MEDICAL ANTHROPOLOGY IN THE UNDERGRADUATE CLASSROOM
These essays, written by undergraduate medical anthropology students at Luther College are the fourth in the MASA blog’s series of excellent undergraduate writing. Medical anthropology professors interested in submitting the best work of their students should contact Jonathan Stillo (firstname.lastname@example.org) the MASA Chair for more information.
How are Hmong shamans, Zulu sangomas, Malian midwives, and Wisconsin case workers related? What does it mean to be healthy? What is the cultural meaning of illness? The introductory class in medical anthropology at Luther College allows students to discover the answers to these questions and more. We focus on making familiar strange as we demystify the unfamiliar and exotic. Here we share with you student notes from their first “excursions” into the field of medical anthropology. Sometimes the road to understanding is long and winding. It is often a challenge to acknowledge that some of our most deeply held beliefs about medicine, ethics, and morality might be challenged. Our class took the time to discuss and understand the points of confusion, anger, or frustration by writing forum blogs. Below are a few examples of such deliberations. Perhaps, the students’ first discoveries in medical anthropology will take you back to your own first encounters with the discipline.
Assistant Professor of Anthropology and Women & Gender Studies
Racial Health Disparities: Environmental Not Genetic Influence
By: Elizabeth Hovden
Elizabeth Hovden is a junior at Luther College majoring in biology with future plans to attend a physician’s assistant graduate program. She longs for a career in medicine as it will provide an opportunity for her to combine her two great passions: exploring science and helping others. Elizabeth volunteers regularly at a community free clinic, which serves a population primarily of Hispanic immigrants, and it is through this opportunity as well as through her studies of Medical Anthropology that her understanding of medicine and its culture has broadened. She has enjoyed learning how different cultures value and practice medicine and how these alternative practices can be complemented by biomedicine. Elizabeth believes it will be important as a medical practitioner to be conscious, considerate, and accommodating of cultural practices.
Biological differences and health disparities are evident among racial groups in the contemporary biomedical literature. Certain racial groups possess greater risks of diseases such as high blood pressure, diabetes, and obesity. These racial differences are often incorrectly explained by genetics based on the understanding that race is a biological concept. Having studied human evolution and genetics as well as medical anthropology, I recognize the flaws in this explanation. I propose instead that race and racial differences are social constructs.
Scholars in the field of applied medical anthropology argue that genetic variation is gradually accumulated as a result of evolutionary processes such as natural selection (N. Jablonski and G. Chaplin 2002, 45). As a result, the vast extent and continuous variation of human characteristics cannot be fully explained by examining only the genetic characteristics of individuals such as allele frequencies (A. Goodman 2000, 41). Scientists agree with this perspective. My genetics professor, for example, shares the perspective that genes alone have little influence on traits. She argues that phenotypic variability is the result of both genes and the environment. Environmental conditions such as sunlight, nutrition, stress, and toxins have a great impact on human biological variation, health, and disease. Access to healthy foods, safe living conditions, and places to exercise are essential determinants of health and often variable among racial groups. The variability of health and disease cannot be explained by genetics alone, for the impact of the environment is critical.
As explained in the television documentary “Unnatural Causes: Becoming American” (2008), Mexican immigrants, despite being poorer, are healthier than most Americans when they arrive. As they become acculturated to the American environment and are faced with economic challenges, the status of their health deteriorates. Through my volunteer work at the Decorah Free Clinic I have witnessed firsthand the effects stress and economic insecurity have on the health of racial minorities. Chronic health concerns such as diabetes, high blood pressure, and obesity are common in the Hispanic immigrants who attend the Free Clinic. The rates of these diseases are influenced little by genetic causes but are explained entirely by environmental conditions. The immigrants who attend the Decorah Free Clinic are faced with a great economic need to work long hours at low income jobs to provide for their families. Economic uncertainty and taxing working conditions provide a chronic stress that is detrimental to their health and increases the occurrence of disease. In this manner, socioeconomic status and its associated stress are social factors directly linked to health.
