Future Medical Professionals and the Medical Gaze

These essays, written by undergraduate medical anthropology students, are the first in a series that the MASA blog will publish. Medical anthropology professors who would like to showcase the best work of their students should contact Jonathan Stillo, the MASA Chair at jstillo@gmail.com.

Professor’s Introduction

The essays presented here were written by undergraduate students in an upper level anthropology course at the University of Washington entitled “Anthropology of the Body.” This course was offered without pre-requisites, which attracted not only anthropology majors but also students majoring in biology, public health, political science, international studies, entrepreneurship, and communications. Many students enrolled in this course are planning careers as medical professionals and sought out this class knowing the value medical schools place upon anthropological training. The following works are included here:

The Effect of Foucault’s Work on the Approach of Future Medicine” by Lisa Hysa

“The Inevitable Medical Gaze” by Tess Han

“We Can Change the Way We See It” by Russom Desta

In these papers, the authors reflect upon the medical system that they aim to join, taking a critical look at how contemporary medical practices frame the human body, how subjectivity is shaped and constrained in this context, and the role that health care professionals can play in improving individual patient experiences. These essays not only demonstrate the value of anthropological training for medical professionals, they show us how future medical professionals envision themselves putting that training to use.  

–Jennifer J. Carroll, Ph.C. (University of Washington)

The effect of Foucault’s work on the approach of future medicine
By: Lisa Hysa

Lisa Hysa is a pre-med student at the University of Washington majoring in Physiology and minoring in Anthropology. She spends most of her time volunteering in a Radiology Neuroimaging and Biotechnology laboratory at the UW where she is investigating the longitudinal effects of mild traumatic brain injury and how it may relate to the initiation of Dementia, Depression, or Alzheimer’s disease. She also volunteers at the Emergency Department at Swedish Hospital, where her interactions with staff and patients inspire her to further pursue medicine. In her spare time, Lisa enjoys the company of her friends and family, exploring new places, drinking coffee, and being outdoors.

I have always been fascinated with science. This led me to pursue a career in the medical field. My coursework at the University of Washington has previously consisted of only science-based classes. So, being curious, I wanted to get out of my comfort zone and explore other academic fields, such as anthropology. I thought that anthropology would give me a different outlook and perspective on healthcare and patient-doctor relationships, which would better me as a future doctor. By this, I mean coursework that would allow me to study patients as not just cells, molecules, and body parts, but as a whole system with other social and psychological aspects. I appreciate how medicine is applicable to the wider population—but having learned why medicine works in application to human bodies was a very important aspect that broadened my understanding of medicine. Through the analysis of medicine’s approach with an anthropological perspective, it is clear that there are many successes but also many pitfalls to this approach. However, after analyzing both, I find even more reason to pursue the medical field due to the possibility for the future development and improvement of medical care.

Medicine has an epistemology that emphasizes objectivity and the scientific method. All current data and treatments used in the clinic are proven and replicable through this scientific method, which is what gives medicine its credentials. Medicine is taught and performed through a specific lens that French philosopher, Michel Foucault, called the “medical gaze.” This lens follows a specific set of steps: “a symptom was situated within a disease, a disease in a specific ensemble, and this ensemble in a general plan of the pathological world” (Foucault 1975, 29). This particular way of thinking and diagnosing is taught to many, if not all, medically trained professionals in the United States. I look forward to learning to see through this specific lens, because it is such a unique and distinctive knowledge that allows medicine to continue being productive.

One important aspect of the medical gaze is the focus on a collective view of people. I think this sort of mentality makes it easier to organize people, but also more difficult to create a personalized and individual approach of medical interaction.  As Foucault puts it, it is not a “perception of the patient in his singularity, but a collective consciousness” (Foucault 1975, 29). Foucault criticizes the medical gaze by pointing out that patients are now standardized amongst each other to create an “average” or “normal” person to whom all are compared. However, this medical gaze is essential for a medical student, because, before one can learn how to treat a specific person, they must learn how all people should be treated. As further stated by Foucault, medicine embraces the “knowledge of a healthy man, that is, a study of non-sick man and a definition of the model man” (Foucault 1975, 34). Therefore, in order to understand how and why medicine works, one has to look at the foundation of this medical approach.

I am interested in being a doctor because I want to learn how to help everybody. However, I believe this is best done with the scientific method—it has been disciplined into my head since the beginning of my undergraduate experience. Therefore, I think it is logical that these teachings continue to use basic statistics in order to have an average and a standard deviation that can then have a statistical significance to prove the usefulness of a medical treatment. This comes as second nature to students like myself, who have been trained since day one to think this way and to only see this way of thinking.

It is difficult for doctors to have an individual approach with patients when the focus of medicine is to get the patient to the “model man.” This requires an agreed initial definition of this term—accomplished through a collective medical approach. If this approach is explicitly presented to doctors like myself, we can better our profession and methods to clinical practice by recognizing that this clinical standard defines “normal” bodies through “the standards for physical and moral relations of the individual” (Foucault 1975, 34). I agree that it is difficult to fit all different categories of body into a statistically significant average value (body) with which the medical approach operates. It is also important to realize that the definition of a normalized body is not necessarily solely socially constructed, but also focuses on statistical measurements. An example is that a “normal” body should have a certain body temperature, blood pressure, cholesterol level or weight to height ratio. All of these are efficient ways of qualitatively measuring bodies and comparing them to the “normal” body to see if there is any need for medical attention. However, particular social groups have been shown to have statistically significant predispositions to certain irregularities that divert them from the norm. One example is the statistic that black men are more susceptible to heart disease. This sort of information may cause a doctor to focus on preventive care for heart disease which may be an issue because the patient may be upset with the fact that the doctors make him believe he will get heart disease, when it is not necessarily true. These statistical values follow this man in a medical atmosphere, limiting his individuality—he is now part of a collective knowledge.

