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MEDICAL ANTHROPOLOGY. Kuswandewi Mutyara PUBLIC HEALTH DEPARTMENT. HUMAN. Dimension physiology Dimension psychology Dimension sosio-cultural Dimension spiritual. Physiology. Psychology. Spiritual. Sosio - cultural. Anthropology. ~ the study of man

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MEDICAL ANTHROPOLOGY


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    1. MEDICAL ANTHROPOLOGY Kuswandewi Mutyara PUBLIC HEALTH DEPARTMENT

    2. HUMAN • Dimension physiology • Dimension psychology • Dimension sosio-cultural • Dimension spiritual Physiology Psychology Spiritual Sosio- cultural

    3. Anthropology ~ the study of man • The most scientific of the humanities & the most humane of the sciences • Aim: the holistic study of humankind – its origins, development, social & political organizations, religions, languages, art & artefacts

    4. Medical Anthropology • A branch of social and cultural anthropology • It is concerned with a wide range of biological phenomena, especially in relation to health and disease • Definition according to Foster and Anderson:A biocultural discipline concerned with both the biological and sociocultural aspect of human behaviour, and particularly with the ways in which the two interacted throughout human history to influence health and disease

    5. Medical Anthropology (cont) • Anthropologists studying the socio-cultural in all human societies, beliefs and practices relating to ill health • Linked to beliefs about the origin of misfortunes • Necessary to examine the social organization of health and illness in that society (the health care system) include the ways in which people have become recognized as ill • Anthropologists are particularly interested in the group of ‘healers’ (special social group; their selection, training, concepts, value, and internal organization) • Healers play roles beyond their healing functions and usually their focus on his ‘ill’ family, community, village not individual

    6. Main Tasks of Medical Anthropology • How individuals in a particular society perceive and react to ill health and the types of health care that they turn to, to know something about both the cultural and the social attributes of the society in which they live • It is possible to link medical sciences (microbiology, biochemistry, genetics, parasitology, pathology, nutrition, and epidemiology), social and cultural factors for explain the cause of illness

    7. Medical Anthropology And The Human Life Cycle • Important aspect of medical anthropology is the study of the human life cycle, and of all the stages from birth to death • In recent years, medical anthropology has paid considerable attention to the cultural characteristics of 2 particular stages of human growth and development: • childhood and old age

    8. Case Study: Oral Rehydration Therapy (ORT) in Pakistan • Diarrhea diseases are usually associated with poverty and the resultant malnutrition, poor sanitation, contaminated drinking water and vulnerability to infection • Kill about 5-7 million people/year • Solution to this problem involve health professionals, social scientists, economic, social, and political changes • ORT is a safe, inexpensive, and simple way to prevent and treat the life-threatening dehydration in infants and children

    9. Case Study: Oral Rehydration Therapy (ORT) in Pakistan • The researchers found that many of the mothers were ignorant of oral rehydration solution because diarrhea diseases was very common as a natural and expected part of teething and growing up and not as an illness • Some believed it was dangerous to try to stop the diseases • Others explained infant diarrhea as due to certain folk illnesses such as evil eye, jinns, which should be treated with traditional remedies or by traditional healers • Many mothers saw diarrhea as a ‘hot’ illness which required a ‘cold’ form of treatment

    10. Case Study: Oral Rehydration Therapy (ORT) in Pakistan • They classified most Western medicines, such as antibiotic and vitamins as also ‘hot’ • A few even rejected ORS because they thought that salt ‘was bad for diarrhea’ • Anthropological research has found that this partly due to indigenous beliefs about the causes and dangers of diarrhea disease and how they should best be treated • Health care programmes should always be designed to address medical concerns but also to involve community participation

    11. DIET AND NUTRITION

    12. Diet and Nutrition • Food  a symbolic meanings • Different cultural groups  different their beliefs and practices related to food (how food is cultivated, harvested, prepared, served, and eaten) • 5 types of food classification : food versus non-food, sacred versus profane foods, parallel food classification, food used as medicine, and medicine as food, social foods • People`s diet may be based on cultural rather than nutritional criteria

    13. 1. Food Versus Non-food • Each culture defines which substances are edible and which are not  flexible • May leave out useful nutriments from the diet

    14. 2. Sacred Versus Profane Foods • Related to religious beliefs • Taboos: prohibit ingestion of the food and forbid physical contact with it • Profane food: unclean and dangerous to health • Strict taboos against certain types of food are characteristic of a number of religious faiths (Hinduism, Islam, Judaism, etc) • Junk foods & vegetarians