Understanding the impact one’s environment has on his or her health is essential for creating mechanisms to decrease racial health disparities. To improve the health of all individuals, the environment in which they reside must be altered in ways to promote health. Access to healthy foods, places to exercise, good school systems, and financial security are factors that will decrease stress and foster healthy behaviors. The impact of genetics on health and disease is minuscule in relation to that of the environment. For this reason changes to one’s environment are essential to improving health.
A. Goodman (2000). “Why Genes Don’t Count (for Racial Differences in Health).” In P. J. Brown and R. Barrett Understanding and Applying Medical Anthropology. Boston: McGraw Hill. Pp 39-43.
N. Jablonski and G. Chapin (2002). “Skin Deep.” In Understanding and Applying Medical Anthropology. Peter J. Brown and Ron Barret, eds. Pp. 44-48. New York: McGraw-Hill Companies.
UNNATURAL CAUSES: Is Inequality Making Us Sick? Episode 3, “Becoming American.” (2008).Vital Pictures.
A Culture that Leads to Another
By: Tatyana German
Tatyana German is a graduating senior of Luther College studying Music Performance and Psychology. After graduation she will be enjoying the sights of Italy with Luther College’s Nordic Choir, which will be her third overseas adventure to date. Her home resides in Rochester, Minnesota, but she hopes to eventually move to the Minnesota twin cities or to Chicago in order to pursue a career in opera. Prior to this semester she had never taken an anthropology class, making the subject matter entirely new and unfamiliar. She is glad to have had the opportunity to learn materials outside her major studies under the direction of Professor Maryna Bazylevych.
In class this semester, we read The Spirit Catches You and You Fall Down by Anne Fadiman (2005). The author of this book was able to not only show me the struggles that the Hmong people faced, but opened my eyes to all aspects of the biomedical culture. Biomedicine has been called a “culture of no culture,” and it is a culture about which I was previously unaware. Learning about other cultures, like the Hmong living in the United States, has helped me learn more about this aspect of my own.
The interactions that took place between the Lee family and their doctors both surprised and horrified me. I questioned both sides in their repeated encounters. I wondered along with the author, “[h]ow could the Lees not see that Lia needed more help than a quick fix medication? How could they still believe epilepsy was a gift for their child?” As the story continued, the questions were increasingly directed at the American biomedical professionals: Did they really file for child abuse against the Lee’s? Why are they so unaccepting of the Hmong culture? Why are people so cold towards these foreigners who don’t fully understand our ways or even want to be here? Finally, Anne Fadiman brought up the most important question: What gives us the right to force our cultural beliefs onto those who do not choose become part of it? This is what spoke to me the most.
One day in class discussion, we decided to stand on the line of an invisible spectrum which showed whether or not we thought the doctors had done the correct thing in taking Lia out of the Lee’s custody. At the time, I was leaning towards the idea that this was the wrong course of action. However, I can’t help but to wonder if I would have believed otherwise prior to this class. In the past, if I heard that Lia was ill and her parents refused to give her the medicine she needs simply because they felt it was causing harm with no definite proof, I might have believed that the doctors made the correct decision. I would have believed that Lia needed to be taken care of properly and that it is the doctor’s right to put Lia where she would be best taken care of.
It saddens me that I would think so subjectively, and that many still do. I realize now that Lia’s parents loved her very much and that they chose to stop the medicine because they honestly thought it was harming her. I can’t imagine the pain they went through having their daughter taken away and finding out she got worse after she was forced to take medicine again.
I seriously question whether we, as Americans, would have done the same thing if this had happened to us in another culture. Let’s stop to think about what we would do in a strange country with a sick child. Imagine we were told to give them something that we believed to be hurting them. Then imagine having our child taken away because we didn’t fully understand what was happening – because this strange way of healing appeared to be doing more bad than good. I doubt we would have dealt with it any differently than the Lees did.
