Culture matters for health

Let me break my long silence with a quick announcement for a conference.  The ANU is hosting a symposium and short course on the subject of cultural epidemiology.  Seems like and event that would be of interest to readers of this blog.  Here are the details:

*Culture Matters for Health: Exploring cultural epidemiology & related
approaches in a symposium and short course.*

26-29 October, University House The Australian National University,
Canberra.

According to the 19th centure anthropologist and doctor, Rudolph
Virchow, ‘disease is a disturbance of culture’. Over the past 150 years,
cultural epidemiology has evolved as a hybrid or sub-discipline with a
body of work and research approaches that resonate with Virchow’s
proposition.

*Scoping cultural epidemiology in the Antipodes – a symposium.*
Through the presentation of brief papers and posters over one and a half
days, the symposium will explore the inter-relationships between
culture, health and illness.

*Cultural Epidemiology short course*
This two day course introduces students to the emerging discipline of
cultural epidemiology, defining what it is and how it might be
undertaken. It focuses on employing cultural theories, concepts and
related methods to the health of populations and sub-populations.

Speakers include:
Professor Sandy Gifford, Director, Refugee Health research Centre,
School of Social Sciences, LaTrobe University
Professor Claude Fischler, Director, Centre National de la Recherche
Scientific, Paris
Associate Professor Julir Park, Associate Professor of Anthropology,
University of Auckland
Professor Tony Blakely, Director of the Health Inequalities Research
programme, University of Otago,
Dr Maggie Walter, School of Sociology, University of Tasmania
Jill Guthrie, Australian Institute of Aboriginal and Torres Strait
Islander Studies.

For more information and to register go to:
<http://nceph.anu.edu.au/Short_Courses/CulturalEpi/index.php>

*Register early to be guaranteed a place – strictly a limited number
available!*

Business Anthropologist in Sydney Hospital

Yesterday I had a chance of observing organisational space in a Sydney hospital as I joined a UTS Centre for Health Communication group. Rick Iedema and his staff do wonderful ethnographic research in hospitals filming professional collaboration around patient care. Yesterday’s topic was the designed spatial settings in hospital. In our group was apart from the UTS researchers also hospital staff and the architect of the visited spaces. Completely dressed up as hospital employees we were able to visit the different surgery and recovery rooms. One of the staff members washed her hands when entering a new room. When I asked her about that she told me that all the doctors were obliged to wash their hands when going from one patient to another in order to prevent the spread of diseases. For many years academic articles have been written, she told me, to show the neg correlation between handwashing and disease spreading. However, still only 15% of the male doctors did wash their hands. Therefore, she saw herself as a role model to show others that handwashing should be done every time. Articles, information, stickers, and role model however had not helped to increase the handwashing rituals of male doctors. ‘It is behavioural,’ she said. I told her that ethnographic study would probable show that hand washing was perceived as to be in the female domain by male doctors. That handwashing, in contrast to scrubbing of surgeons, is not in the professional domain of doctors. Interventions to increase the handwashing should therefore be based upon changing the meaning of handwashing in the professional culture. This is where interests of contemporary businesses and organisations such as this Sydney hospital have interests in anthropologists and their methods. The detailed accounts of what really happen at the work floor of a, for example, hospital makes professionals aware of their own action. Helping with their reflection on action in order to increase their reflection in action (Schön).

There are many rituals in hospitals that are questioned by researchers but that are exercised by practitioners. The Amsterdam Academic Centre had a campain last year to recruit nurses who where asked to get rid of unnessasary rituals by showing a picture of a Ladakhi oracle acting a cleaning ritual with a patient. In my anthropological fieldwork in the early 1990s I encountered many rituals among the Ladakhi shamans in the upper Indus valley in Northern India. This Tibetan Buddhist community has male (llhamo’s) and female (llapa’s) village oracles and eight monastery oracles. The oracle is perceived as the possessor of power and the linking between the human and the spiritual world. By virtue of calling and training the oracle is able to restore the disturbed relation between patients and the supernatural forces that have brought disorder (Miller 1997). The power is not exclusively attached to the person of the oracle. It is the relation between the oracle and his patients that generates the power (Taussig 1987). The shaman and his audience construct a joint interrogation of their ideological environment. Shamans employ their power in public rituals for the benefit of the community or individuals. And there is why the rituals in the Sydney hospital are so difficult to get rid of as the are part of a larger construction of healing.

