Medical Anthropology: Ethnomedicine, Medical Pluralism, and Globalization

Ethnomedicine and Biomedicine

• Biomedicine is considered a form of ethnomedicine by medical anthropologists.
• Traditional view: Biomedicine and ethnomedicine are opposed. Modern anthropological view: Biomedicine is simply one type.

Medical Pluralism

• Definition: Coexistence of multiple ethnomedical systems in the same time and place.
• Common: Most societies exhibit medical pluralism.
• Pragmatism: People use different systems to address health issues, without strict adherence to one.

Witchcraft and Naturalistic Explanations

• Compatibility: Belief in witchcraft can coexist with naturalistic thinking.
• Evans-Pritchard: Classic work on the Azande people: "Witchcraft, Oracles and Magic Among the Azande."
• Witchcraft is used to explain unusual misfortunes, including specific instances of illness, but doesn't explain everything.
• Example:
  • Tripping and spilling drinks: Not witchcraft.
  • Infected toe after tripping: Possibly witchcraft.

Flexibility in Explanations

• Multiple Explanations: Room for naturalistic explanations and biomedicine alongside beliefs in witchcraft.
• People use multiple ethnomedical systems simultaneously.

Healers and Biomedicine

• Assumption: It's inaccurate to assume healers are unaware or averse to biomedicine.

Navajo Nation Example

• Cosmology: Understanding of the known world and supernatural figures.
• Healing Practices: Dry paintings (sand paintings) depict these figures.
• Tuberculosis (TB) and Harmony: In Navajo culture, contracting TB when others in the household don't suggests being out of harmony with the cosmos.
• Harmony Restoration: Therapy aims to restore harmony with the universe.
• Antibiotics: The Navajo Nation participated in early antibiotic testing for TB in the early 20th century and were open to antibiotic treatments.
• Dual Approach: They addressed both the biological cause of TB (bacteria) and the spiritual/cosmic imbalance.
• Out of Harmony: Stepping on a snake track can cause disharmony and illness.

Cultural Perceptions

• Common Misconception: Assuming non-biomedical healing systems indicate ignorance or rejection of biomedicine.
• Reality: Medical pluralism is common, involving multiple ethnomedical systems including biomedicine.

Strengths of Different Systems

• Biomedicine: Effective at understanding biological causes of illness.
• Other Healing Systems: Address cosmic, cultural, and social dimensions of illness.
• Integrated Use: Systems are used for different cases or components of sickness.

Globalization and Health

• Globalization's Impact: Huge factor in human health.
• Industrialized Foods: Globalization has increased access to processed foods, leading to higher rates of obesity and diabetes.
• Deforestation: Destroying forests leads to standing water, which is ideal for mosquitoes breeding.
• Mosquito-borne Diseases: Increased mosquito populations spread diseases like malaria and dengue fever globally.
• Land Use: Using forest land for agriculture, mining, and ranching contributes to these dynamics.
• Irrigation: New irrigation systems can lead to schistosomiasis due to snails carrying parasites. Schistosomiasis is a parasitic infection.
• Symptoms: Schistosomiasis can cause blood in urine and digestive issues. Mild or very debilitating symptoms depends on how severe the case is.

Urbanization and Disease

• Contributing Factors: Bigger cities, urbanization, migrant labor, and transportation technologies.
• Epidemics and Pandemics: These factors facilitate the spread of infectious diseases.
• Examples: COVID-19 and HIV.
• Germ Mutation: Movement and interaction facilitate the mutation of disease-causing germs.

Infectious Diseases

• Zoonotic Diseases: Most infectious diseases originate in animals.
• Transmission: Germs mutate to infect human hosts through contact with animals.
• Examples: Ebola and COVID-19 (likely from bats with an intermediate animal).

Biomedical Technologies

• Tools: Vaccines, antibiotics, antivirals, and anti-parasitic drugs.
• Unequal Access: Distribution challenges in a globalized world with inequalities.