One important idea that Foucault brings up is the patient becoming an object due to the medical gaze. I do not think doctors necessarily try to do this, but I believe doctors should be aware of this pitfall. The patient is “now required to be the object of gaze, indeed, relative object, since what was being deciphered in him was seen as contributing to a better knowledge of others” (Foucault 1975, 83). When we look at the world with this medical gaze, we illuminate the mechanical aspects of people. This gaze reduces the patient to their physical mechanisms, and functions. It enlightens the idea that the body is just an object: physically and conceptually limited. The medical gaze may ignore social or cultural factors that can affect the body. However, the ability to easily and quickly diagnose and treat a patient is a very difficult task. This is a skill that requires lots of schooling in order to master it and appropriately use it. One example as to what is not included in the medical gaze is the idea of spirituality with the body, such as chakras. The medical gaze does not look at the body as anything more than physical and mechanical so treatment and approach is only focused on quantifiable components. This view makes it easier to narrow down the medical issues through symptoms and physical examination. Therefore, I can acknowledge the idea that the medical gaze warps the image of the human patient into a human “object,” but it is in exchange for a system of medicine that works.

The fact that we can achieve knowledge through the medical gaze to help a large and diverse population is very important. It specifically includes an emphasis on the biological and mechanical functions of the body. However, this does not necessarily mean that all medical professions follow this set of standards per se. I personally want to practice medicine with an overarching scientific approach, while still including sociological and anthropological insight. With this knowledge, I can be a better doctor by keeping in mind that disease and sickness is not necessarily only physically cured. Patients are people; therefore there are many other aspects such as mental, emotional, or cultural areas that may need assistance. These sorts of factors beyond the scientific method require an approach beyond the limits of the medical gaze. I hope to make patient experiences more personal and individualistic to at least mask the distress of this scientifically focused medical approach. I also believe every new generation of doctors, especially when exposed to this sort of philosophical work, will have new insight and knowledge to add into their clinical practice that will address social factors.

The medical gaze may appear ineffective, but I believe it is a very realistic approach. I want to practice a form of medicine that has high success rates and that is applicable to people with all types of cultural backgrounds. In order to help the most people possible in such a large nation as the United States, we need doctors to focus on the mechanics of people. I believe that medical schools are rigorous and difficult for a reason: it is not easy for anybody to be able to practice this sort of medical gaze and keep such objectivity when necessary. There are always other “non-clinical” resources, such as hypnosis or spiritual chanting for patients. They are left to choose whichever medical approach best suits them. This is the beauty of medicine; there are so many approaches, all of which have their very own specific target audience. Even after learning the “medical gaze” that medical students are taught, I am still interested in pursuing this career. I can only relate to and understand scientific and objective forms of medicine, because that is how I think. I will fit perfectly in this atmosphere in the future, where I can continue my love for science in application to helping the physicality of human bodies.

Works Cited:

American Heart Association. “African-Americans and Heart Disease, Stroke.” Last modified September 30, 2014. http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStroke News/African-Americans-and-Heart-Disease_UCM_444863_Article.jsp

Foucault, Michel. The Birth of the Clinic; an Archaeology of Medical Perception. New York: Vintage, 1975. Print.

 

The Inevitable Medical Gaze
By: Tess Han

Tess Han is currently a senior at the University of Washington studying Medical Anthropology and Global health with a minor in Nutritional Sciences. She is passionate about improving the health and well being of others. Tess plans on continuing her education to earn a Masters in Nutrition and become a Registered Dietitian. With aspirations of becoming a nutritionist, she hopes to provide guidance and assistance to anyone who wishes or feels the need to improve their lifestyle by diet and nutrition.

In his book The Birth of the Clinic, doctors these days have a “medical gaze”. He occasionally refers to it as a “clinical gaze” or an “observing gaze”(Foucault, “The Birth of the Clinic,” 146.). This “medical gaze” is a taught, learned, and institutionalized way of looking and making sense of the body by doctors around the world. It doesn’t take into consideration the patient’s sociological context, because doctors are reframing patients as merely another file or case to look at. The relationship between the doctor and the patient has become extremely standardized as a result of this medical gaze. The following describes my past and present experiences with this medical gaze and how it will affect my future plans of hopefully becoming a health administrator. A career where most, if not all, administrators see with the medical gaze.

After completing my undergraduate degree in Medical Anthropology, it is my goal to attend graduate school and receive my Masters in Health Administration. The ultimate end goal is to become a generalist administrator and manage an entire facility, such as a hospital. With that responsibility comes a lot of paperwork: the paperwork of many many patients. Most likely, I won’t be working with any patients directly, which may force me to only see patients as another file. After reading about standardization and the negative consequences of the medical gaze, I am worried that I would be participating in and fueling the medical gaze. I don’t want to be seen as someone who doesn’t care for other people’s well being. While that isn’t true, that will be the stereotype mapped onto me if I reach that profession.

