READER pp 98-107 Social Inequalities, Emerging Infectious Diseases
These written remarks are intended to accompany (not take the place of) your reading of both the introduction by the editors and article itself by Paul Farmer. This article assumes you have a broad background; however, we're only in the third week.
Comments on introduction in italics:
-Pay close attention to the definition of 'emerging diseases' in the opening line. Think of them as the attention-getting diseases in the news.
-What is "environment" in the study of disease? Here he strikes at the core of medical anthropology.
-As the summary points out, politics/government policies are ecological factors in human disease. Do you remember last session how we emphasized that epidemic diseases have a cultural and historical dimension?
-What is pig-duck agriculture and influenza? The idea is this: In rural China, many peasants live close to their pigs. The influenza virus is endemic in pigs and also in ducks (which are migratory). People, pigs, and ducks continually trade the rapidly mutating influenza virus. Pigs/ducks/rural Chinese are the sources of the new influenza epidemics that emerge annually. Flu shots try to keep up with those changes each year.
Comments on Paul Farmer's article:
-Ebola hasn't been in the news yet this year (1999); it is one of a group of hemorrhagic (bleeding) viral diseases that incubate quickly, kill most of its victims, and make world headlines. Preston's The Hot Zone was a best seller in 1994. We have a unit on it.
-Malaria is a separate topic covered later in TEXT. This disease was once a widespread problem in warmer areas in the United States. There was a concerted effort to eradicate the mosquito vector with DDT after World War II in this country.
Farmer argues that malaria worldwide is a disease of poverty.
-The epidemiological transition is this: as countries industrialize and improve the welfare of their citizens, infectious diseases decline, people live longer, and 'diseases of civilization' like cancer and heart diseases become major killers.
-Politics, policy, and disease. How are these related? Let us illustrate. With the aid of the old Soviet Union, Egypt built one of the world's biggest dams on the Nile at Aswan. It has protected Egypt against drought, generated electric power, and provided water for irrigation. Unfortunately, stagnant water in irrigation ditches encouraged spread of another wormlike parasite, schistosomiasis. There is a unit on it in TEXT.
A road-paving program in Africa is believed to have helped start the world AIDS epidemic. Elsewhere in Africa, mosquitoes, a host for sleeping sickness has spread that disease by hitching rides on trucks along newly paved roads.
-Disease Invisibility. A frequent theme in social science is that problems among the poor only become society's problem when it affects the middle class and well-to-do. Black activists have said that heroin was in Harlem for years; however, only when it spread to middle class America did heroin get recognition as a problem.
AIDS remains a problem among the disadvantaged; it gets our attention when a high-profile person gets it. The irony is that present-day three-drug therapy with protease inhibitors costs $12,000 - 16,000. per year.
-Epistemology in philosophy inquires into how we acquire knowledge. In this article, its use seems to be about why we are aware of some diseases more than others. He sees diseases in a social and political context.
TEXT Ch 2 Interdisciplinary Research in
Health Problems
These written remarks are intended to supplement your reading. DO read the TEXT pp 32-69.
Health problems viewed in an ecological context can be viewed in four ways; therefore, the chapter is divided into four sections.
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1. Bioenvironmental Data p 34.
This includes biology, other ecological concepts, geography, the physical environment and so on. It studies the relationship between a population and its environment.
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2. Clinical Data p 43.
The clinician sees his/her world this way. It focuses on the diagnosis and treatment of the individual. There is a preoccupation with pathology. Clinical data is often narrow in its focus. It is a characteristic western analytic approach to disease. It is concerned with diagnosis and treatment. The clinician doesn't see a representative cross-section of the community at large.
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3. Epidemiological Data p 45
The geographic distribution of disease is observed. This technique uses disease statistics as determinants of disease. It is a powerful tool in examining trends and the incidence of disease. It identifies groups, subgroups, frequency of occurrence, and change through time.
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4. Social and Cultural Data p 48.