Call for papers: “Beauty and Health”

Call for papers – Medische Antropologie, Dutch journal of medical anthropology – “Beauty and Health”
Please submit papers to Alex Edmonds at a.b.edmonds@uva.nl by January 30

Beauty and health. In most societies beauty can be seen as a sign of health, presenting the body as the materialization of wealth and power. But as anthropologists we are also familiar with an astonishing range of aesthetic ideals and body modification procedures that are violent and harmful to the body. The Western beauty ideal of a slim and youthful body leads to practices that carry their own health risks, ranging from severe dieting to cosmetic surgery. And then there is the growing importance of the ‘aesthetic of health’, the idea that the continuous improvement of the body is possible and desirable. Beauty can be both a sign of health and an invitation to endanger it. ‘Beauty and health’ in its many varieties, is a theme that prompts reflection from several focus points, not only anthropological, but also psychological, medical, sociobiological and historical.

Doctors complain about ethics oversight – just like anthropologists! (well, almost)

I have been working on an ethics teaching module and just came across this December 2007 editorial in the NY Times by Atul Gawande. Medical anthropologists might have encountered Gawande through his articles for the New Yorker or for his book of collected essays, Complications: A Surgeon’s Notes on an Imperfect Science — which I think is great material to assign to undergraduates in an introductory medical anthropology class. Gawande has an anthropological appreciation for the technological, social, cultural, political, and organizational forces that shape science and medicine. Plus his writing is punchy, dramatic, and neatly wrapped up with concise morals-to-the-story that makes it easy to digest for students who are new to anthropology’s way of complicating everything, especially neat morals-to-the-story.

Still, Gawande is a doctor, not an anthropologist, and I thought it was mostly anthropologists (plus our social science relatives who also do ethnographic research) who chafe at the way ethics oversight developed to regulate biomedical research has crept over to the social sciences. We can all agree that ethical research is a good goal in either domain, but anthropologists are acutely aware (in a way that sometimes IRBs / ethics committees aren’t!) that there are very different research ethics issues at stake depending on whether you’re testing a new drug or doing ethnographic fieldwork.

But in his NY Times article, Gawande shows us a conflict where medicine chafed at the way ethics regulation originally developed for biomedical research crept into applied research on the social organization of medicine.

Here’s an excerpt:

A year ago, researchers at Johns Hopkins University published the results of a program that instituted in nearly every intensive care unit in Michigan a simple five-step checklist designed to prevent certain hospital infections. It reminds doctors to make sure, for example, that before putting large intravenous lines into patients, they actually wash their hands and don a sterile gown and gloves.

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations.

CFP: Global Food Crisis

The US National Association of Practicing Anthropologists has just released a call for papers on the subject of the global food crisis.  Here are the details:

Global Food Crisis: Perspectives from Practicing and Applied Anthropologists
Sponsor: NAPA Bulletin, National Association for the Practice of Anthropology (NAPA)
Contact Information:

David A. Himmelgreen
Department of Anthropology, University of South Florida
4202 E. Fowler Ave, SOC 107
Tampa FL 33620
Email: dhimmelg [at] cas.usf.edu

