San Jose las Flores, a village in rural northern El Salvador “repopulated” entirely by former refugees who returned to their area of origin in June 1986. In a survey of randomly selected households, knowledge of hygienic practices was documented among mothers, despite low levels of literacy and education. A campaign stressing sanitation and health education, conducted by village health promoters, and the use of oral rehydration therapy were associated by the health promoters with a decline in diarrheal mortality in children. Anthropometric measurement of children under five, however, showed an increase in acute undernutrition compared to survey data reported from the region in 1978. Respondents reported a high rate of total child mortality (255 of 1,000 live births), with cause of death attributed to actions of the Armed Forces of El Salvador (FAES) in 43% of cases. War-related mortality of family members was also high (a mean of 7.1 per respondent), again with the leading cause of death (91 %) reported to be actions of the FAES.
TL;DR: The contributions of a physical anthropologist to a multidisciplinary team charged with evaluating, diagnosing, and treating children who have severe craniofacial defects is described and the problem of maintaining a professional identity as an anthropologist in a nontraditional setting is discussed.
Abstract: In this article we describe the contributions of a physical anthropologist to a multidisciplinary team charged with evaluating, diagnosing, and treating children who have severe craniofacial defects. As an example of biomedical anthropology, it illustrates the value of the anthropologist's population-based perspectives in a setting dominated by a focus on the individual patient. The problem of maintaining a professional identity as an anthropologist in a nontraditional setting is discussed. Estrangement occurs not only because biomedical anthropologists must adapt to the practical realities of the medical system, but also because traditional academic anthropology continues to undervalue the work of practicing anthropologists.
TL;DR: Some of the issues one may confront in conducting collaborative biomedical research in this kind of setting are discussed, drawing on my experiences in the New York State Department of Health.
Abstract: State health departments offer a diversity of collaborative research opportunities for biological anthropologists. This article discusses some of the issues one may confront in conducting collaborative biomedical research in this kind of setting, drawing on my experiences in the New York State Department of Health. Unlike an academic setting, the choice of a research topic is likely to depend upon the bureau in which one works and not solely on one's interests or prior specialty in biological anthropology. Though findings may not be publishable in anthropological journals, one can contribute to the literature of other disciplines. It is relatively easy to find collaborators from other disciplines, both inside and outside the health department, and collaboration has significantly broadened my knowledge.
TL;DR: Analysis of data from the British National Child Development Study has permitted analysis of differences between those diagnosed with wheezy bronchitis and those with asthma at ages 7 and 11, finding striking differences in parental social status, occupation, education, housing, family size, birth order, and geographic distribution.
Abstract: The British National Child Development Study has followed everyone born in one week in 1958 in England, Wales, and Scotland at varying intervals since birth. Examination of the data from this study has permitted analysis of differences between those diagnosed with wheezy bronchitis and those with asthma at ages 7 and 11. Among the 15,398 individuals at age 7 and the 15,303 at age 11, 446 (449 at 11) had asthma and 2,488 (1,194 at 11) had wheezy bronchitis. There are striking differences in parental social status, occupation, education, housing, family size, birth order, and geographic distribution between the asthmatics and the wheezy bronchitics. There are also differences in reasons given for long school absences among children in the two diagnostic categories. By 1969 the disease classification had begun to change, and by 1974 the category of wheezy bronchitis was no longer in use. We examine some of the possible societal reasons for the change in classification.
TL;DR: Strategies to overcome barriers to successful research collaboration multiply easily and involve awareness of each host institution's reward systems and hierarchies are described.
Abstract: Biomedical research is often a collaborative effort involving anthropologists, epidemiologists, and clinically based medical researchers and care givers. In multidisciplinary, multi-institutional research projects barriers to successful research collaboration multiply easily, in part because different disciplines conceptualize study design and other research issues differently. Institutional requirements for research (human subjects' approval, for example) also differ. When research activities are performed by clinical personnel at clinical institutions, research must give way to care giving. Strategies to overcome these and other problems are based on the professionalism of clinical and medical research staff and involve awareness of each host institution's reward systems and hierarchies. Practical, concrete solutions to these problems exist and are described.