We are part of a culture that believes it is better than others. We’ve become so habituated to the judgement and ignorance of our society that we believe it is the fault of others when difficulties arise. There was never a moment when the American doctors looked at the use of shamans and the importance of the soul, yet the Hmong family, though stubborn, sought help from Western medicine. We live in a one sided society that likes to believe we are accepting of all cultures, when in fact we merely want to assimilate those who differ to become more like us.
Why are we so against the idea of the soul being more important than life? Is it because we are scared of death and that is why we avoid the topic as well as those who are dealing with it? The Hmong are a fascinating group and rather than becoming frustrated by their lack of compliance and assimilation, I believe we ought to look at them for new answers and new points of views. These people are seeking refuge in the US, therefore it is incredibly insensitive of us to assume they automatically would want to become part of the culture we have built and deemed superior. America may be known as the giant melting pot, but one can only taste all the flavors of what’s inside if one flavor does not attempt to drown out the rest.
Fadiman, Anne. 2005. The Spirit Catches You and You Fall Down. New York: Farrar, Straus, and Giroux.
What’s a Melting Pot?
By: Rachel Skolaski
Rachel Skolaski has just graduated from Luther College with a bachelor’s degree. Her major is biology. Rachel is from New Glarus, WI. She is interested in medical anthropology in order to understand how different cultures handle various illnesses. She has always had a keen interest in the human eye and therefore will be attending Indiana University School of Optometry the upcoming fall.
Throughout my medical anthropology course at Luther College this spring, we discussed several stories of immigrants coming to America. They come here, they may or may not adapt, and there is a sense of a clash of cultures. As Americans, we tend to assume that if people move here, they will conform, at least a little, to our habits and culture. If they live here, they must become like us, right? We have tried to force the American ideals and practices down their throats and have disgraced America’s status of “The Melting Pot.”
Americanization was a common theme in this spring course and continues to be an important topic in medical anthropology. We read the book The Spirit Catches You and You Fall Down by Anne Fadiman in which a baby Hmong girl, Lia, and her family emigrated from Laos. Almost immediately, they clash with the doctors of Western medicine. During the whole experience, each side (American doctors vs. Hmong parents/shaman) could not devise a single treatment to heal Lia, and in the long run lost her body and spirits. This may tie in to a hint of ethnocentrism from both sides, but can be viewed as a lack of Americanization from Lia’s family. Her family did not come to America to adapt to our culture and they did not seem to respect our systems and our medical tradition while they were in our country. We are so accustomed to view our doctors as the professionals, the trusted providers for our health that we can almost become infuriated at Lia’s family at the lack of understanding. Americanization was futile among the Hmong family.
We also recently read about Latino immigrants coming to America. They came and tried adapting to our culture, only to haves detrimental effects. In the television documentary “Becoming American,” it was explained that the health of these immigrants was better before they arrived here. Over a generation, the health of immigrants living in the US was actually degraded. They became more susceptible to psychiatric illnesses and discrimination after moving to the US. Unlike the Hmong, they moved to the US and tried to “Americanize” themselves. They acquired jobs, they pursued educations, and they lived how we lived. Some immigrant parents even worked so much that their kids could not even be exposed to their old Latino culture.
So maybe it was beneficial for the Hmong to resist Americanization while the Latino population should have fought harder to sustain their cultural identity. The Melting Pot is supposed to be a mixture of people living in harmony with a common culture. Obviously this is not the case in America, nor does it seem possible in the near future.
Fadiman, Anne. 2005. The Spirit Catches You and You Fall Down. New York: Farrar, Straus, and Giroux.
The Latino Paradox
By: Adrianna Vazquez
Adrianna Vazquez is a Sophomore at Luther College majoring in International Studies and Political Science. Her region of study is the Middle East. She will be is taking a Arabic course at the University of Wisconsin Madison this summer and will be traveling to Jordan next summer, She is very excited to experience a new culture. She enjoys traveling and reading in her free time.