Description

The NAPA Bulletin welcomes submissions for a thematic issue on “Global Food Crisis: Perspectives from Practicing and Applied Anthropologists,” to be tentatively published in Spring 2010. NAPA Bulletin is the official publication for the National Association for the Practice of Anthropology (NAPA), a section of the American Anthropological Association. Recently, a convergence of events including environmental threats (e.g., floods, droughts, frosts) and cost of fuel in the United States and around the globe has resulted in skyrocketing food prices throughout the world, leading to a global food crisis not seen in decades. The ensuing threats of hunger and food insecurity have caused civil strife and political instability in dozens of developing countries. In the United States and other industrialized countries, rising food prices has further eroded the buying capacity of consumers and threatened the ability of families to access nutritious food in sufficient quantity. While the increase in food prices have been felt by most Americans regardless of socio-economic status, low income families have been the most drastically affected. The effect of this trend in rising prices on food security is clearly seen by increases in the use of soup kitchens in majority of the major U.S. cities. This proposed NAPA volume will bring contributions from both practicing and applied anthropologists to examine how rising food prices are affecting peoples’ food choices, to discuss the way international and domestic food and energy policies are exacerbating the problem of hunger and food insecurity in both developing and industrialized nations, and to provide recommendation for addressing the global food crisis in the coming years. This CFP invites practicing and applied anthropologists and other social scientists with expertise in aspects of agriculture and food, especially as they relate to global food policies, structural adjustment programs, and the development of food assistance initiatives either within or outside the United States to contribute full-length articles (approximately 7,500 wordsto this proposed volume.

Please submit a 250 word abstract and 150 word biographical sketch to David Himmelgreen , no later than November 1, 2008.

Some articles on the NT Intervention

Several articles have appeared in today’s The Australian regarding the Northern Territory intervention, and on indigenous health and welfare more generally.  Of most interest to me was a report on calls to soften some aspects of the new government regime.  The article notes that while there have been some reported positive outcomes of the new paternalism in the NT, such as an increase in the amount of fresh food being eaten.  I’ve heard anecdotal evidence from an anthro working in Arnhem Land that the quarantining of welfare payments and the introduction of stamps for certain products has certainly had an effect on consumption patterns.  For example, kids are claiming “not to like” lollies anymore but to prefer fruit-based snacks like Roll-ups because the latter can be bought with stamps.  This allows them to continue to spend their free cash on cigarettes and other products not covered by the stamps.  It would seem that the new system has introduced new hierarchies of need where people have to make choices about which pleasures to keep and which to modify.  This is all interesting stuff and it would be great to see more reporting by anthropologists about what they’re seeing in the communities that they work with. All contributions are welcome and we are happy to reproduce them on this blog.

One area on which the Intervention doesn’t seem to be having an impact, and might even be making matters worse in some ways, is child welfare and the prevention of abuse.  This was of course the issue that prompted the Intervention in the first place.  According to a report by the Secretariat of National Aboriginal and Islander Child Care,

“A major unintended consequence of the NT intervention has been to stall and delay the necessary reform of the child protection systems (and) care needed to support children at risk of abuse and neglect,” the secretariat says in its submission.

“It has not uncovered the abuse of children or resulted in any significant change in child abuse notifications.

“Ironically, the intervention seems to have swept to one side the very issues that precipitated it in the first place.”

Other related articles in today’s Oz are as follows:

Call to lock in indigenous health gains
http://www.theaustralian.news.com.au/story/0,25197,24422991-5013172,00.html

Action, not words, needed to close gap on indigenous health
http://www.theaustralian.news.com.au/story/0,25197,24422990-5013172,00.html

Closing prosperity gap a $10bn gain
http://www.theaustralian.news.com.au/story/0,25197,24423119-7583,00.html

Guest post: Current Indigenous Debates, CDEP and the culture of Cultura Nullius

I am happy to present this guest post by ANU PhD Student Bree Blakeman and environmental economist, Dr Nanni Concu.  This article deals with a number of themes that we have focused on at CM: the concept of culture and how it is applied in real life contexts, engaged anthropological commentary on current events, and the specific issue of the government Intervention into Aboriginal communities in the Northern Territory.  The article provides some considered observations grounded in ethnographic research which, I think, serve to challenge the usual terms of the debate about the Intervention.  Hopefully this will provoke new discussion on what remains an important, and unresolved, issue.

Jovan

There is a sense of the uncanny following contemporary Indigenous policy debates while living in a remote Indigenous Homeland. For the last twelve months we’ve done just this, discussing the varying issues with our adoptive family. At first instance we thought this feeling of discomfort arose from the glaring power differential: listening to people thousands of kilometres away make decisions about the lives of our family in a language largely unintelligible to them, in a forum out of their reach. However, in the course of our life on the Homeland, it struck us that it is something more pervasive and, arguably, a lot more sinister. It is as if the life of our family – their everyday lives, responsibilities, values and goals – are being effaced. Through a pervasive rhetorical device – an implied cultura nullius – these debates effectively negate the life of those they then claim they must act to save.