The medical gaze was built in such a way that it created a standard for everything in the medical field including those who work in it. “First, it was no longer the gaze of any observer, but that of a doctor supported and justified by an institution…it was a gaze that was not content to observe what was self-evident…it was calculating” (Foucault, “The Birth of the Clinic,” 109).. In addition, the medical gaze has broken down the relationship between the doctor and the patient. Doctors are seeing so many patients in a day that they only distinguish a patient from their test results. The continually shrinking time interval of the appointment length to see a patient is a negative consequence of the standardized doctor-patient relationship. These brief appointments cause the doctor to see the patient as an object that is nothing more than a machine that needs repairing instead of a subject who is a human being and needs special care and compassion, especially when faced with a medical concern.

The medical gaze also created a set of boundaries around what is considered “normal” for the human body, which could further diminish the doctor-patient relationship. When doctors see patients with a medical issue, they are considered outside of this “normal” range and it’s the doctors’ responsibility to put them back into a normal state. While these guidelines on what is considered “normal” can be reassuring and aid us in determining when we have a health related issue, there are a lot of instances when people’s bodily functions are outside of this normal boundary, but they are perfectly healthy. Doctors are so fixated on this sense of normalcy that they tend to disregard the fact that some bodies perform slightly differently than others. A controversial example is intersex and gender assignment. Infants born with ambiguous genitalia are quickly assigned a gender in which “the genitalia and physical appearance can be made to look most normal” (Creighton, “Surgery for Intersex.”) These newborns that don’t have the opportunity to speak up for them, go through an intrusive surgery because their bodies don’t fit perfectly into a female or male category. Unfortunately, this normalization of the body that doctors use has encroached on the rest of the public, which has led everybody, not just doctors, to view the world with a slight medical gaze. When the majority of society views the body in this way, it becomes extremely difficult to change the standards of what “normal” is and, in turn, makes it difficult to change health professionals’ standards.

Looking back, I never recognized the medical gaze and standardization of the medical field, because it is what I grew up with. When I was very young, I had a primary doctor that I would go to for every visit. Then he retired. Ever since, I have been going to different doctors every time. I would go to different locations in the UW Medicine network depending on which clinic I was closest to or which had the soonest available appointment. One time, the doctor asked me who my primary care doctor was, and I didn’t know what she was meant. The doctor explained, and I understood and replied that I did not have a primary care doctor. It never occurred to me how much easier my visits to the doctor would be if I only had one. Having a primary care doctor who knows my medical history would make appointments flow more smoothly and result in a more logical diagnosis. Every time I saw a different doctor I would have to talk to the receptionist and see if I’m entered into the system and once I see the doctor I have to explain my medical issue as well as my medical history. This always caused a little frustration, but apparently not to the point where I would choose to stick to one doctor. I realized that I should really have a primary care doctor so that there is a medical professional who knows my body patterns and my past medical history. By only seeing one doctor who knows more about my body than some piece of paper, will hopefully allow the doctor to treat me with compassion and eliminate the medical gaze.

After taking a medical anthropology class and reading Foucault’s The Birth of the Clinic, I can clearly see all of the things he mentions in his book about the medical gaze. I grew up in a community where standardization of the medical field had been long established, therefore I didn’t see or care that I had no sense of a doctor-patient relationship. Now I realize the importance of having a primary care doctor with a strong doctor-patient relationship. One should have a relationship with the person who is examining and diagnosing your body because you are putting a great amount of trust in that person to make you feel healthy again.

As I continue on with my education, my values and the way I choose to view the medical field could very well change. I hope to care and have compassion for each patient even if I never even meet him or her in person. On the other hand, I could find it hard to be sympathetic towards someone I only know through a piece of paper and take the easy way out: the medical gaze. I don’t believe that a health administrator could avoid seeing with the medical gaze when the extent of their patient care is providing services that barely contains genuine interactions. This has caused me to reassess my career goals. I now hope to become a nutritionist where I’m able to have a strong doctor-patient relationship while aiding someone on his or her journey to a healthier lifestyle.

Works Cited:

Foucault, Michel. The Birth of the Clinic; an Archaeology of Medical Perception. New York: Pantheon, 1973.

Creighton, Sarah, “Surgery for Intersex,” Journal of the Royal Society of Medicine (2001): 218-220.

 

We Can Change the Way We See It
By: Russom Desta

Russom Desta is studying Medical Anthropology/Global Health as well as Biochemistry at the University of Washington. He hopes one day to become a physician and believes that an anthropology background provides will provide him with a humanistic social approach to providing care. One reason he wants to become a doctor is because there is more to the profession than the science of treating the body. The healthcare field has countless social interactions, cultural differences and its always evolving. Russom also spends his free time volunteering, working at the Fred Hutchinson Cancer Research Center and reading interesting medical cases.

As an aspiring physician, I have experienced many of the trials and tribulations associated with becoming eligible for medical school. I have taken courses in introductory physics and biology, volunteered time at hospitals and clinics, and have shadowed a physician, which most would consider a staple ingredient in building one’s pre-medicine foundation. In sum, all these tasks are of value in building a basis for my future career as a physician. I feel that of all these building blocks, such as being allowed the chance to shadow a physician, allow students like myself to get the most hands on view of what happens in a doctor’s day to day operations. It is in these moments that we see our studies and skills being applied in the real world.

