Anthropology 2290F/G Lecture Notes - Enterotoxin, Flu Season, Social Inequality

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Sept, 17, 2013
Disease, Illness, and Sickness in a Time of Cholera
http://www.youtube.com/watch?v=MVZC1mQkvmw
-This documentary’s narrative is presented by doctors and the people living in Haiti themselves dealing with the
disease either as victims or those treating them
-The director comes at us like this is almost an ad you would see for a charity but more subtle and he wants to
show that the disease is a nightmare for the country but also to show there is hope and progress is being made
-They explain the basics of the disease in how it enters our bodily and water systems and the effects from there
but they do it in a way that is easily understandable for a large population and it almost seems like something you
would see in a high school biology class
-They do show that the disease commonly strikes in impoverished areas but they don’t really get into the social
factors leading to this because they are more focused on general education about the condition
http://www.youtube.com/watch?v=E7wfmfgI54Q
-The narrative is presented by the filmmaker himself because he is the one talking to the people in Angola and
there are also statistics present throughout to show the mortality and causes of cholera
-It shows the education of children about safe practices and what to do if a family member is infected as well as
how to treat their water with chlorine
-Again this video reminded me of commercials asking for donations to charities especially when it showed the
small children in hospitals but I think the real focus of this video was education and showing that by simply telling
the people how to make things cleaner they will follow through but you have to start young
-This video does not get into the social factors related to poverty with the disease but it is obvious because of the
location where the video was shot and the conditions of the hospital
http://www.youtube.com/watch?v=jG1VNSCsP5Q
-This video was something more that you would show to children because it is not scientific in its approach but it
does provide all the necessary information to keep cholera out of a village and the fact that the main person
passing the information in a little boy is trying to show that children have a role to play and if education starts with
them there will be big changes
-The video is very effective because in a short time span it effectively shows how to prevent cholera outbreaks,
how to keep clean and safe when it is around, and what to do when someone is sick
-The textbook provides the following definitions (all on page 36):
-Disease is a “biological problem involving abnormality in the body’s structure, chemistry or function” (medical
focused)
-Illness “refers to a patient’s experience of something wrong, a sense of disruption in well-being that may be the
result of disease or caused by cultural beliefs” (personal focused)
-Sickness is “focuses on the consequences of social response to a person” and their personal experiences with
disease and illness (socially focused)
Cholera as Disease:
-Cholera is a communicable disease because it is transmitted from person to person
-The basic definition of cholera from the WHO states: “Cholera is an acute intestinal infection caused by ingestion
of food or water contaminated with the bacterium Vibrio cholerae. It has a short incubation period, from less than
one day to five days, and produces an enterotoxin that causes copious, painless, watery diarrhoea that can quickly
lead to severe dehydration and death if treatment is not promptly given. Vomiting also occurs in most patients”
-Epidemiology has tracked the disease from the Indian subcontinent around the world and the vibrio cholerae
bacterium is most commonly spread from person to person as a water born disease
-Because the bacterium lives in the intestinal track it is more likely to spread when there is no disconnect between
water used for the elimination of human waste and drinking water
-Diagnosis for cholera is dependent upon Vibrio cholerae O1 or O139 being confirmed in the patient with
diarrhoea but an oral vaccine against cholera exists and is used by Doctors Without Boards as a means of
preventing the disease
-Treatment for the disease is a combination of antibiotics to reduce the effects of the vibrio cholerae bacterium
and oral rehydration salts to maintain fluids but despite the ease of treatment the WHO estimates that between
100,000-150,000 people die from cholera each year
Sept, 17, 2013
-Because cholera is a fast spreading disease action must be taken to provide treatment, locate the source and
clean up the water within days of the outbreak
Note:
-In terms of medical anthropology the next two sections are very important because as medical anthropologists we
are interested in the way that people encounter disease, illness and sickness at a cultural and social level
-We need to pay attention to the way that people talk about cholera while also paying attention to how and why it
moves through a population the way it does (ex: we need to consider why someone does not have safe drinking
water and how they relate the disease to their socio-economic condition)
-If we assume that personality is, in part, dependent upon culture for its development then we must also assume
that the lines between illness and sickness are blurred in spots.
