In the introduction to Duncan's book, Transforming Therapy, she had mentioned a pair of siblings who had fallen ill after their mothers death. The sister, Antonia's, illness was believed to be espanto which is the same as a fright illness. What struck me as interesting in this particular section was the way the illness was described. As the brother Mauricio had explained "When she gets sick her mind doesn't work" (Duncan 1). Later he also goes on to say that the medicine saves their lives; they'd die without it. My fascination comes from the connection the between mind and body believed by this particular Mixe family and their acceptance of Euro-American medicine. Later in the Introduction, Duncan goes on to explain that there is a deeper connection between nature and health. So this makes me wonder where this type of switch came from. It seems to me that Mauricio and Antonia are from a younger generation and believe in a mind/ body connection, opposed to maybe a more traditional Oaxacan belief of nature/body's health. There had to been some form of globalization that created this switch. Im curious to understand where sparked such a change within this culture, which I'm sure the book with discuss more in depth. Also what other cultures are experiencing this type of rapid globalization. Are they more accepting of the Euro-American medicine as the Mexteco's seem to be? What sort of problems does this create within the culture?
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Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It- Kali Limeneh2/13/2019 Arthur Kleinman and Peter Benson in their article "Anthropology in the Clinic" highlight the shortcomings of cultural competency and suggest other critical ways of offering quality care to diverse populations. The writers argues that, cultural competency puts limitations on what culture really is. For instance, cultural competency, influences healthcare givers to have the mindset that, culture is “synonyms with ethnicity, nationality, and language” (Arthur Kleinman & Peter Benson ). Merely being a part of a different cultural background doesn't necessarily mean that all the choices you make are based on that fact. Instead, the writers highlights the importance of ethnography, and suggests a more complicated approach to solving the problems associated with cultural competency. The writers included the explanatory models approach. That approach strives to understand patients by asking a set of questions. Although I agree with the importance of ethnography, I suggest a straightforward method of achieving competent healthcare for all people.
I found this article very interesting, especially because I have a combination of anxiety and depressive disorders. I liked how Dr. Tran mentioned how many Western societies believe there is a dichotomization of the mind and body, while many other societies view the mind and body as a connected whole. This is very important to understand their explanatory models.
Many of the patients Dr. Tran interviewed stated that their sadness or worry was a result of their physical pain or from “excess of civilization.” This really allowed me to think more about my symptoms. For me, I usually view any bodily aches as symptoms from anxiety, not the other way around. However, I do relate to their feeling of society being a contributor to their suffering. Sometimes I feel as though I may not have such bad anxiety, sadness, or OCD (Obsessive Compulsive Disorder) symptoms if smartphones and other technologies did not exist, resulting in the increased socialization of people. I am looking forward to hearing more about what Dr. Tran has to say on this matter. The main point of the reading “Clinical Myths of the Cultural ‘Other’: Implications for Latino Patient Care” by Linda M. Hunt and Katherine B. de Voogd is that “efforts to be ‘culturally competent’, in the absence of a patient-centered approach, may unintentionally encourage stereotyping, thereby negatively affecting the quality and content of clinical care” (Hunt, pg. 918). This paper talks about a study that was done on clinics in southern Texas regarding Latina patient’s views on amniocentesis and clinicians views on what they thought their Latina clients thought about amniocentesis. The clinicians thought that that Latina women were more likely to decline amniocentesis because their Latina clients are fearful of the procedure and that they had weird folk beliefs that kept them from accepting the procedures. They also thought that medical decisions were family matters and their families kept them from accepting the procedure and that Latino people are mostly Catholic and fatalists, which prevent them from accepting the amniocentesis. Clinicians also stated that they tended to share less information about amniocentesis with Latina women so that they would accept the amniocentesis. When interviewing and surveying the Latina patients, the study found that they did not reject the amniocentesis any more than clients of other ethnicities. Latina patients did say they were fearful of the procedure, but those that were fearful still accepted the procedure. They also said they were family oriented, but they only shared with family to ask for advice and most of the family members left the decision up to them, saying they would support them no matter what they decided. Those that affiliated with being Catholic still accepted the test; they prayed about having a healthy baby, but their religion did not prevent them from having the test. Religion also did not play a factor in whether they would abort or not; most of them said they would not abort and would love their baby no matter what. Even though they were against abortion, they still received the test. The paper raises the question about how clinician views could be so off about their clients from the reality.