One thing that we talked touched on briefly this semester was Latino health in the United States. This really interested me because I am half Mexican and much of my family is from Mexico and migrated to the United States. I don’t not know very much about medicine or the medical world, but I found the Latino paradox very interesting. Like most people and many of the doctors in the video, I had assumed the better off individuals in society (the rich white people) would be healthier. However after watching the film for class and discussing it with my father (who is from Mexico) it actually made a lot more sense.
First off the food that many Latinos eat is home cooked meals that are usually bought at a market. The food includes fresh produce and consists of many of the food groups we need to be healthy. From my own experience, the meals prepared also taste much better than any American food I have eaten. One may argue that taste doesn’t really matter, but it still feels good to eat good food. In the United States, you see fast food joints around every corner in the city, and many of the meals made at home are frozen pizza or lasagna and consist of a lot of processed food.
Becoming Americanized causes poor health in our population. Don’t get me wrong: I know there are many Americans who eat healthy, but we have the stereotype internationally of being fat and only eating fast food (which many of us do!). In one film we watched in class, the Bernals ordered pizza. I thought right away, “that is where their unhealthy lifestyle comes from.” Immigrants like the Bernals see that it is American to order Pizza Hut. They also find that it is easier to order pizza with their busy lives because they have to work so hard to pay bills and support their families. They continue to eat this way, get high cholesterol and other health conditions, and suddenly they are no longer healthy.
Another thing the movie emphasized that I found to be spot on was the family ties. It is unclear whether it has as much of an impact as the food, but it was still important. When I go to family gathering on my dad’s side of the family – the Mexican side – we eat and laugh and have a great time. We play games and sing and do activities together. My mom’s side is different: she grew up in Iowa and has a very “American” family. We eat and talk, but then everyone leaves because they have so much to do. Family time is not as important as the errands and work to be done. I think this affects people mentally. I feel really happy to be with my dad’s side of the family, and when I am happy I like to think that I am healthier. I am also happy when I see my mom’s side, but that is only every now and then.
Family ties help you feel connected. When you feel connected and a part of something it helps your mood and health. Overall, I thought it was interesting to look at one specific group of individuals and compare their health to a bigger population and try to connect the dots. This made me look at health in a different way and sparked more interest in me with health and medicine. It taught me that there is more to the medical field than hands on roles like being a physician.
By: Noelle Burreson
Noelle Burreson is from Alexandria, Minnesota, and is graduating this spring from Luther College. She is graduating with an Anthropology major along with a museum studies minor and a communication minor.
In class, we learned about the challenges that are associated with “brain death”. How do we classify it? When are they “dead”? When is it ethical to stop life support? Can we still use their organs to save another person’s life? There are countless number of questions that arise with this topic.
One article that we read, “Inventing a New Death and Making It Believable” by Margaret Lock (2002), discussed the challenges of defining brain death. Before experts could define what brain death was, a special President’s Commission met and debated the topic. This commission tried to establish a single set of standards that would be accepted and adopted everywhere in the United States. Ultimately, they argued that “whole-brain death” corresponded with “irreversible loss of all brain function.” It is believed that the brain-death diagnosis is an irreversible state (Lock 2002: 214-216).
However, Lock points out that it is not entirely possible to establish, with absolute certainty, whole-brain death by conducting tests that are routinely use to determine this condition. She states, “it has been shown repeatedly that in many diagnosed cases of brain death some residual activity remains in the upper brain.” It is understood that this brain activity “has no functional significance or prognostic value and will cease within days, but its existence means that in a strict sense of the term all activity of the brain has not entirely and absolutely ceased” (Lock 2002:215). It was even agreed that two specialists had to make the diagnosis separately, as well as conducting the tests after a certain time interval in order to confirm brain death. The “test” would include making sure the patient could breathe on their own and check the condition of the lower brain/brain-stem. If the brain-stem does not respond, the upper brain cannot survive, thus brain-death could be diagnosed.
