Study how society impacts health
By Venkata Susmita Biswas - CHENNAI
22nd October 2012 12:00 AM
Medical anthropology is a branch of anthropology that studies the various aspects of health and wellness in the context of various cultures and the relationship between the body and culture. The knowledge of medical anthropology can give many professionals an edge over their peers— right from doctors and psychiatrists, to archaeologists and medical historians. Though this multidisciplinary course has numerous lucrative opportunities to offer, it is yet to mark its presence in our universities and medical schools.
What is medical anthropology?
In the words of Prof Roland Littlewood of University College London, London, “While anthropology is the study of human beings within their community, medical anthropology which is a sub-speciality of anthropology looks at how people become patients. It analyses their socio-economic conditions and other parameters that determine how they will seek treatment and how they understand their own illness.” In the process of this analysis he says medical anthropologists necessarily live with the community they are documenting and note how they live, what their customs and conventions are, “We are more interested in the locals and what they think of their own situation, how they organise themselves, etc. We also focus on what is important to them, if it is religion or something more sacred. As these factors finally determine how they will react to medicine and if that will cure them,” he explains.
Prof HK Bhat, a pioneer in the field of medical anthropology in India explains the importance of the study of medical anthropology. He says, “In some cultures, a certain section of the community may be barred from eating a particular food product. And that leads to that section being deprived of certain nutrients. These cultural aspects can have negative or positive impacts and we study these details. This information can help doctors identify the root cause of a problem and treat it accordingly.” Prof Bhat shares a little insight about medical anthropology, “Illness and disease are different things. A patient comes to a doctor with illness and a doctor has the tools to treat the disease. Only when the illness and disease match will the patient be cured. This understanding is very important,” he says. Prof Littlewood tells us that the patient may actually be looking forward to a chat with the doctor about his illness rather than just a prescription. In such cases it is essential that the cultural context of the illness is found and accordingly treated.
Citing a case study, Prof Bhat, puts his area of study in perspective, “In a small south African village, there is a community whose 90 per cent members have a bacterial infection. But that 90 per cent does not think of itself as unhealthy. It is instead the 10 per cent of healthy people who think they are ill!” He says that since every community has its own way of treating health problems it is up to people like him to study these cultural aspects and become a mediator between the patient and doctor. He adds that every medical system like ayurveda, unani, yoga, etc, is effective on a certain disease. And that one has to be selective while choosing treatment. “Some societies do not use biomedicine. In such cases we must negotiate with the patient to get him to agree to the medication.”
Opportunities in India
One of the areas where medical anthropology has great application is that of mental health. Prof Littlewood who shares his inputs on medical anthropology and its use in the sector of mental health at The Banyan Academy of Leadership in Mental Health in Chennai, says that one can find out what situations lead people to lose mental stability and what can help them. Prof Sushrut Jadhav, University College London, says, “Indian mental health professionals have not had much exposure to the social sciences and to their own culture. They are getting more and more alienated from their own culture which is a lot like what the West tries to do. There is very little dialogue between social sciences and health and between mental health and cultures. This leads to a disconnect between the doctor and patient and eventually to non-compliance on part of the patient to the treatment, especially in the case of mental health.”
Prof Jadhav adds that medical anthropology is very important to India because, “In India there is increasing inequality. Doctors and patients are caught up in a class war. All those in the mental health sector are removed from the culture of rural India — the values, the language, what makes them ill, etc.” He says that though there are a few places in India where medical anthropology is taught, in the field of mental health there is hardly any communication between mental health and anthropology. The Indian subcontinent has myriad social stigmas (caste, gender, race, religion, etc) that are included in these studies. “At The Banyan we are now studying the reasons why people become homeless and their problems.”
Prof Bhat adds that medical anthropologists can apply their knowledge in public health centres, private hospitals, in projects that study health problems of rural people and even bring to the notice of the authorities a situation that needs their attention. “For example, we have been studying the effects of endosulfan in Kerala and Karnataka, Handigodu syndrome in Karnataka, etc. Also in the radius of our study are some marginalised communities of the country, tribes from north-eastern states. If we can point to what social and medical aspects need attention, we can hope for a better life for them,” he says. Prof Bhat says that there is immense opportunity for anyone who wishes to pursue medical anthropology in India and abroad. He adds that many positions in bodies like WHO, UNICEF and the like are occupied by medical anthropologists.
The Banyan Academy of Leadership in Mental Health in Chennai is The Banyan’s initiative to study and increase stakeholder participation in the sector of mental health. In an attempt to take this forward, BALM and University College London together launched a short course module which deals with different aspects of mental health. This course hopes to increase the use of medical anthropology in mainstream healthcare in India. Says Mirjam Dijkxhoorn, deputy director, BALM, “As of now, the role of medical anthropology is marginal, but the UCL-BALM course has helped introduce participants (who are often mental health or health professionals) to concepts of medical anthropology and different ways to look at expressions of culture and manifestations of illness.” This three-day course is directed by Prof Jadhav of UCL and the other resource persons include Dr Jane Derges, Dr David Goldberg, Dr Sumeet Jain, Prof Roland Littlewood and Yemi Oloyede from UCL.
According to Mirjam, “Psychiatrists, clinical psychologists, psychiatric social workers, occupational therapists, medical anthropologists, other social scientists, and clinical practitioners in mental health from the NGO, public, and private health sectors can all take part in the course taught by BALM. It is useful for any healthcare professional, since it is an attitude and a way of looking at clients and their cultural backgrounds and the way that they view the world and experience their illness. So being sensitive to the client’s cultural beliefs and understanding of an illness will help the treatment process of any health professional.”
Neetu Sarin, assistant professor, Ambedkar University, New Delhi, who attended this course this year says, “As an academic I was interested in looking at this interdisciplinary subject that has so far been divorced from other social sciences like psychology and more importantly medicine.” Being a psychiatrist she says, the course has helped her gain a better understanding of her clients. Sarin also adds that though in India there is little influence of medical anthropology, the same subject is studied as sociology in our colleges and universities. Preethi Singh, a student of MA Gender Studies who also took up this course says it answered some important questions about the anthropological and clinical dimensions of gender studies.
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