From the insights I have gained from observing medical professionals and from the subject matter we have discussed in this course, I feel that there is a need for humanity in our healthcare system. As medicine has moved forward with technology and practice, the “medical gaze,” which Foucault (1973) defines as the separation of the patients’ body from the patient herself, has had a larger presence in everyday practice. This notion of a “medical gaze” is intended to allow physicians to remain objective and impartial to the human factors that influence one’s perception of another being. By remaining objective and unbiased, physicians are able to treat each patient equally and consistently. However, by taking on this medical gaze and medicalization of the human body, physicians are removing the personal humanistic facet necessary for providing holistic and well-rounded care. Though objectivity is important in providing equal and unbiased care, modern day physicians must also consider human nature and its many facets in order to assess their patient holistically.

When a person is ill and visits their physician, they are often met with a string of questions aimed at identifying the most critical issue. The questions often refer to where it hurts, how much it hurts, how the pain feels, etc. What people don’t often realize is that, from the start, physicians are observing you through a medical gaze that focuses on treating your symptoms and finding the most critical issues. While shadowing one doctor, I observed that he had poor bedside manner. He never really connected to the patient on a personal level or asked questions that would build an emotional or personal relationship. The doctor’s questions were intended to narrow the scope so that a determination could be made on what was wrong with the patient. In doing so, the doctor separates the illness from the person, the soul, viewing their patient not as a human subject but as an object.

Foucault describes this methodology in The Birth of the Clinic when he states “the fundamental act of medical knowledge was the drawing up of a ‘map’ a symptom was situated within a disease, a disease in a specific ensemble, and this ensemble in a general plan of the pathological world” (Foucault 1973, 34). In this statement, Foucault describes how the medical gaze allows the physician to break down a person into their most basic components: their illness and everything else. In using their understanding of medicine, they are able to form a judgment of the illness that will allow for a practical application of their skills and knowledge. During my time shadowing, I felt as though doctors did not care to know names or faces but rather focused on the piecing together of lab values, vital signs, and imaging with objective observations so that they could find a resolution for a diseased state. They focused on change and deviations from “normal” but failed to focus on the individual person. In a previous course discussing the medical narrative I learned that in the first year of medical school, doctors learn the anatomy of a cadaver, taking apart each body part piece by piece and developing an intricate mapping of the body’s internal cavity. By taking a scientific rather than humanistic approach to the body, doctors are able to improve their abilities to perceive and analyze a situation free from bias and prejudice, but consequently are removing themselves from a holistic “whole patient” perspective that medicine was once based upon.

Doctors use medical gaze in order to look for deviations from normal, but since diagnosing is an observatory science or many parts of the body those deviations place people in groups that may not be accurate. People are often being grouped in “pre” categories denoting that they are at risk for diseased states. These notions of diagnosing people in “pre” diseased states are preposterous. There is a fine line between being cautious and being fearful. Giving patients potentially scary diagnoses will forever set forth a precedent that they must live in fear of all the risks associated with the disease. Without knowing all the available data from the patient, the doctor may not find a logical reason for why the patient has such deviant levels. Only looking at the numbers in turn, hinders the doctor from being able to provide a full spectrum of care.  Nikolas Rose touches upon this when he states:

Men presenting to their doctors with high blood pressure are risk profiled in terms of age, weight, family history, smoking…if at high risk, may be advised to make changes to behavior, diet or lifestyle, or pre-emptively placed on a drug regime to reduce the risk of occurrence of such disorders (2007, 72)  

There are many factors that cause a person to have high blood pressure that do not have anything to do with examples provide in the quote, by limiting the scope to four factors a physician is not doing everything to treat the patient.

Another classic example of normalizing people is with the Body Mass Index, a method of combining height and weight which allows a doctor to determine whether a person is overweight, normal or underweight. The limited factors used in determining “normal” body weight cannot be solely used to justify the next steps for a doctor to treat the person. This simple method does not account for muscle mass, missing limbs or even something as simple as whether the patient was wearing clothes or not. I believe that the patient will be better served once physicians try to encompass all available factors including numerical data and holistic data.

As a scientist, I understand the benefits of the medical gaze and why is has been a popular has been the primary project of medicine for centuries. The medical gaze allows doctors to treat patients in an objective, medically focused manner. It allows patients to be treated equally and doctors to provide consistent medical care. However, despite its benefits, the medical gaze prevents doctors from viewing the patient holistically and seeing the bigger picture. In order to be a strong, competent, and well-rounded physician, doctors must break through this conditioning and view the patient holistically. As a hopeful future doctor, I would like to see a shift in the medical gaze towards a more holistic approach that involves more than treating the symptoms. We must move our standards of practice towards finding preventative measures and working on healing not jus the body but the factors that influence one’s health choices. Once we are able to step away from the medical gaze and the disjointedness of body and soul we can utilize this larger scale view to its fullest potential turning medical practice into a more all encompassing solution.

Works Cited:

Foucault, Michel. The Birth of the Clinic; an Archaeology of Medical Perception. New York: Pantheon Books, 1973.

Rose, Nikolas S. Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-first Century. Princeton: Princeton University Press, 2007.

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COMING SOON! Undergraduate Essays in Medical Anthropology

Beginning later this week, the MASA blog will start featuring selections of thoughtful writing done by undergraduates taking classes in medical anthropology. We are looking for professors to submit some of their students best writing (essays less than 1000 words) that will be peer-reviewed and organized topically. If you are an interested professor or student please contact Jonathan Stillo, MASA Chair, at jstillo@gmail.com. 