Non-Biomedical Disease Control

• Alternative Methods: Economic, social, and environmental improvements can prevent spread.
• McKeown Study: A historian, Thomas McKeown, studied tuberculosis rates in England and Wales.
• The common assumption is that biomedical science and technology are always primarily responsible for the decline of an infectious disease.
• The bacteria for Tuberculosis was identified in the 1870s and 1880s.
• Chemotherapy and the vaccine for TB were created at some point. This helped the death rate decline more. The vaccine isn't very effective at fighting disease, though.
• TB death rates per million people was already declining before there was any scientific discovery made.
• Improvements: Cleaner living conditions, better-ventilated housing, better sanitation, and good sewage and water systems.

Medical Anthropology: Current Topics

• Ethnographies: Studies on COVID-19 impacts and responses. Ex. Emily Mendenhall's book, Unmasked, about Okoboji, Iowa.
• Cultural Variations: Perceptions of risk, vulnerability, and responsibility for illness.
• Healthcare Systems: Comparison of publicly funded systems vs. individual responsibility, like in the United States.
• Social Causes: Inequalities and environmental factors affecting health.
• Research Funding: Pressures influencing research questions.
• Industrial Pollution: Difficulty in studying industrial pollution due to industry stakes.
• Clinical Interactions: Social and cultural dimensions of interactions between patients and providers.
• Biomedical Education: Focus on anatomy, physiology, and pharmacology rather than cultural factors.
• New Biotechnologies: Marcia Inhorn's work on assisted reproductive technologies in the Arab world and Islam to understand religious acceptance of having human beings manipulate that.

Ethnographic Study: Crack Cocaine Dealers in New York City

• Ethnographer: Felipe Berg's study "In Search of Respect."
• Methodology: Participant observation and interviews.
• Focus: Network of about 25 people involved in crack cocaine economy.

Socioeconomic Context

• Spanish Harlem (El Barrio): Populated by Puerto Rican immigrants since the 1950s and 60s.
• Disinvestment: Urban decay, broken windows, and graffiti.
• Public Sector Decline: Breakdown of police, social welfare, garbage collection, and sanitation.
• Public Education: Disinvestment in education leads to lack of economic opportunities.
• Minimum Wage: Decreased purchasing value since the 1980s.

Community Life vs. Illegal Activities

• Community: Raising families and participating in community life.
• Drug Use and Sales: Growing competition between legal employment and illegal drug economy.
• Everyday Life: Photos from 2005 showing regular people engaged in community activities.

Crack Cocaine in Public Spaces

• Abandoned Buildings: Used for drug-related activities.
• Potent Form of Cocaine: Easy to sell and transport.
• Public Violence: Drug-related violence affects the entire community.

Shift in Manufacturing Industries

• Manufacturing jobs have moved overseas in order to have better access to workers by companies.
• Unprotected Workers: Fewer regulations around workers and environmental standards to build profits better.
• Unionized Workers: Important for wage, benefits, and job security.
• Manufacturing Decline: Loss of manufacturing jobs in New York City.
• New Sector: Finance, Insurance, and Real Estate (FIRE).
• New Skills are needed: There's a new alignment between the street and manufacturing jobs.

Street Culture vs. Office Culture

• The problem is that young New Rican men don't want to work. Often start working at age 11.
• Schools: School is alienating. Students were tracked out of college prep courses based on ethnicity.
• Problems in Economy: We have a shift in what kinds of jobs are available in the neighborhood.
• Disrespect: Key concept experienced in service jobs.

Experiences of Disrespect

• Primo: Hired as a mail clerk. Supervisor criticized his literacy and accent.
• Ray: Experienced a tense elevator ride. Caused someone to feel unsafe and yell from exiting the elevator.
• Gender, Race, Class: Intersect to create discord. Limited biculturalism.

Crack Dealing

• Environment: Burned-out buildings, unpredictable people, potential for violence.
• Ambivalence: Strong positive and negative feelings. People take alternatives if available.
• Alternative Jobs: Doorman, home health care worker, plumber's assistant, cashier.
• Lack of Jobs: Not enough jobs for the number of people.

Glorification of Drug Use

• Psychological Defense: Glorification to protect self-esteem of these men.