The book The Spirit Catches You and You Fall Down by Anne Fadiman is a journey through the experiences of a young girl who suffers from epilepsy named Lia Lee. This book follows the Lee family and the hospitals journey and navigation through Lia’s medical needs. The main point of this reading is to show how Western medical care is not universal to all cultures and not being prepared, educated, or aware of this fact can create major issues for the health of an individual in need of medical care. Trying to give Western medical treatment to ethnic groups that come from very different cultures and medical techniques can be insanely difficult. In this book, the Lee family are unfamiliar and untrusting of the Western doctors from the very beginning. The inability to communicate to the doctors mixed with their faith in their traditional way of healing complicated the treatment for their daughter. The deeper you get into the book Lia’s seizures worsen, and so does the communication and trust between her doctors and her family. However, the Lee family’s case is extreme but this failure to successfully understand a culture and communicate to the patient and family are not uncommon in hospitals. This story helped me understand and learn how confusing this process can be for both the cultural and medical perspectives. From an outsiders point of view it is easy to think that this is an easy fix. From an outsider and Western perspective, if the Lee family would have just given their trust and listened to the doctors then the problem would be fixed. However, if you consider the story from the otherside- How would they be able to trust the doctors when they have had no past experience with how western medicine works? How could they when they have no way to fully communicate and understand the doctors? Questions like these need to be considered regularly in hospitals when dealing with other cultures, languages, and traditions in order to provide the best care possible. It is necessary for hospitals to be familiar with the journey of Lia Lee and the doctors that treated her in order to be more aware of cultural diversity when giving Western medicine. However, this is much easier said than done.
On Thursday, February 7th, I attended the Cesar Chavez Cultural Center's panel in which students spoke of their experiences as a student that holds the identity of being a Dreamer or undocumented. For those who might not know, a Dreamer is "a young person who qualifies for the Development, Relief, and Education for Alien Minors Act" (Hildreth 2018). This Act is a piece of a legislation that was introduced first in Congress in 2001 but was never passed. The purpose of the Dream Act was to create a way for young people whose parents brought them to the U.S. without documentation when they were minors to eventually receive citizenship. The Act was never passed so in 2010, former president Barack Obama passed DACA (Deferred Action for Childhood Arrivals). DACA allows applicants to request consideration of deferred action for a period of two years. DACA is subject to renewal and does not give recipients official lawful status. "Deferred action" means that people that hold DACA will be protected from deportation for two years and are in danger of being deported after those two years are up. An important point that the students on the panel brought up is the fact that not all Dreamers are DACA recipients especially now that President Trump chose to end it back in 2017. By the beginning of 2019, former DACA recipients will no longer be protected from deportation. Some Dreamers are recipients of Temporary Protected Status. Temporary Protected Status is granted to persons of certain countries that are experiencing problems that place their nationals at risk of being deported there or that would compromise the foreign government's ability absorb the return of its nationals ("Temporary Protected..." 2018). The certain countries must fall under the category of hardships such as confronting: 1) an ongoing conflict, 2) environmental disaster, 3) or extraordinary and temporary conditions. TPS holders are able to work legally in the U.S. and live within the country without fear of deportation for 6, 12, or 18 months at a time ("Temporary Protected..." 2018). This status can easily change depending on the Secretary of Homeland Security's assessment of the national's foreign country's status ("Temporary Protected..." 2018).
