NOTES for Week 14

TEXT Chapter 8 Health Resources in Changing Cultures pp 281-323

In this course, we have discussed many stressors, including disease, heat, cold, altitude, the work place, isolation, caring for the elderly, and many others.

This chapter is about culture change as a stressor. Culture change can be devastating to health. The impact of these events is introduced in the opening pages. The TEXT is very concise, so read carefully.

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I. The Story of Ishi pp 283 through 290.

This is one of the tragic stories occurring early in this century. Although a true story, its motif is like a tragedy from grand opera. The narration in the TEXT is straightforward. There is an excellent video about Ishi. We show it in the Indians course next semester.

The Native American Ishi came to Orville, California in 1911. He was in rags, unable to speak in other than his own language, and would not say his name. He was the last of his people, the Yahi.

Brought to the attention of anthropologists, he was taken to San Francisco and lived in quarters at the museum until 1916 when he died of tuberculosis. He was a gentle person, neither hostile nor angry for all that he had been through. Tuberculosis ended his life. He deeply touched the people who knew him.

Follow this reading with the subsequent sections on change, contact, and contact processes. Cultural change imposes upon people without any choice on their part is called acculturation-culture change with an element of force.

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II. Culture Change in the Arctic pp 290 through 302.

McElroy, one of the authors of the TEXT has done extensive fieldwork in the Arctic, so her section here is especially worthwhile. Be sure to read the Profile about health issues amongst modern-day Inuit.

It is a discouraging story of pervasive alcoholism, tuberculosis, unemployment, teenage pregnancy, and despair. The birth rate for Inuit is two ½ times that for all of Canada. They are in an environment unable to sustain a large population.

Earlier this year, Canada created a new province, Nunavut, which in effect was a restoration of land and subsistence rights to some 22,000 Inuit people. It began with assurance of ten years of payments from the Canadian government. I'm unaware of any recent articles about how it is doing.

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III. Health Care in Changing Societies

Everything is very readable in this chapter. This section examines health care as a system. The section on Health Care in Japan is cited as an example of medical pluralism.

We certainly have medical pluralism in America, as we've stressed in the beginning with units about 'complementary and alternative medicine.' Biomedicine, or as it is called 'cosmopolitan medicine' is present in major cities throughout the world. It competes, or at least coexists with traditional medicine everywhere.

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IV. Health Care for Immigrants and Refugees pp 309 through 316

As you read about refugees from South East Asia, reflect back on out video about the Hmong shaman in the City of Chicago. Many of these folks come from an entirely different culture and now have to deal with America's technology-driven health care system. Be sure to pay attention to terms like 'coining.'

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V. The Anthropology of AIDS pp 316 to the end of the chapter.

This unit correlates with our previous unit on AIDS. The next two articles are from other sources. They are included here to supplement the Story of Ishi and to highlight the health problems of many Native Americans today.

It is an unfortunate irony that Native peoples were devastated by epidemic diseases at contact, and now have many health problems as a result of contemporary diets rich in fats and carbohydrates along with sedentary lifestyles.

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ORIGINAL ARTICLE

California Indians and the Mission System: Effects of Acculturation

Contact with Europeans was devastating for Native Americans and no story is more poignant than that of the California Indians. Their lives were disrupted in two stages. The imposition and demise of the mission system were the first phase. The Gold Rush after 1848 was the second. This article is about the Mission Indians of California.

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The Franciscan Junipero Serra arrived in 1769 to convert the California Indians to Christianity. He was part of Spain's effort to extend political influence and counter political expansion by England and Russia. The mission system sought to 'extend Spanish domain and make the Indians into useful subjects of the Crown.'

The Franciscans used a technique known as reduccion or concentration as a means of controlling and exploiting the Indians. It was a system of piety and imperialism. By the early 1820s, a chain of 21 missions extended up the coast to around San Francisco Bay. At their peak, the missions were home to more than 20,000 Indians, or nearly all of the indigenous peoples remaining in central and southern California.

Reduccion was intended to wean the Indians from their pagan ways and to incorporate them into the mission labor pool. Rather than harvest acorns (a mainstay of California Indians), hunt deer or gather shellfish, they were expected to cultivate grains and vegetables, work in vineyards and tend horses, cattle, sheep, pigs and goats. This loss of traditional subsistence life ways would leave subsequent generations adrift when the mission system collapsed 65 years later. It also had immediate consequences: they were forced to give up their tradition well balanced subsistence based on foraging. fishing, and hunting.

The initial 'bait' to entice Indians were glass beads. They also liked a mission porridge called pozole. The missionaries said they 'caught the Indians by the mouth.'