We encourage blog readers to share these posts via social media and to add your voices to the comments section below the posts.

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A Message from a New Medical Anthropology Journal

Dear MASA member,

This is a call for submitting a short essay about your dissertation process for a new journal we are launching this year, Medicine Anthropology Theory, which will be the first open-access, English-language journal focused on medical anthropology and science and technology studies (seewww.medanthrotheory.org). We feel that there is a real need for an independent journal of this kind, particularly for the growing number of scholars who do not have easy access to subscription-only journals. The journal’s editors are Eileen Moyer and Vinh-Kim Nguyen, who were asked to take over the Dutch journal Medische Antropologie when Sjaak van der Geest retired, and who have taken this opportunity to rethink the journal.

The journal will publish a wide range of work relevant to scholars of medical anthropology, STS, and critical global health studies. In addition to dissertation-related essays, peer-reviewed articles, and book and film reviews, we will include photo essays, conference reports, and other essays in a section called The Nightstand. The first issue will be published in December 2014.

The Dissertating section of the journal is a space for students who are writing their dissertations and recent graduates to share their ideas with the wider academic community, and to inspire other students. We would like to invite you to submit an essay (1,000 words) that considers how your thinking developed and changed during the dissertation process. How was your focus refined? Which of your insights were unexpected? This is an opportunity to introduce a broader readership to those key texts that influenced your research, the challenges that caused you to rethink your agenda, and the ‘a-ha’ moments that forced you to change direction. What are the new studies or ideas that are relevant for a broad audience? What do you think are the big questions for future research?

If you are interested in submitting such an essay, please contact me at the email below. We are looking for submissions to be published on the website in December and January, and which will be (virtually) ‘bundled’ into our second issue in April 2015. I am happy to answer any questions you may have, as well.

Sincerely,

Yolande Schöller
Dissertation Essays Editor
Medicine Anthropology Theory
www.medanthrotheory.org

Email: yolandescholler@gmail.com

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MASA Annual Graduate Student Mentor Award Deadline Aug. 1

MASA Annual Graduate Student Mentor Award
Deadline August 1

Purpose: To recognize excellence in graduate student mentorship and acknowledge the important contributions of medical anthropologists who have provided exceptional guidance and outstanding support to graduate students in this field.

For whom and for what: This award is aimed at senior or mid-career scholars who have demonstrated an ongoing commitment to teaching and mentorship throughout their careers, particularly those who have taken the time to thoughtfully and successfully guide their MA and PhD students through their fieldwork experience and the thesis/dissertation writing process.

Attributes to Consider: Communicates clearly and supportively with students and offers consistent, positive guidance; provides timely and productive feedback on written work;

Creates a friendly, encouraging and academically challenging environment; makes an effort to teach medical anthropology in innovative and effective ways;
Encourages students to submit abstracts of their own at conferences, write and submit their own work to journals, teach well and value teaching and begin to function on their own in those public arenas that include medical anthropology;
Has a good track record of retaining students: remaining on committees, retaining advisees, and actually graduating a good proportion of their advisees;
Inspires students to pursue their own research, teaching and advocacy goals in medical anthropology, despite the daunting nature of graduate school and the dissertation process;
Helps students connect with other professionals in their field outside of their own departments and helps familiarize them with the unwritten rules of their professional community;
Steps back and allows students to learn from their own mistakes; lets them step forward on their own and begin making their own decisions; lets them define and take appropriate risks.

Nomination Procedures and Application Materials:
A minimum of three letters of nomination should be from current and/or former students outlining the ways in which the candidate has been a strong mentor, advisor and/or teacher. Additional letters may also be submitted by junior colleagues whom the candidate has mentored; however, this is not a requirement. Each letter should consider the above criteria and address any other attributes or practices that have led to supportive, successful mentoring. Nominations for the faculty mentor award will remain open for three years for consideration by the award committee.

Submissions:
Nomination and support letters will be accepted until the deadline of August 1. Please send all nomination letters to Jonathan Stillo at jstillo@gmail.com. The award recipient will be honored during the SMA Business Meeting and Award Ceremony at the AAA Annual Meeting in Washington D.C. this December.

What Will Be Awarded, and When:
Awards will be announced at the SMA business meeting at the AAA. Candidates will be presented with a plaque of appreciation and a two hundred dollar check.

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Viral Stories—Studying AIDS-Related Stigma in Kenya

By: Elizabeth J. Pfeiffer

I was preparing to conduct the final interview of my dissertation research in Mahali (a pseudonym), Kenya, as Jane sat down across from me for the third time. We were sitting in a consultation office in the truck container clinic where we had agreed to meet on that cold and raining August morning. The lump in my throat had been with me since I had awakened that morning. I knew its persistence was due to the fact that it was my last day of nine months of ethnographic fieldwork, and that I would soon need to say goodbye to people and places I had come to care about very much. I was there to study AIDS-related stigma.

IMG_2755

Blue container truck clinic.

During the two times we had met before, and as Jane traced the various trajectories of her life with me, I was especially struck by how prominently HIV/AIDS featured across her story. This probably shouldn’t have surprised me, since people living in Kenya have experienced one of the world’s harshest AIDS epidemics. I had decided that for our final life-history interview together, I would begin our time with a single question: “Tell me about your life as it relates to HIV/AIDS.” This launched Jane into a very lengthy and detailed story, or oral history, about the epidemic from her own subjective positioning. Jane had come to live in Mahali, a small urban town located along a major highway in Rift Valley Province, in the 1980s, only a few years before the emergence of Ukimwi or Slim, as the disease was originally named in this part of the world. Her narrative about a circulating virus—spanning across all the decades of the epidemic—not only shed light on some of the ways that the stigma associated with the now chronic illness HIV/AIDS operationalized at my field site, but on the complexities of the contemporary “modern” and interconnected global world.

