Global Health Blog

  1. Illness Narratives in Anthropology

    June 20, 2015 by Odette Zero

    She had talked to her the day before, and she had seemed so healthy. She was only slightly past her due-date, and now she was dead. The baby too. How could this have happened? It might have been that guy down the road- people say that he practices black magic.

    This is an adaptation from an illness narrative of an indigenous woman in Peru collected by a graduate student in the Department of Anthropology. I have never met this woman, but as a research assistant I have listened and translated her story. Through my expensive earphones in the Starbucks on Sherman Avenue, I am transported to a world of mysterious illnesses, witchcraft and health disparities, along with a fascinating culture on the brink of acculturation to westernization. In this adaptation, the woman is explaining that she feels the major health concern in her community is maternal mortality. Her friend died during childbirth, and no one knows why. Without a biomedical understanding of what happened, this woman turns to another explanatory model for the illness: witchcraft. Witches and black magic become the answer to the unexplainable, and these types of explanations can be harmful when they foster a lack of community trust, as well as divert attention from the real public health issues that this community faces.

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    An illness narrative takes a health condition outside of purely medical environments and places it into a more relevant sociocultural everyday context. I have learned in my global health courses that illnesses do not happen in a vacuum. They are never just caused by a mutation, bacteria, virus or accident. Take AIDS, for instance. While AIDS is caused by human immunodeficiency virus and can be treated with antiretroviral therapy, it is also caused by poverty: a lack of transportation and money to visit a clinic, lack of education, poor living conditions, and other social determinants of health. Therefore, a purely biomedical understanding of any illness will not lead to sustainable change, as biomedicine can only treat the symptoms and not causes of illness.

    Arthur Kleinman, a famous medical anthropologist, has proposed that the act of sharing illness experiences can be therapeutic and cathartic for the tellers as well as for those listening who also suffer from the same illness. For me, at the heart of the field of Anthropology is a desire to give a voice to the voiceless and show how structural systems have an impact on the individual level. Illness narratives have the power to portray this.

    In The Illness Narratives, Arthur Kleinman writes, “illness has meaning; and to understand how it obtains meaning is to understand something fundamental about illness, about care, and perhaps about life generally.” As in all fields of anthropology, medical anthropology collects a piece of the human experience so that it is not lost to the oblivion of human memory. In regards to my personal memory, I plan to keep these past and future stories in mind as I continue in my global health career.

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  2. Northwestern’s Response to the Crisis in Nepal

    June 3, 2015 by Abhinav Veerina

    Source: NU Stands with Nepal Facebook PageOn April 25th, a magnitude 7.8 earthquake struck Nepal, about 50km northwest of Kathmandu. Two weeks later, Nepal was struck again with a magnitude 7.3 earthquake. Over 8,000 have died and thousands more have been injured. Nepal’s infrastructure, cultural centers and spirit have been devastated. I am heartbroken.

    Last summer, I spent five weeks in Kathmandu conducting research. The friends I had made are all safe. Nonetheless, I grieve for the warm, beautiful Nepali people seeing their nation in shambles. Not only has it killed, injured and displaced countless people; it has leveled ancient cultural landmarks and monuments. The New York Times posted a unique interactive feature comparing historic sites before and after the quake, revealing the haunting consequences of this disaster. Kathmandu Durbar square, one of the historic sites in the feature, has been reduced to rubble. It was one of my favorite places I had visited during my time there. I remember strolling into the square on a gray afternoon, admiring the intricacies of the former palace, showcasing a uniquely Nepali architecture style. I marveled at how ancient the structures were, and I mourn that it cannot give others the same wonder anymore.

    My homestay brother and dear friend from Kathmandu, Maaz Ashraf, offered to share his experience. He is studying in the United Kingdom at the moment and said that, “the whole situation kind of made me feel a bit helpless…yes, I donated but was it really going to the right place? I don’t know”. He explained to me how his perception of the disaster hinged on the exaggerated tales spread throughout social media and how that kept surging his concern for family and friends.