    15. 3. Parallel Food Classification • Divided into 2 main groups: ‘hot’ and ‘cold’  food; medicines, illnesses, mental and physical states, natural and supernatural forces • Health balance between these 2 categories, ill health is treated by adding hot or cold foods or medicines to the diet in order to restore the balance • Local historical, cultural factors, personal idiosyncrasies may play a part in assigning foods to these categories

    16. 4. Food as Medicine, Medicine as Food • Overlap with parallel food • Special diets as a form of ‘medicine’

    17. 5. Social Foods • Consumed in the presence of other people  symbolic • Creating and expressing the relationships between people • Different types of meal convey different messages • Meals can also be used to symbolize social status

    18. Culture and Malnutrition • Cultural influences may affect nutrition (increased risk of malnutrition): undernutrition or overnutrition • Have an indirect effect on nutrition, such as beliefs about the structure and functioning of the body (shape, size, etc) • Influence malnutrition: social, political, economic, and environmental context • Globalization can effect on global diet

    19. Infant Feeding Practices: Cross-cultural Comparisons • The care and feeding of infants in every human group  difference in the techniques of infant feeding, in the age and technique of weaning • Breast-feeding is best  declined in most countries  described as the greatest nutritional crisis in today`s world  depriving babies of the nutritional and immunological, increasing the dangers of malnutrition and the risk of diarrhoeal diseases/infection • Social, cultural, personal, and economic can influence

    20. The ‘Nutrition Transition’” Globalization, Dietary Changes, and Disease • Urbanization, industrialization, and westernization its important to human diet  ‘nutrition transition’ • The overall impact of this nutrition transition is seen especially in child health, with a significant rise in obesity world wide • Globalization  new types of foods from the West

    21. The ‘Disease of Western Civilization’” Dietary Changes and Disease • Diseases: appendicitis, benign colonic tumours, cancer of the large bowel, ulcerative colitis, pulmonary embolism, obesity, diabetes, etc • ‘Western diseases’ • Over 40% of people in UK are overweight, and the problem just serious in the USA • Over the past 100 years, fat consumption increased by less than 50 % while sugar consumption doubled and the quantity of fibre consumed in the diet markedly dropped

    22. Diet and Cancer • Different types of diet linked to certain forms of cancer • 1/3 or more of all cancer may be related to dietary and nutritional factors • Total caloric intake, nutritional excess or deficit, the exposure to carcinogens, and the consumption of alcohol also increase the risk of cancer

    23. Diet and Cancer It is important that although no causal relation has been definitely established between any nutritional factor and any of the indicated cancers, a clear pattern of protection appears to characterize a high intake of fruits and vegetables, whereas a less clear pattern of increased risk appear to characterize positive energy balance and excessive intake

    24. Recommendations • The basic diet should be adequate and varied • The diet should be always include a high intake of fruits and vegetables • Total fats and oil in the diet should provide nor more than 15-20% of total energy, fatty foods should be avoided • Red meat should be provide less than 10 % of the total energy • Dietary salt from all sources should amount to less than 6 g/day for adults

    25. Recommendations • A variety of starchy or protein-rich foods of plant origin should provide 45-60% of energy • Intake of refined sugar should be limited (less than 10% of total energy) • Perishable food, if not consumed promptly, should be frozen • Meat and fish should be cooked at relatively low temperature • In the presence of an adequate, balanced diet, dietary supplements are probably unnecessary and possibly unhelpful for reducing cancer risk

    26. Recommendations In addition to these dietary changes, they also recommended adequate physical exercise, reducing alcohol intake and tobacco smoking

    27. CARING & CURING: The Sectors Of Health Care

    28. What do people do when they are getting ill ?

    29. Sectors of health care: • Thepopularsector • The folk sector • The professionalsector (Kleinman, 1980)

    30. The popular sector • The lay, non-professional, non-specialist domain of society • ill-health is first recognized & defined, & health care activities are initiated • includes all the therapeutic options that people utilize, w/o any payment & w/o consulting either folk healers or medical practitioners • includes a set of beliefs about health maintenance • + 70-90% of health care

    31. The popular sector (cont’d) E.g.: • Self-treatment or self-medication • Advice or treatment given by a relative, friend, neighbor or workmate • Healing & mutual care activities in a religious facility, cult or self-help group • Consultation w/ another lay person who has special experience of a particular disorder, or of treatment of a physical state • The main area: family Main providers: mothers or grandmothers

    32. Self-treatment • Based on lay beliefs about: - the structure of body - the function of body - the origin & nature of ill-health - the variety of substances (e.g. medicines, traditional folk remedies) - ‘old wives’ tales’ - effects of behavioral & diet changes

    33. Source of health advice in the popular sector • Those w/ long experience of a particular illness or type of treatment • Those w/ extensive experience of certain life events • The paramedical professions who are consulted informally • Doctors’ wives or husbands, who share some of their spouses’ experience • Individuals who interact frequently w/ public • The organizers of self-help groups • The members or officiants of certain healing cults or churches