Understanding individual behavior, social, and cultural data require fieldwork. When a single culture is studied, it is called an ethnography.
Behavior can be looked at it two ways. The old terms for the two perspectives are 'emic' and 'etic.'
Western analytical approaches understood kuru as caused by a prion, spread by cannibalism. The Fore people interpreted it as sorcery. Their perspective is ethnoscience.
Other Topics to Watch for in Ch 2
-p 32. The Eskimo vignette is merely an example to illustrate cooperation-necessary in medical anthropology when there are many disciplines involved.
-pp 35 - 38. Read about the biological terms in bold type. The authors have explained them with analogies to Eskimo life. Those terms apply to the disease chart on the top of page 36. Note well that chart is a western science classification. Indigenous peoples will view them differently. Think back of personalistic and naturalistic interpretations of disease covered in an earlier reading and correlate those terms with the discussion of kuru.
The food chain on page 37 has another implication beyond energy. The levels in the pyramid also concentrate toxic substances such as PCB and heavy metals, both of which have made their way even to the Arctic.
-p 42. What is a prion? Prions are infectious agents that do NOT have DNA or RNA. The proteins themselves are capable of causing disease. The best known of these are scrapie in sheep, mad cow disease, and kuru. The connection of kuru to scrapie and mad cow was made when a description of kuru early on was read by a British scientist familiar with mad cow disease. Creutzfeld-Jacob is a comparable human prion disease.
Kuru is universally fatal and there is no known treatment.
-p 44. You should now be familiar with the anthropological distinctions between disease, illness, and sickness. They are fair game for exam questions.
-pp 44. Spiritualist healers are a topic we cover elsewhere. The study of them by Kaja Finkler is now one of the classics in medical anthropology. Mexican spiritualism is a 'non-medical health care system.' It gets results; western analytical scientists attribute the results to the placebo effect, but that is another story in a future week.
-p 45. Clarify in your mind the difference between epidemic and endemic disease.
-p 46. Understand incidence, morbidity and mortality.
-p 47. Etiology is about the determinants of disease. You'll recall in an earlier reading that how a medical system views the cause of disease as central to its whole system of ideas.
- p 48 Fieldwork and participant observation are core terms in doing cultural anthropology.
-p 52. Labeling disease is a nice section. Read it for the implications that a disease label has for people. Here is an example not in the book. A 'fainting spell' is certainly different that a seizure in the eyes of any state motor vehicle division of government. Persons with seizures can be denied a driver's license. A person who faints can blame it on something like a hot day. Personal labels matter.
-pp 53-55 the "Profile: The Everyday Lives of Retarded Persons " deserves comment. My own son in this category is now 30 years old.
First, 'retarded' may be in the popular vocabulary but is no longer used in the field. Nowadays the terms 'developmentally disabled' (DD) and 'mentally ill' (MI) are used. Thanks to medications and changed cultural attitudes, the numbers of people housed in state institutions have been greatly reduced. For the DD with which I am familiar, states have found it cheaper to house them in the community in group homes. Many of those homes have blended into their community so successfully that they are unnoticeable.
When my son Karl entered a newly built fifteen resident home in Kankakee, the neighbors were angry about 'retards' being moved into their neighborhood. Now the neighbors bring cookies and brownies; they have proven to be good neighbors.
Employment opportunities have greatly increased. We have a training center in our town that helps these folks with job skills. Karl has been a bagger at Jewel for several weeks now and is proud to have a job in the community that pays him a real wage. Training center clients (now called 'consumers') have a job coach who supervise their workers, mediate problems, and help in community placement.
Opportunities for DD are vastly improved when compared to years past. Group living allows Karl to interact with peers and to receive support from them. Last year when one of Karl's brothers got married, Karl expressed a wish to marry his girl friend of several years. We talked about that at home-a discussion painful for all of us; it just isn't realistically possible.
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The last section pp 57-69 is about medical anthropologists. Any graduate student in the field is fair to ask: can he or she get a job. This section about what they do will answer those questions.
..... CJ'99