    His thoughts as a Nepali resonate with my own troubles regarding the disaster. In the days following the quake, I noticed a surge of news and social media coverage and sympathy. However, even a week later media coverage has moved on and with it support for humanitarian aid. Why have headlines and social media coverage changed just days later, particularly here in the USA? What is the best way to help?

    These questions troubling me funnel into Northwestern’s response to this disaster – what is being done on campus to assist humanitarian efforts? Shortly following the quake, President Morton Schapiro sent an email urging the Northwestern community to “extend [their] sympathy” and provided information about how to best “support the international relief efforts”. In addition, a student organization, NU Stands with Nepal materialized, in an effort to “mobilize NU students to support the Nepal earthquake relief efforts” because of the belief that everyone has “personal ties to everyone affected by this disaster through our shared humanity”. Their model of aid is based on an organized and methodical three-step response: raising money to donate to GlobalGiving (a non-profit that connects donors with grassroots projects), telling human stories and sharing their efforts. Another student organization, Alpha Iota Omicron, Northwestern’s South Asian Interest Fraternity held a fundraiser and in addition, was offering the opportunity for the Northwestern community to “write letters of encouragement for children in Nepali orphanages”. TEDxNorthwesternU decided to donate 50% of the ticket proceeds from their conference on May 9th to disaster relief in Nepal.

    To add to all these efforts, various departments in the humanities came together to present “Humanities for Nepal” on May 28th, an event that brought to light cultural elements of Nepal while providing a medium for donation. It included presentations from Professor Sarah Jacoby, Northwestern’s resident ‘buddhologist’, Rob Linrothe, professor of art history, and Kritish Rajbhandari, a graduate student in the comparative literature studies department.

    I was concerned about the response to the disaster in the news and social media, however, I am thankful that the Northwestern community is assisting the disaster in the way that they are. I believe that the humanitarian efforts on campus have made informed and well-researched decisions. They are supported by nationally respected global health organizations like GlobeMed, and funds raised will go to non-profits, such as GlobalGiving. Furthermore, many on-campus efforts are providing alternative options to help besides monetary support. While Northwestern is certainly playing its part in extending to the global community and assisting Nepal in its time of need, we must remember that the implications of this disaster will endure for years and Northwestern’s engagement and support must also continue.

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  3. Rebecca Seligman closes Faculty & Fellows Colloquium with talk on cross-cultural mental health

    May 31, 2015 by Arianna Yanes

    To close the Buffett Institute Faculty & Fellows Colloquium, Rebecca Seligman spoke to a room crowded with professors, students, and Northwestern community members about cross-cultural mental health. More specifically, her talk used the examination of dissociation to illustrate larger issues in studying mental health across cultures. Dissociation is triggered by highly stressful experiences that are injurious to self and allows people to protect themselves from extreme emotion. In a dissociative state, an individual lacks volitional control over actions and often will not remember the events that take place.

    The first case study presented by Seligman was Mrs. T, a 28-year-old Sikh woman living in Montreal. She was referred for psychiatric assessment because of distress she was experiencing and dissociative episodes in which she would not recognize her husband and could not care for her young child. The second case was Jalita, a Brazilian woman living in impoverished conditions under high stress. She visited a psychiatrist and also had been going into trances like Mrs. T.

    Both women occupied socially and politically marginal situations and suffered from depressed affect and anxiety. Both experienced shaking, rigidity, chills, dizziness and orientation. Though the psychiatric symptoms of these two women seem very similar, the differences between their cultures largely dictated the course of their treatments.

    In the case of Jalita, in Salvador, Brazil, the culture contained a spirit possession religion in which the spirits displace consciousness and occupy the bodies of individuals. Jalita’s symptoms indicated the need for her to be initiated into the religion. She was able to find meaning in her symptoms and classify them as the work of powerful spiritual others, pointing the psychiatric causes away from internal reasons. Her symptoms, which would typically be seen as distressing and disordered, became functional in her social context.

    Mrs. T, however, did not express her distress in a culture that made sense of such symptoms with religious or spiritual explanations. Rather, hers was a case of textbook pathological dissociation and she was not empowered in the same way Jalita was. Her dissociation violated ideas and norms of the culture in which she lived, and as such, was rendered dysfunctional.