This whole matter becomes even more complicated when you add organ donation into the mix. If the person is clinically diagnosed as brain dead, is it ethical to keep a person “alive” just to keep organs functioning until a need for them arises? This is hard to say, especially when brain death is not a clear cut diagnosis. If it was one of my family members, it would be hard to believe that they are “dead” even though their heart it still beating. On the other hand, it would be hard to deny another person a second chance at life just because I could not say goodbye to my family member. Good things can come from organ donations, but good things always come at a cost.
Lock, Margaret. 2002. Inventing a New Death and Making It Believable. In Understanding and Applying Medical Anthropology. Peter J. Brown and Ron Barret, eds. Pp. 210-220. New York: McGraw-Hill Companies.
Refusing Organ Transplants
By: Allison Colsch
Allison Colsch is a Junior at Luther College studying Biology. Her plans after Luther include attending graduate school for physical therapy. She is from New Albin, IA. Allison has taken Introduction to Cultural Anthropology and Medical Anthropology.
“As Angela was being wheeled into surgery, she began to question her decision to accept a kidney donation from her mother. They spent months talking about the operation, listening to the consequences for both parties, and weighing the pros and cons. Even after all considerations she could not help but feel guilty for accepting such a gift from someone she loved so much. She knew that regardless, it was too late to change her mind. In the final moments before surgery, she recalled something her mother had said in their discussions, ‘Giving you life has been one of the greatest gifts. The only greater gift is the chance to give you life a second time; that is not something all mother’s get to experience’. Remembering her mother’s words gave Angela a sense of peace as she headed into lifesaving surgery” (Elisa Gordon, 2001)
In my medical anthropology class this spring, we talked a lot about organ donation. Organ donation is a highly controversial practice. The pros and cons of this practice are difficult to weigh for both donors and recipients because many aspects of this process are based entirely on individual views. In her 2001 article, “‘They Don’t Have to Suffer For Me’: Why Dialysis Patients Refuse Offers of Living Donor Kidneys,” Elisa Gordon adds to this debate by discussing the refusal of dialysis patients to accept organs from living donors.
In the article, Gordon cites a list of reasons that dialysis patients provided for refusing a kidney donation from a living donor. The list included fear of causing immediate harm to the donor, feelings of guilt, feelings of being a burden, friction in interpersonal relationships after donation, and emotional and financial pressures. Perhaps one of the most cited reasons was that the organ they would receive would constitute a “gift that cannot be repaid” and many were not willing to live with that fact (Gordon, 2001). They did not want the pressure of living a life that was up to the donor’s standards; they were not prepared for someone else to tell them how to live their life. Many also felt that the amount of guilt that came with receiving an organ from a live donor would be too much to bear. They stated that they would feel guilty if the transplant was unsuccessful or if the donor later needed the kidney. Finally, some dialysis patients felt it was unfair to expect a donor to start off their life with a disability, since organ donors are generally younger people.
While the article did a great job of highlighting many of the more negative aspects of live organ donation, an interesting topic to investigate would be the benefits of being a live donor. The process and procedures of organ donation have obvious risks for the donor, but many living donors can cite specific aspects of their lives that have been improved by donation. One of the most common benefits named by living donors is the psychological benefit. The satisfaction of being able to save or improve the quality of life of another human being is a satisfaction that many of us will never be able to feel. Although the above scenario is fiction, I personally know a mother who was able to save her son’s life by live organ donation. Although he was the one with the need, she believes that she benefited nearly as much or more than he did.
Gordon, Elisa. 2001. “’They Don’t Have to Suffer For Me’: Why Dialysis Patients Refuse Offers of Living Donor Kidneys,” Medical Anthropology Quarterly 15(2):245-267.