Cholera as Illness:
-When we think about cholera as an illness a good place to start is how a person or community understands
causation and causation here is defined as the method of transmission of the disease
-A worker with the WHO that is trained in Public Health will assume causation in a manner similar the one
described above so simply put, the person who is infected with cholera will have somehow ingested the Vibrio
cholerae O1 or O139 bacterium
-Upon diagnosis the patient would be treated according to WHO guidelines however, consider the cholera
outbreak in Haiti following the 2010 earthquake
-Voodoo used there, like the creole language spoken in Haiti, is a synthesis of cultures and draws upon African
religions brought by slaves and Christianity
-Someone who is a practitioner of Voodoo is potentially going to view the acquiring of cholera as something that
someone has done to them (similarly, some Indigenous communities in Canada also believe in an external
causation in this manner)
Consider a Simple Scenario:
-A patient walks into the clinic you are doing research in
-They have been experiencing severe diarrhea for about 24 hours and are very sick
-Once the team gets them stabilized you begin interviewing them
-With cholera a fast epidemiologic response is needed.
-Of course people do not speak like epidemiologist so you ask them about the past 48 hours
-They start by telling you that a neighbour had asked for help with something but that they were not able to
provide it and they then talk about what they ate, where they drank, about their family and so forth
-While you key in on a small creek that runs through their village as a potential source they begin thinking about
the neighbour because after being slighted by the patient, the patient assumes, they must have made them get
sick so how do you react?
-What is interesting to the epidemiologist does not need to be what is interesting to a medical anthropologist
-In this example there are two ways of experiencing illness from different cultural perspectives
-The first is linked to the history and development of western European culture and the relationship between
modernity and medical science
-The classification of the disease is dependent upon the isolation and classification of the symptoms diarrhea,
vomiting, and the detection of the Vibrio cholerae O1 or O139 bacterium
-The second is linked to the culture of Voodoo, which should not be considered as lesser than the former option
because here understanding the illness is related to the patients social ties
-The person who has become sick may have wronged someone with the power to harm them but what is
important in this case is that the patient knew to travel to the clinic for help and while there is disagreement with
the cause, the treatment is understood
-To tell them that their understanding is wrong is to discredit their knowledge system a mistake made too often
and similarly, assuming that all Haitians will have this belief is also a mistake
-An additional area of study for medical anthropology in this area is the effect of the illness on the individual
-Disease, when defined as the loss of health, makes it hard for a person to perform their normal day to day
functions and a disease like cholera, with its rapid onset and sever symptoms, has a heightened effect in this
manner and in cultures where identity is tied to concepts such as masculinity the loss of the ability to work for a
man could alter their value of self (consider your own feelings when during flu season)
Sept, 17, 2013
-We must also consider how the person with cholera feels physically because it is essentially a death by draining
-The bacterium causes the body to expel large amounts of fluid and with the fluid loss comes a decrease in blood
volume (recall how we feel on the hottest days of the summer when we are not able to drink enough fluids)
-Cholera increases this effect, dehydrating the body which begins to effect body function after just a 1% loss of
fluid and f you are working in an area where people die regularly from cholera the physical symptoms are
compounded by the knowledge that you have a condition that can kill you
-If you are living in a place like Canada and are getting proper treatment the symptoms can cause a different kind
of social anxiety
Cholera as Sickness:
-Sickness in an interesting concept for medical anthropologists so think about the above videos in how the people
with cholera were depicted (Were they passive victims who were done to by foreign workers? Do they need to be
saved by Western medicine? Are they active participants learning about cholera and knowing how to prevent the
disease within their own community?)
-In many ways the study of medicine is a study of power relationships and the depiction of a disease state can tell
us a great deal about these relationships (consider the depiction of Haiti after the earthquake)
-Internationally Haiti is already depicted using a certain narrative poor, lacking order, dirty, or corrupt and the
narrative of the discovery of cholera, which was brought to Haiti by workers from Nepal, is told with the pre-
existing narrative in place
-The study of sickness can also highlight social and economic structures and Cholera is the “disaster disease
-It often strikes after a flood or earthquake has destroyed or upset sanitation services so the study of the repair of
the sanitation system is important
-Does the community have the means to repair it themselves or do they depend upon help from outside forces?
-What about cholera outbreaks that are not connected to a natural disaster, what role can war play in the spread
of the disease and how is the sickness narrative told in this case?
-What role does social inequality play in the spread of cholera?
http://www.youtube.com/watch?v=0d-PGHu881U
-The producer of this video is showing that rich countries are able to counter diseases like Cholera because they
have the infrastructure to do so as well as the resources where as places like Haiti are in a cycle of poverty making
it impossible for them to implement basic sanitization perpetuating he cycle further
-Medical anthropology can focus on how we treat our sick:
-Do we move the sick to a hospital where they can assume the patient role?
-Are they treated at home? -Do they live in an area that has access to medical facilities?
-What about issues of dignity? (consider the clinic shown in the Haiti video on cholera, how would you feel being
confined to a bed with a hole in it to allow your excrement to drop into a bucket?)