    Through the investigation of these two cases, larger themes in cross-cultural mental health were illuminated. The most salient takeaway was that pathology is relative and the classification of disorders depends largely on context. Expression of distress is loaded with cultural and social meaning, which can provide valued social roles for individuals like Jalita or leave those like Mrs. T disenfranchised. After Seligman’s talk, it became clear that the study of mental health on a global scale requires a critical understanding of the meaning created by psychological symptoms and the healing or harming powers this meaning may have.

     

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  4. Plagues of the Past, Present and Future: A Visit from Laurie Garrett

    May 19, 2015 by Emily Drewry

    IMG_1279As a way to celebrate 20 years of global engagement and scholarship, the Buffett Institute invited a series of esteemed speakers to address the Northwestern community. The afternoon of May 15th, guests had the opportunity to hear from Laurie Garrett, one of America’s leading voices in the field of global health. Her talk, entitled “From AIDS to Ebola: What Have We Learned?” offered a comprehensive history of plagues throughout human history, deftly linking the epidemics of the past with those that have taken place recently.

    Garrett’s familiarity with plagues is well recognized in the global health community at Northwestern; as mentioned by NU lecturer Michael Diamond, her books are frequently assigned to students within the global health curriculum. Garrett has been widely recognized for her writings, as the only individual to win the Pulitzer Prize, the Peabody Award, and the Polk Award.

    “I’ve always been fascinated with plagues,” Garrett began her talk, “for the social, historical, economic, and governmental dimensions.” The interdisciplinary paths of her talk emerged early on and provided listeners with a comprehensive understanding of how plagues fit into both the historical and current context.

    Garrett began her talk with a chronological description of the great plagues of the world, from the Black Death in Europe to the plague in Surat, India of 1994, to more recent outbreaks of HIV, SARS, MRSA and Ebola. Each time she wove another thread into the patchwork of the global health history, she brought out the commonalities between the devastation behind these epidemics: that of stigma, fear, and misunderstanding.

    In the case of the most recent Ebola outbreak in 2014, the 21st known outbreak of the disease, the world “ignored prior outbreaks, warnings of the environment, and the increased probability of outbreaks,” says Garrett. The world had no diagnostic tools, no surveillance, no vaccine, and no known treatment, leaving medical workers and communities horribly underprepared for the outbreak. In fact, from the very beginnings of the most recent strain, a lack of communication between the governments of Sierra Leone and Liberia, as well as delayed action by the WHO, created a precarious delay in response. This lapse in preparedness struck Garrett as a “breakdown in solidarity and collaboration in global health.”

    Garrett’s perspective as an active leader in the global health field allows her critical understanding of the factors involved in a large-scale epidemic. As a Senior Fellow for Global Health at the Council on Foreign Relations, Garrett remains active in the field, modestly speaking of her involvement as she told the stories of plagues through past decades. In fact, her work and dedication to the field were clear and invaluable for all in attendance of her talk.

    In his remarks following Garrett’s talk, Professor Diamond spoke of his admiration for Garrett, praising her holistic approach to understanding global health, as well as her recognition of the heroism of people on the ground.

    In fact, Garrett spoke repeatedly of the power of grassroots action throughout both the Ebola and HIV epidemics. It was the communities’ responses that made massive changes in numbers of cases and diminishing the spread of both epidemics, she said repeatedly, while not undermining the impressive efforts of grossly understaffed and resource-deficient healthcare workers.

    As for the question of what we have learned in studying the plagues of the past to the present: Garrett clearly believes it to be the organized and thoughtful preparation for epidemics before they escalate. Her talk highlighted various points during each outbreak that could have been avoided or scaled down by improved methods of communications between political, economic, or social structures. Outbreaks cannot be understood without each piece of the puzzle, and her talk deftly provided a look at both the puzzles and improvements in hindsight with the skill of someone well immersed in the world of global health.