IMG_4867 small

The author conducing an interview

Jane first came to learn about Ukimwi through local talk, gossip, and media representations—or the words of others—about prostitutes who were suffering from a mysterious disease. Soon the rumors in Mahali about Slim became uncomfortably personal for Jane. It was through a circuit of local gossip that she learned that her husband’s lover was suffering from Ukimwi. This news propelled Jane into action and to make the following observations and conclusions:

I very much wanted to go and to see this disease that I had been hearing about …. [Then]I got the chance of going to see [my husband’s lover] …. Because I wanted to see. How does a person look like when she has HIV, the Slim? So…I saw how slim she was and how she was changed. …

 After she died … many others followed her [and they died also]. And I think even they did not follow [her in death] because they were sick, but because of knowing how they had been sharing [sexual partners]. … I started seeing a lot of dying. …. We were hearing reports that HIV was so high in Mahali. So the [newspaper] articles could announce to the entire country, “Take care [be careful] in that place.”… It was the highway.

From the start, through a combination of circulating—local, national, and international—stories about HIV/AIDS, people living in Mahali came to think about, respond to, and even experience the AIDS epidemic and notions of risk in very particular ways. HIV/AIDS was understood not only to be a “prostitute’s disease,” but because of its positioning along a major highway, dangerously rampant in Mahali. At the same time, people could even die of Ukimwisimply by knowing that they had engaged in sexual relations with an allegedly infected person. All of these stories impacted the ways people thought about their community, the lives (and deaths) of those living in it, and themselves.

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The highway running through the center of the urban part of Mahali

Jane went on to share numerous stories about the various ways that HIV/AIDS had impacted her life. At one point, she spoke of her sister’s boyfriend, who had died of complications associated with AIDS. She offered the following words to describe her experience at his burial, and that further underscored for me the potency of spoken words—their significant role in the activation of AIDS-related stigma—and the ways that people sometimes used them to spontaneously “attack”one another:

… The boyfriend died. …When we went for the burial…the brother [of the deceased] attacked us [with words]! In front of all the mourners. He asked [those in attendance]: “You people who are here. Do you know when a person died—when anything happened long time ago—what people would do? How could they communicate? Because there were no phones.” [He] went on, “Like by screaming—you hear people screaming. You would know there is a danger. You could burn smoke. When you see the smoke that was going upwards, you knew there was danger….So, now this one here today” Now [he was] hitting the coffin. “This one is danger. This was my brother and my brother died of HIV. And I want to tell all…. You know the [girlfriend]—the girl he was moving with! Don’t greet [the girl or any of her relatives]. Don’t talk to them!” Oh—I felt like fainting …

 As Jane makes overt in the above passages, words in Mahali were powerful, sometimes even more so than the virus, itself. At the same time, people living or associated with HIV/AIDS were construed as dangerous—with the potential to threaten what mattered most to all people living in Mahali (both the stigmatized and those doing the stigmatizing), such as life chances, health, reputations, and relationships. To temper the threats felt by the brother of the deceased, he attacked Jane’s whole family with loud words that served to both shift blame onto Jane’s sister for the man’s death, and to communicate that the girlfriend was dangerous, and thus a person (and family) to be feared and socially avoided.

Daily life for Jane and her sister—as it was for all Mahali residents—was dangerous, uncertain, and circumstances could (and did) change rather unexpectedly. It was also full of insecurities, inequitable suffering, and plagued by historic legacies of political and ethnic violence and conflict. It is within this context that my dissertation explores the circulation of all kinds of information about HIV/AIDS—from national HIV/AIDS statistics, anti-stigma campaigns, and global treatment and prevention messages, to medical reports, illness narratives, eulogies, memories, and local gossip and rumors—that worked their way into local narratives or what I refer to as viral stories. Drawing on the lived experiences of people like Jane, I demonstrate the power of words—as people circulated, processed, and expressed them—as they produced frictions within and between people, and thus fueled AIDS-related stigma in this part of the world.

 

An anti-stigma campaign sticker hanging in the community

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About the Author:

Elizabeth (Libby) J. Pfeiffer had conducted anthropological research in the USA, Jamaica, and Kenya that broadly explores issues related to health, social inequalities, gender, globalization and development, and education. She recently (January 31, 2014) earned a PhD in Social-Cultural Anthropology, with a doctoral minor in African Studies from Indiana University, Bloomington.   With funding from a NIH pre-doctoral training fellowship award in Translational Research (TL1RR025759; A. Shekhar, PI) and a Kinsey Institute Graduate Student Research Grant, Libby conducted ethnographic research that centered on the social and structural roots of AIDS-related stigma in a community located along a major highway in western Kenya. She wrote and successfully defended her dissertation, Viral Stories: HIV/AIDS, Stigma, and Globalization in Kenya with the support of an Indiana University College of Arts and Sciences Dissertation Year Fellowship Award. In February 2014, Libby began a T32 NSRA post-doctoral training fellowship in STD/HIV research at the Indiana University School of Medicine, which will enable her to continue her research endeavors in Kenya. Please contact Libby: elpfeiff@indiana.edu

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Coming Soon: Student Dispatches from the Field

Beginning next week, the Medical Anthropology Students’ Association Blog will begin publishing short posts about your undergrad, Masters, and PhD Medical Anthropology fieldwork experiences. You are invited to send 500-1000 word submissions to Jonathan Stillo at jstillo@gmail.com. The first in this series will be by Elizabeth (Libby) Pfeiffer who recently completed her PhD at Indiana University. Keep an eye out for it and please send us your own fieldwork-inspired pieces. The only requirements are that you are a student and that the piece is in English and is well-written.