Debates about remote Indigenous communities, with very few exceptions, are crafted with a discourse of negation: people on the ‘margins’ of society, on the ‘margins’ of the economy with ‘little or no education’ who are nothing more than exiled economic citizens. The implication is clear as Helen Hughes said recently – Indigenous people can’t read, they can’t write, they don’t have skills, [and seasonal fruit picking] is about the only thing they can do! Their communities are rendered as socio-economic vacuums in our thriving settler State. When the debate is cast in these terms, one can understand the sense of urgency to educate Indigenous people, ‘skill’ them up and make them ‘job ready’ so we can break down, in Marcia Langton’s words, ‘the apartheid system of employment’. They are waiting for us to fill them out and colour them in with education and skills, to bring them into the real world and the real economy.

However, one feels entirely unconvinced living in a vibrant remote Yolngu* community – one of around a thousand on the 1.5 million sq km of Indigenous owned land – listening to these debates and the assumed negation, or cultura nullius. Considered time in these communities will reveal very little ‘missing’ or ‘lacking’ in the social fabric. If anything, it is the visiting Balanda, or white person, who feels on the margins, lacking in language, education and practical skills. There are often more than five languages spoken in any one Homeland, a great source of amusement as kin show off their skilled and often uproarious word play. Days are spent in the breast of kin and country, hunting and gathering food to compliment shop bought products, collecting bark and pandanus for painting and weaving (which later adorn the walls and shelves in local and international art centres), and plugging in a few hours of CDEP work – mowing lawns, fencing, gardening etc. – to ensure their fortnightly pay. The evenings are spent catching up with the latest gossip and sharing in music, dance and food.

Anthropologist helps sell hand-washing habit

The New York Times has run a story about Val Curtis, an anthropologist who directs the Hygiene Center at the London School of Hygiene & Tropical Medicine: Warning: Habits May Be Good for You by Charles Duhigg. The story discusses how Curtis turned to consumer goods manufacturers like Procter and Gamble and Unilever in her attempts to persuade people in the developing world to wash their hands habitually with soap. Although seemingly innocuous, illnesses carried on the hands that might be prevented by simply washing them often lead to diarrhea, one of the leading killers of children in the developing world.

The marketing divisions of these corporate behemoths had abundant experience insinuating themselves into the everyday habits of consumers, helping us to feel ‘dirty’ if we don’t brush our teeth multiple times each day or that we are inadequate if sweat shows in the armpits of our t-shirts. As Curtis explained:

There are fundamental public health problems, like hand washing with soap, that remain killers only because we can’t figure out how to change people’s habits…. We wanted to learn from private industry how to create new behaviors that happen automatically.

Curtis looked at the ways in which advertisers try to establish cuing behaviour for habits, such as associating being with friends with having a beer or having a Snickers bar when one is a bit spacey in the middle of the afternoon. If the advertising works, the relatively common cue starts to provoke people to think about the product (even if the product is a dubious ‘cure’ for a manufactured ‘problem’).

Food crisis appeal

Seeing as we have talked a little about the global food crisis on this blog I thought I’d draw attention to an appeal by avaaz.org to try to influence an upcoming UN summit on the subject.  Included in their webpage is this video, in which it is stated that currently 90% of Sierra Leoneans are unable to afford the currently inflated price of a bag of rice.  Food for thought indeed.

erectile dysfunction drugs, cross-culturally

I’ve been silent on Culture Matters for way too long: first I was on a research trip to Egypt, and then I was recovering from a bug caught during said research trip to Egypt (Flagyl is my friend!). And speaking of pharmaceutical products, ever since coming back I’ve had a stack of drug boxes on the desk in my office that has elicited a lot of curiosity from visitors:

These are all the local brands of sildenafil that I found in a single pharmacy. There’s the Pfizer-licensed Viagra, but we also have Virecta, Erec, Kemagra, Vigorama, Vigoran, Phragra, and Vigorex. The Kemagra box features a tiger: Rrawr!