Of course the reality of deportation is scary for all Dreamers, but it seems to be especially scary for college students that are trying to navigate the world of higher education without documentation. The point of the panel that I attended was not only to discuss the problems that come with being undocumented, but also how other identities that Dreamers hold impact their agency as they pursue their degrees. Some of the panelists spoke on their identity as first generation students. The panelists commented that they had originally been concerned about possibly not being able to attend college because they 1) didn't know how to navigate the process for applying to college as someone who was undocumented and 2) didn't know how they were going to financially afford to pay for college since undocumented students are unable to receive federal financial aid. It might sound redundant to say but the parents of Dreamers are undocumented themselves. This means that they lack the experience of navigating the world of higher education (at least in the U.S.) and are not fully equipped to help their children on their higher education journey. The journey becomes even more difficult for these students when most schools across the country lack the support that Dreamers and DACA recipients need. Not many institutions are equipped to supply resources for their undocumented students so many undocumented students are forced to struggle to find resources on their own. Thankfully there are scholarships and small organizations and groups of people across the nation that are dedicated to helping undocumented students, but I find it ironic that a poll done in 2017 showed that majority of people are in support of DACA and yet there are so little resources to actually support DACA recipients. Why is it that our schools are not accommodating of undocumented students although people claim to support them? Is it a lack of education on the matter? Or is it the historic idea that immigrants should have the opportunity to build themselves, but they should not be easily awarded the same tools that natural born citizens have? A couple of the panelists brought up the fact that their identity of being Latinx has an impact on how people engage the conversation of immigration and documentation. With the current political climate regarding immigration and the border wall, there has been a lot of anti-immigration rhetoric that has targeted Latinx communities (although Dreamers and undocumented individuals consist of more than just the Latinx community). Much of this rhetoric has placed immigrants in negative lighting which is unfair and inaccurate and prevents us from even really asking ourselves any meaningful questions. Getting to the bottom of the important questions like the ones I previously asked is definitely an important step into figuring out how to help Dreamers and undocumented persons. As a panelist stated (and all the other panelists agreed), a couple of ways to get the process going is by educating oneself on the issues and having more conversations around them. As an add-on, I think it is important that people understand that for these students, gaining citizenship is (for the most part) not a possibility. The most important step of gaining citizenship is obtaining a green card, but to do so one must either be sponsored by an employer (which they aren't allowed to work legally) or have a close relative that has citizenship seek permission to have the undocumented brought in to the States. Most undocumented students do not have close relatives that have citizenship so getting a green card is impossible. With no clear possibility of becoming a legal U.S. citizen but having lived most of their lives here and being a part of American society, it is clear that deportation is not an appropriate answer to this situation. How can a Dreamer or undocumented person ever hope to achieve citizenship when they don't have any viable options in their situations? Works Cited: Hildreth, Matt. “Immigration 101: What Is a Dreamer?” America's Voice, 14 Jan. 2018, americasvoice.org/blog/what-is-a-dreamer/. “Temporary Protected Status: An Overview.” American Immigration Council, 29 Aug. 2018, www.americanimmigrationcouncil.org/research/temporary-protected-status-overview. “Why Can't 'Dreamers' Just Apply For Citizenship?” WCCO | CBS Minnesota, WCCO | CBS Minnesota, 5 Sept. 2017, minnesota.cbslocal.com/2017/09/05/gq-dreamers-citizenship/. I recently had the pleasure of attending a panel of UNC students and alumni who are part of the DREAM act. For those of you that don't know what the DREAM act is, it stands for Development, Relief, and Education for Alien Minors. This allows immigrants and undocumented minors to go to college and attend universities. Although DREAMERS can come from anywhere, the ladies and gentlemen of this panel were specifically Latinos. While listening to these brave individuals speak about their situations, there were many questions that were raised in my mind. I also experienced a lot of “whoa” moments. These were times where I was shocked at someone’s situation. I will start with the first one. It was when every DREAMER’s life was turned upside down in 2017, when president Trump announced the end of DACA. DACA is the Deferred Action for Childhood Arrivals. This allows individuals, who are in the United State unlawfully after being brought into the country as children, to escape deportation and apply for a work visa. One DREAMER on the panel spoke about the day she realized she could no longer pursue her dreams of becoming an educator. Since her degree required more than two years to complete, the amount of time people under DACA have until they must renew it (which now cannot be done since it is being terminated), she had to change her degree path to something she could complete in the allotted time. When another student spoke about the decision to end DACA, the room became solemn as she shakily said with tear filled eyes “Other people get to choose their lives and you can’t, even though you’ve worked so hard to be where you are.” Whoa. One thing that got the gears in my head churning was when a panel member stated that “people of color have it harder.” I immediately started thinking of the different experience’s immigrants of color versus immigrants who are white. If they get different opportunities, if they experience different levels of hostility, and different levels of support. One panel member stated that one of the biggest stigmas about DREAMERS is that everyone thinks that they all come from Mexico. She expressed that even the Latino members on the panel came from different countries with very different cultures. I would like to see a study conducted on the views of documented and undocumented Latinos versus documented and undocumented “white” immigrants. Does someone of a different skin color give them less of a right to be in the U.S than an immigrant who is white?