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2014 Science, Technology and Medicine Graduate Paper Prize

2014 STM Graduate Paper Prize

The Science, Technology, and Medicine (STM) interest group of the Society for Medical Anthropology is pleased to welcome submissions for the 2014 STM Graduate Student Paper Prize. This prize is awarded annually for a paper that offers an innovative approach to issues in science, technology or medicine. These issues include:

  1. How scientific research, technological transformation and professional medicine inform public health policy and popular culture and affect the intimate realms of bodily experience;
  2. The ways laboratory and experimental medicine (both public and private sector) are influenced by economic and political institutions and patient mobilization;
  3. The specificities of the development, regulation, marketing and distribution of pharmaceuticals and biologics;
  4. How local experiences of illness and health are refracted through established modes of discrimination (such as class, race and gender) and unequal access to new medical technologies; and
  5. The extent to which pragmatic and embodied responses to medical science and technology shape concepts of personhood and degrees of political membership.

Submission rules:

  • The word count should be 6,000-8,000;
  • All authors must be enrolled as a graduate students at the time of submission;
  • The paper can be under review at the time of submission, but it cannot be in press or published;
  • To enable a blind review process, the submission email should include two word documents: (1) a cover sheet with author name, affiliation(s) and acknowledgments, and (2) the paper (abstract included) with no identifying information listed.

The winner of the prize will be announced at the 2014 AAA Annual Meeting in Washington, D.C. The winner will receive an award certificate or plaque, detailed suggestions from the committee of judges on ways to prepare the article for publication, and a cash prize of $100.

Submissions should be emailed by June 1, 2014 to Nayantara (Tara) Sheoran, nayantara.sheoran [at] graduateinstitute.ch. For more information on the STM interest group, go to: www.medanthro.net/research/stm/index.html.

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The MASA Blog Wants YOU! (to write a blog post)

The Medical Anthropology Students Association would like to invite graduate and undergraduate students from across the globe to submit 500-1000 word posts for for us to publish on the MASA blog.

These posts should be related to medical anthropology and can be about current events, your research, policy or anything else that you think we will be interested in. The posts should be well-written, clear, and without much jargon and technical language.  We are especially eager to hear about your own research and will be happy to publish your field photos (as long as you have obtained permission from the people in them).

Please post this to your department listservs and pass it along to anyone who might be interested in contributing. This is a great opportunity to introduce the medical anthropology community to your field site, and to start interesting conversations about research methods, ethics and for discussing interesting research in medical anthropology.

You don’t need to know WordPress to write a blog post, simply send us the text as a Word document, and we will let you know whether we will accept to publish it, or whether edits are necessary. The posts should not have been published elsewhere previously, but if they are, you must have permission to republish it and provide us with the original citation. In addition to appearing on our blog page, we will also link to the posts on our Facebook page so thousands of people will be able to see them. For more info or to send a submission please contact Jonathan Stillo (jstillo@gmail.com). 

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2014 Preventing Chronic Disease Student Paper Prize: Due January 23, 2014

Preventing Chronic Disease, a US Centers for Disease Control journal has opened their 2014 student paper competition. The winner will have their paper published in PCD! See below:

PCD Student Research Paper Contest — Call for Participation

Preventing Chronic Disease (PCD) announces its 2014 Student Research Paper Contest. PCD is looking for graduate and undergraduate students to submit papers relevant to the prevention, screening, surveillance, and/or population-based intervention of chronic diseases, including but not limited to arthritis, asthma, cancer, depression, diabetes, obesity, and cardiovascular disease. A peer-reviewed electronic journal, PCD was established to provide a forum for researchers and practitioners in chronic disease prevention and health promotion. The journal is published weekly by the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion.

The winning manuscript will be recognized on the PCD website and will be published in a 2014 PCD release.

Papers must be received electronically no later than 5:00 PM EST on January 23, 2014. For more information on the contest and how to submit a manuscript, visit http://www.cdc.gov/pcd/announcements.htm#student, and click here to open the paper competition flyer: StudentResearchPaperFlyer2014.

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Three SMA Awards (Dissertation, Mentor, Travel)

SMA Dissertation Award
Deadline: July 1 (Extended to July 15th)

Purpose:
In 2006, the Society for Medical Anthropology inaugurated the Medical Anthropology Students Association (MASA) to recognize and serve student members of the society. Students make up one-third of SMA’s membership and represent the future of the field. One way for SMA to honor its student members is through inauguration of an award recognizing the excellence of a recently completed doctoral dissertation. To that end, the SMA Executive Board has established the SMA Dissertation Award (formerly called the “MASA Dissertation Award”), created to recognize an outstanding dissertation in the field of medical anthropology, broadly defined.