The great force that disrupted the lives of coastal California Indians and compelled change was disease. Long before the missionaries arrived, the early Californians had been exposed to viruses and other pathogens through occasional contacts with white explorers along the coast or with Indians living near Spanish settlements. The epidemics increased in scope and severity as a result of close and prolonged contact between native Californians, Franciscans, and colonists. Sexual contact with Spanish soldiers and settlers, forced or voluntary, spread venereal diseases throughout the coastal population. Syphilis took an especially fearsome toll. Many women with STD infections became sterile, died in childbirth, or experienced stillbirths. Many infants were born with congenital syphilis.

The swift absorption of the coastal Indians into the mission system was due in large part to social disintegration--the tearing apart of their ancient culture by sickness and deprivation. The Indians were forced into crowded, unsanitary settlements often separated by sex into men-only or women-only barracks. Beatings were frequent. One cause for beatings was failure to attend weekly Mass.

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By 1834, the missions were secularized by the then newly independent Mexican government. In less than two decades, California became the 31st state. In the 65 Mission years, Indian subsistence skills were lost. Many became vagrants, outsiders, out of place amidst the new order of ranching and farming. Some ended up working for a Swiss immigrant--Johann August Sutter. Gold discovered at his mill triggered a new onslaught of miners--a mostly male breed undesirables prone to alcohol and violence. This initiated the final phase of California Indian extinction.

..... CJ '96

Resource

Indians of California Time-Life Books, Time-Life, 1994.

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ORIGINAL ARTICLE

The "New World Syndrome"

Kenneth Weiss and colleagues have applied the label New World Syndrome to a set of noninfectious diseases that appear in elevated frequencies among Native Americans and groups with substantial Native American admixtures. These diseases include non insulin-dependent diabetes (Type II, adult onset diabetes), gallstones, gall bladder cancer, and increased obesity. Rates for these diseases in North America tend to be highest in Native American populations.

Among blended populations such as Mexicans and Mexican Americans, the disease rates vary with the amount of Native American admixture. In other words, the more Native-American ancestry a person has, the greater the risk of developing these diseases, other factors being equal. As you might expect, all of these diseases run in families.

These three characteristics point to genetic susceptibility to the diseases among Native American peoples. Noninfectious diseases, however, are affected not only by genetic predispositions but also by environmental factors. In the case of the New World Syndrome, rates of these diseases have increased dramatically since World War II. To understand this increase, we need to look at not only genetic factors but also at changing environmental conditions.

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Weiss and colleagues argue there is strong evidence that genetic susceptibilities to the New World Syndrome diseases existed in the earliest inhabitants of the Americas. If such genetic predispositions are unique to New World populations, then there must have been rapid genetic changes since the initial occupation of the Americas by migrants from Asia. Weiss and colleagues think that the genes that currently predispose individuals to the New World Syndrome were at one time advantageous. This is discussed elsewhere in these articles as the discordance hypothesis or 'thrifty genes.' Weiss and colleagues think that the genes that currently predispose individuals to the New World Syndrome were advantageous in sparse food foraging environments.

What kind of gene would be advantageous to foragers but troublesome for those in a high fat, high carbohydrate diet of leisure? They suggest that the relationship New World Syndrome diseases to nutrient utilization provide a possible answer. These genes conferred changes in metabolism allowing more efficient utilization of food resources and fat storage. Given the importance of stored fat resources in foraging populations, particularly during pregnancy and nursing, such genes would be advantageous in an environment characterized by frequent food shortages.

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Today, however, these same genetic factors re proving disadvantageous to individuals with Native-American ancestry. The reasons may lie in the continued 'westernization' of these populations and the associated changes in diet. An increase in carbohydrates and fats in the diet will result in greater fat storage, leading to obesity and increased risk for other noninfectious disorders. Populations without Native American ancestry have also shown increases in certain noninfectious diseases because of changes in culture and lifestyle. Native Americans have also shown increases in certain noninfectious diseases because of changes in lifestyle and culture. Native Americans and related populations show greater increases because of genetic susceptibility.

During the 20th century, health conditions of indigenous people has markedly changed from the earlier ravages of epidemic diseases. They now show diseases of their economic status: alcohol and drug abuse, spouse abuse, homicide, and violence.

..... CJ '96

Resource

Hirschfelder, A. and de Montano, M. The Native American Almanac New York: Prentice Hall, 1993.

Relethford, J. The Human Species 2nd ed. Mountain View: Mayfield Publishing, 1994.

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READER pp 303-308 Teaching Framework for Cross-Cultural Health Care

This article reminded me of another book that I use as a resource for this course: Transcultural Nursing.

What are your views on the content of the article? The central theme is this: doctors should be patient and listen to each patient, being careful to work within that patient's model of disease.

In this article you will beet ideas that should be familiar to you now:

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This is being written by me having just come from a busy medical clinic at UIC in Chicago. I can't see Western biomedical physicians as being very patient with non-biomedical medical models

..... CJ '99