    The scripts of outbreaks may be predictable, said Helen Tilley, Director of Science in Human Culture and Associate Professor of History, in her comments following Garrett’s talk. Each time a new disease emerges in full force, society sees the following aspects: confusion of its origin, heightened stigma, intense fear, political divisiveness, and religious explanations. It is preparedness for and education about these scripts that will help the world react to future outbreaks. In fact, said Tilley, “epidemics hold up a mirror to society.”

    The lecture, followed by comments from Diamond, Tilley, and Northwestern alumnus Victor Roy, gave attendees a fascinating look into how epidemics have changed, yet stayed the same, over centuries. The recommendations for improvements were realistic, interdisciplinary, and spoke to the immense challenges that face the global health community in the future. “The next epidemic will come,” concluded Garrett, “and it could be worse.”

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  5. Sarvodaya Shramadana Movement: An Ingenious Grassroots Organization

    May 6, 2015 by Lajja Patel

    Sri Lanka

    Sri Lanka is a multicultural and multilingual country that has had a long history of armed conflict. Sri Lanka’s rich multiethnic communities that make it a diverse country today were once a source of conflict that led to lasting civil war. In the colonial era, the Portuguese, Dutch, and British tried to colonize Sri Lanka, however, in 1948, the country gained its independence. In 1956, the passage of the Sinhala Only Act, which declared Sinhalese to be the official language of Sri Lanka, caused internal turmoil. The Tamil speaking communities violently opposed the passage of the Sinhala Only Act and organized into Tamil militant groups. Communal violence broke out in 1983 followed by a civil war that lasted twenty-six years, ending in 2009.

    Last week, the Buffett Institute, Northwestern IPD, Center for Forced Migration Studies, EDGS, and Department of Religious Studies co-hosted a lecture titled “A Holistic Approach to Development and Peace Building: the Sarvodaya Movement in Sri Lanka.”  The guest speaker was Dr. Vinya Ariyaratne, General Secretary of the Sarvodaya Shramadana Movement, which is Sri Lanka’s largest non-governmental grassroots development organization.

    While Sri Lankans are in the post-war era today, the impact of the war is experienced daily on the economy and the livelihood of individuals.

    In order to promote social change in the post-war era, the Sarvodaya Shramadana Movement, which originally started forty-seven years ago, has successfully mobilized 15,000 out of Sri Lanka’s 38,000 villages to engage in a process of self-help and self-development initiatives. Sarvodaya Shramadana is an intriguing movement because it is based off Buddhist teachings that encourage psychological transformations at the individual level prior to addressing social and economic development.

    The Sarvodaya movement insists that changing the consciousness of individuals and allowing them to feel empowered is a critical step in initiating economic and social development. Participants of the Sarvodaya movement practiced kindness, altruistic joy, equanimity, and compassionate actions through meditation and community programs. In addition, the four principles of social conduct – sharing, pleasant language, sharing of motivation/energy – were also practiced at the individual level. Only after individuals went through a “Personality Awakening” were they trained for social infrastructure development and economic development strategies.

    The Sarvodaya idea of first altering the psychosphere and spiritual forces to counter violence and social stagnancy is ingenious. Sarvodaya is a unique movement because unlike most organizations, it doesn’t tackle the issue of economic development until the community has been mobilized with capable elected officials. Other organizations, such as Kiva, try to transform communities by starting with economic development through microlending. In contrast, the Sarvodaya movement is a holistic approach to development and peace building since it begins by encouraging an individual awakening prior to addressing the larger problems facing the community. The Sarvodaya model is particularly ingenious for a multiethnic and multilingual country such as Sri Lanka because the movement aims at first uniting people of different backgrounds. In order to make long-lasting changes, the citizens must take it upon themselves to initiate self-help. Therefore, the process of “Personality Awakening” is critical to creating self-sustaining developments.

    As a result of the Sarvodaya Movement, significant progress has been made in terms of resettlement and infrastructure development, with slow progress towards reconciliation and addressing the root causes of war.

    The Sarvodaya mission’s long-term goals are to create lasting peace, promote enduring community, and secure a certain quality of life in Sri Lanka. Ultimately, the Sarvodaya mission hopes to initiate discussion about the root causes of the war.

     

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