In Hunt and de Voogd’s piece Clinical Myths of the Cultural “Other”: Implications for Latino Patient Care, the definition of what constitutes “optimal care” comes to the forefront again. While in The Spirit Catches You, the problem was near complete ignorance of the Hmong culture; in Clinical Myths, the problem seems to be making assumptions and generalizations of a culture that the physicians think they know. Sadly, instead of coming out as heroes of cultural sensitivity, they are guilty of perpetuating stereotypes. When asked why the doctors might think a Latina would decline amniocentesis, they replied that it was fear based. While it is completely understandable that having a giant needle stabbed into your pregnant belly would incite at least a modicum of nervousness, the doctors thought the fear was based in superstition and folk beliefs as opposed to anxiety about the procedure, assuming that their Latina patients had odd ideas about what caused birth defects. For instance, “a lunar eclipse, brujeria (witchcraft), or mal de ojo (evil eye) can negatively affect the health of a developing fetus” (p. 920). In reality, none of the patients interviewed stated their hesitancy in getting the procedure was tied to folk beliefs. The clinicians often stated that their Latina patients came from extended, patriarchal families, and often communicated with the male of the couple instead of communicating with the patients themselves, concluding that the patients would defer to their husbands decision anyway. Once again, while the patients often consulted with their families and husbands, the majority of them were autonomous in their decision. Lastly, the doctors indicated religion as a reason that their Latina patients would refuse the amniocentesis, believing that devout Catholics would leave their children’s health up to god. While many of the patients were religious, all the women who used the phrase “si Dios quiere,” had the procedure done. Are these doctors giving the optimal care to patients to whom they think they understand their culture, but truly they do not? Turns out it isn’t really the doctors fault, but these beliefs about Latin culture is often portrayed in health literature. Primary sources listing presumed understanding of what would make a Latina resistant to certain procedures. It all boils down to the fact that there is danger in generalizations, and doctors cannot make presumptions. It’s a precarious balancing act between sensitivity and stereotyping.
In the book it is asked if perhaps the doctors had been culturally sensitive and had translator and cultural brokers from the start of Lia's treatment that perhaps she would have not found herself in this vegitative state. Personally I thought that she would probably have been helped by a cultural broker and proper translator in that that perhaps she would have been given her medicine and there would be less mistrust from the Lee's towards the doctors. However I still find it hard pressed to believe that the Lee's would still try to treat Lia in their own ways and I'm not fully convinced that she would not be in the same state without the aid of western medication. It is in the book that she did seem to get better when she was at home however that could also be Lia's subconcious recognizing that she was around people that she loved and her seizures going away with the aspect of the septic shock. Ultimately I'm not a hundred percent sure that she would have been able to be saved either way she had several very intense seizures that ultimately greatly affected her brain at a certain point it is hard to see this story and not wonder if perhaps there was anything that could have been done for Lia at allWhat if? This is one of the largest questions in the book The Spirit Catches you and You Fall Down. This idea is what sparks the author to write the eight questions from how many problems from trying to understand what actually happened to Lia and what could have been prevented. Due to so many different scenarios that could have occurred not only spiritually, but also physically these answers are still uncertain. Foua made a statement that Lia had “doctors that are very knowledgeable-but maybe they made a mistake by giving her the wrong medicine and they made her hurt” (258). Which did occur due to the septic prone medication that was given to Lia and possibly could be the cause for her vegetative state. What if the medicine was different, what if there were better options? These questions will constantly be asked, because with each different variable, there come the question, what if? Foua also wondered if it was the dab that was making Lia sick and if the family was still in Laos they “would know how to go and get herbs to fix her” and there may have not been as messy of a scenario as there was (258). This is a reasonable scenario of Lia’s health and if the herbs would have helped how would one even know. “What was not clear was who, if anyone should be held accountable” (258). If anyone is held accountable it is still up to opinion between western medicine, cultural medicine, or the large communication barrier that caused constant drama through Lia’s condition. What if there was only one scenario, does anyone know what would have actually been best for this child’s condition. What if the doctors could figure out all of her side effects to medications, and actually could find the best possible drug for Lia. She wouldn’t have had such an issue with trying so many pills that the Lee’s could actually also try and do best to help her. What if she was at home the entire time, would she have healed differently? These will be constant questions not just while reading this novel, but should be thought of by all medical professionals when treating there patients, what if.
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