On a biennial basis (every odd year) the SMA Dissertation Award is given to the author of a dissertation which is judged to be a significant and potentially influential contribution to medical anthropology. Dissertations are judged on the basis of: (1) scope and excellence of scholarship, including ethnographic research; (2) originality of subject matter; (3) effectiveness and persuasiveness of arguments; and (4) writing quality. Dissertation research of exceptional courage and difficulty is given special consideration. For details, contact Becky Read-Wahidi (mrread@crimson.ua.edu).

The SMA Dissertation Award will be publicly announced during the SMA awards ceremony, held during the annual AAA meeting. The winner will receive a $500 cash award and a plaque.

The SMA Dissertation Award Committee strongly encourages submission of nominations for the competition. Submissions must be dissertations approved, accepted, and filed as the final version with the candidate’s university within nomination deadline period. For the current nomination period, dissertations submitted to the university between the period of July 1, 2011 – July 1, 2013 will be considered. The candidate’s dissertation advisor should attest that this is the copy submitted. Candidates should specify any of dissertation committee members who they feel should not to be included as a reviewer (e.g. they are your advisor; you have a working relationship that would prevent objectivity, etc.).

Submissions: Students planning on (or interested in) submitting their work should review the dissertation page for complete details regarding the submission process. You must send a PDF of your dissertation to the Committee Chair, Becky Read-Wahidi, on or before the final date.

Letters of Nomination: Candidates for the award need not have received their PhD degrees in a department of anthropology, nor in a North American university. However, letters of nomination must state why the dissertation contributes to the field of medical anthropology. Two letters of nomination, one from the candidate’s dissertation advisor and one from a dissertation committee member, should be sent electronically to each of the SMA Dissertation Award Committee members.

For details, contact Becky Read-Wahidi (mrread@crimson.ua.edu), SMA Dissertation Award Committee Chair.
2013 MASA Graduate Student Mentor Award
Deadline: August 1, 2013

Purpose: This award recognizes excellence in graduate student mentorship, and is aimed at senior or mid-career scholars who have demonstrated an ongoing commitment to teaching and mentorship throughout their careers, particularly those who have taken the time to successfully guide their MA and PhD students through field work and the thesis or dissertation writing process. Previous recipients of the MASA Graduate Student Mentor Award are Peter Brown (2012), Frances Barg (2011), Mary-Jo DelVecchio-Good and Byron J. Good (2010), Carole Browner (2009), Joe Dumit (2008), Lenore Manderson (2007) and Mac Marshall (2006).

For whom and for what: This award is aimed at senior or mid-career scholars who have demonstrated an ongoing commitment to teaching and mentorship throughout their careers, particularly those who have taken the time to thoughtfully and successfully guide their MA and PhD students through their field work experience and the thesis/ dissertation writing process.

Attributes to Consider:
– Communicates clearly and supportively with students and offers consistent, positive guidance; provides timely and productive feedback on written work
– Creates a friendly, encouraging and academically challenging environment; makes an effort to teach medical anthropology in innovative and effective ways
– Encourages students to submit abstracts of their own at conferences, write and submit their own work to journals, teach well and value teaching and begin to function on their own in those public arenas that include medical anthropology
– Has a good track record of retaining students: remaining on committees, retaining advisees, and actually graduating a good proportion of their advisees
– Inspires students to pursue their own research, teaching and advocacy goals in medical anthropology, despite the daunting nature of graduate school and the dissertation process
– Helps students connect with other professionals in their field outside of their own departments and helps familiarize them with the unwritten rules of their professional community
– Steps back and allows students to learn from their own mistakes; lets them step forward on their own and begin making their own decisions; lets them define and take appropriate risks

Nomination Procedures and Application Materials: A minimum of three letters of nomination to be submitted from current and/or former students outlining the ways in which the candidate has been a strong mentor, advisor and/or teacher. One additional letter may also be submitted by a junior colleague who has also been mentored by the candidate; however, this is not a requirement. Each letter should consider the above criteria and address any other attributes or practices that have led to supportive, successful mentoring. Nominations for the faculty mentor award will remain open for three years for consideration by the award committee.

Submissions: Nomination and support letters will be accepted until the deadline of August 1st. Please send all nomination letters to Mary Rebecca Read-Wahidi (mrread@crimson.ua.edu). Award recipient will be honored during the SMA Business Meeting and Award Ceremony at the November AAA Meeting in Chicago.
SMA Student Travel Fellowships
2013 American Anthropological Association Meeting
Chicago, Illinois
November 20-24

Deadline September 4, 2013
The Society for Medical Anthropology (SMA) is pleased to be able to offer its student members five student travel fellowships ($500 each) for travel to the 2013 AAA meeting in Chicago. Eligibility is restricted to student members of the SMA who are presenting a paper or poster at the meeting. Fellowships will be awarded based on the clarity, significance and innovation of their submitted abstract, and the strength of a letter of support from a faculty member who can discuss the significance of their presented work.

Eligibility Requirements (must meet all four):
(1) Submit proof of current student SMA student membership
(2) Submit proof of registration for the AAA conference
(3) Submit a copy of your AAA paper/poster abstract
(4) Submit a letter of recommendation from an advisor

Application Procedure:
Please compile all the supporting materials into ONE file and save in pdf format. Email materials and direct any inquiries to the SMA 2013 Student Travel Fellowship Committee at smaawards@gmail.com by September 4, 2013. Fellowship award winners will be notified by September 25, 2013. Awards will be formally announced, and checks will be presented, at the SMA business meeting in Chicago.

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