    34. The folk sector • large in non-industrialized societies • certain individuals specialize in forms of healing (either sacred or secular, or mixture of the two) • the healers - not part of the official medical system - occupy an intermediate position b/w the popular & professional sectors

    35. The folk sector (cont’d) E.g.: • Bone-setters • Tooth extractors • Herbalists • Spiritual healers • Clairvoyants • Shamans • Paraji • Mantri sunat • Mantri

    36. The folk healers • share the basic cultural values & world view of the communities in which they live, including beliefs about the origin, significance & treatment of ill-health • common in societies where ill-health & other forms of misfortune are blamed on social causes, or on supernatural causes • approach: more holistic, includes all aspects of the patient’s life (e.g. relationships w/ other people, w/ the natural environment, w/ supernatural forces, any physical or emotional symptoms)

    37. The folk healers • Often inquire about: - the patient’s behavior before the illness - the patient’s conflicts w/ other people • May have firsthand knowledge of a family’s difficulties through local gossip (useful for reaching a diagnosis) • May employ a ritual of divination, aims to uncover the supernatural cause of the illness

    38. Advantages of folk healing • The frequent involvement of the family in diagnosis & treatment • Provides an effective primary health care team (as the healer is surrounded by helpers) • There is a shared world view, closeness, warmth, informality • The use of daily language in consultations • Familiar setting • Provide culturally familiar ways of explaining the causes & timing of ill-health, & its relation to the social & supernatural worlds

    39. Training of folk healers • Inheritance • Position within a family • Signs & portents at birth • Revelation • Apprenticeship to another healers • Acquiring a particular skill on one’s own

    40. Alternative & complementary medicine overlaps both folk & professional sectors • Spiritual healing • Hypnotics • Massage therapy • Meditation • Hydrotherapy • Aromatherapy E.g.: • Acupuncture • Homeopathy • Chiropractic • Osteopathy • Herbal medicine • Naturopathy

    41. The professional sector • Comprises the organized, legally sanctioned healing professions • Also known as allopathic or biomedicine • Includes: physicians & paramedics (e.g. nurses, midwives & physiotherapist)

    42. Practitioner of scientific medicine • Positions are upheld by law • Enjoy higher social status, greater income, & more clearly defined rights & obligations • Have the power to question & examine their patients, prescribe powerful & (sometimes) dangerous treatments or medication; & deprive certain people of their freedom & confine them to hospitals • Can tightly control their patient’s diet, behavior, sleeping patterns & medication; initiate medical tests • Can label their patients as ill, incurable, malingering, hypochondriacal, or recovered

    43. CULTURE & PHARMACOLOGY

    44. Claridge (1970): The effect of any medication on an individual (its ‘total drug effect), in addition to its pharmacological properties, depends on a number of elements, i.e.: • The attributes of the drug itself • The attributes of the recipient • The attributes of the prescriber • The physical setting

    45. Macro-context Micro-context Prescriber Recipient Drug PhE The ‘Total Drug Effect’ PhE : Pharmacological Effect of the drug

    46. Placebo effect = total drug effect – drug • any effect of attributable to a pill, potion or procedure, but not its pharmacodynamic or specific properties (Wolf, 1959) • the psychological, physiological or psychophysiological effect of any medication or procedure given with therapeutic intent, which is independent of or minimally related to the pharmacologic effects of the medication or to the specific effects of the medication or to the the procedure, & which operates through a psychological mechanism (Shapiro, 1959)

    47. Placebo effect It is the belief of those receiving (and/or administering) a placebo substance or procedure in the efficacyof that placebo or procedure that can have both psychological & physiological effects (Helman, 2000)

    48. The placebo effect also influenced by: • The attributes of the patient receiving the drug • The characteristics of the prescriber • Rapport, mutual confidence & understanding b/w prescriber & patient • Intrinsic effect of the drug (for recreational drug)

    49. Drug dependence Psychological dependence on drugs: The need the patient experiences for the psychological effects of a drug. This need can be of 2 types : • the patient may crave the drug-induced symptoms or changes in mood – e.g. a feeling of euphoria or a lessening of tension • The patient may take the drug to stave off the symptoms of withdrawal

    50. Psychotropic drug use is embedded in a matrix of social values & expectations • The drug can be used to improve social relationship by bringing one’s behavior (& emotions) into conformity with an idealized model of ‘normal’ behavior • Without the drug: ‘I’d be nervy, impatient with other people’ ‘I’d be nasty, jumpy, not nice to live with’ ‘I wouldn’t want to see people’ ‘I couldn’t help those I love’