Anthro in the news 5/17/10

• Africa is not a big country
In a letter to the editor of The New York Times concerning an article on the global war on AIDS, Steve Black zings it for totalizing “Africa.” He writes, “Now just imagine what would happen to investment in the United States if articles did not distinguish between the United States and Colombia and discussed “American drug lords”?” Black spent a year in Durban, South Africa, while pursuing a Ph.D. in anthropology. See also this.

• The tragedy of trachoma
Infectious trachoma is widespread among the indigenous peoples of Australia. Some eye care specialists argue that services in remote areas to provide eye care should be increased. Peter Sutton, an anthropologist, responds that spending more on services is questionable when much of the burden of trachoma could be prevented by improved facial hygiene.

• Let’s face it
A French proposal to ban full face veils for women has prompted much media discussion. The Daily Star (Lebanon) quotes Abdelrhani Moundib, a professor of sociology and anthropology at Mohammed V University in Rabat, Morocco: “The West has the right to preserve its secularism … As a Moroccan Muslim, I am against the burqa. I see nothing in it that relates to Islam or chastity.”

• Talk to me
Just hearing your mother’s voice can raise levels of oxytocin, the “cuddle hormone,” according to an experimental study conducted by biological anthropologist Leslie Seltzer of the University of Wisconsin-Madison.

• Jaws are us (guys)
Human males have thicker jaw bones than human females. The interpretation of this difference, provided by biological anthropologist David Puts of Penn State University, is based in evolution. Physically superior males were more attractive to females as mates, and male jaw bones were part of the selective mix: “Males have thicker jawbones, which may have come from men hitting each other and the thickestboned men surviving,” he said. “Things are different for us now in many ways.” Blogger’s note: I hope he’s right about things being better now.

• Makerere University drops archaeology B.A. degree
Scrapped programs on the main campus of Makerere University, Uganda, include the B.A. in archaeology. In all, 20 programs were dropped including the bachelor’s degrees in dance, tourism and wildlife health and management, and the master’s program in ethics and public management.

Thinking outside the pill box

The latest issue of the Journal of Women’s Health includes three articles describing health risks of women in the United States related to social exclusion and cultural factors. They all demonstrate that good health is about a lot more than medical care.

The first article looks at three factors associated with cardiovascular disease–hypertension, elevated cholesterol, and diabetes–among 733 uninsured, low-income rural women in West Virginia aged 40-64 years. The women were participants in the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program. West Virginia has a high percentage of people 50 years and older, the highest rate of angina and coronary heart disease in the United States, and is tied with Kentucky for first place in prevalence of heart attacks. Prevalence of hypertension, elevated cholesterol, diabetes, and obesity, are also among the highest in the nation. The study found that large proportions of the women are at risk for cardiovascular disease because of untreated hypertension and high cholesterol. They lack access to regular health care due to the limited availability of health services in rural areas. Women who are less educated, a likely proxy for poverty, are particularly likely to have these untreated chronic conditions.

The second article is about emergency care for women who have been sexually assaulted. According to the National Violence against Women Survey, 18 percent of white women, 19 percent of Black women, 24 percent of mixed race women, and 34 percent of American Indian/Alaskan Native women report a rape or sexual assault at some time in their lifetime. This article reports on findings about the “incident history” of sexual assault from 173 women who sought care in an Emergency Department in an unidentified city (possibly in Mississippi since the lead author is assistant professor in the School of Nursing at the University of Southern Mississippi). Of the total, 58 percent of the women were black and 42 percent white. Weapons were much more likely to be involved in assaults on black women, and black women were more likely to be assaulted in the city rather than the suburbs. Substance abuse occurred in about half of the assaults; black women were more likely to report use of illicit drugs while white women were more likely to report alcohol use before the assault.

The third study reports on an evaluation of a community-based pilot intervention in New York City that combined cervical cancer education with “patient navigation” to improve rates of cervical cancer screening among Chinese American women. In the United States, Chinese American women have higher rates of cervical cancer than white women. The study compared an intervention group and a control group. Eighty women received the intervention: two education, sessions, open discussion with a Chinese physician, educational videos, and navigation assistance in identifying and accessing low-cost services. The control group of 54 women received two education sessions delivered by Chinese community health educators and written materials on general health and cancer screening. Twelve months later, screening rates in the intervention group were 70 percent compared to 11 percent among the control group. An important factor in the intervention group was greater perception of the severity of the disease.

Continue reading “Thinking outside the pill box” →

Excremental journeys

Who knew that so many commuters on trains and buses in England carry fecal bacteria on their hands? Val Curtis, medical anthropologist and public health expert, teamed up with five other researchers to assess the presence or absence of fecal bacteria on the hands of over 400 people in five UK cities. Dr. Curtis is a leading proponent of hand washing with soap in developing countries as a powerful mechanism to reduce infant and child mortality.

The findings from the UK study are gripping (so gripping in fact that you may never want to shake anyone’s hand again).

Overall, 28 percent of the 404 people sampled had bacteria of fecal origin on their hands. The authors break that figure down by region and gender. The further north you go, the higher are the percentages of men (not women) with fecal bacteria on their hands. In Newcastle, the most northerly city in the study, nearly 60 percent of the men had fecal bacteria on their hands compared to 5-15 percent in London and Cardiff. The percentage for women in all five cities had a more narrow range, between only 20-30 percent.

Beside region and gender, mode of transportation also revealed differences. Men on buses are more likely to have fecal bacteria on their hands than men who ride trains. And professionals are more likely to have fecal bacteria on their hands than others.

These findings and some complicating factors cry out for further research. First, no difference appeared between people who reported having washed or not washed their hands that morning. Second, the bacteria that were isolated are found in other contexts such as working with food or animals. Third, the sample sizes, especially of men in London (only six) are small, and London is the only truly “southern” city in the study. Fourth, the study assessed only the absence or presence of fecal bacteria and not degrees of difference in the latter.

Blogger’s note: I eagerly await findings from larger follow-up studies that take into account age and ethnicity, and that sample people in more cities. Then on to Scotland and Ireland…and maybe even to the Washington DC metro system that I use to get to work.

SOURCE: G. Judah, P. Donachie, E. Cobb, W. Schmidt, M. Holland, and V. Curtis, Dirty Hands: Bacteria of Faecal Origin on Commuters’ Hands. Epidemiological Infections, 2009.

Image: “Brazil fans on London undergound,” from flickr user markhillary , licensed with Creative Commons.

Vodou healers fight hookworm

In Haiti, Vodou priests (houngans) and priestesses (mambos) use a wide variety of plant species to treat illnesses. About 20 plants are employed as a vermifuge–a medicine that expels intestinal worms.

A recent study screened 12 commonly-used plants used in Vodou treatments for intestinal parasites to detect their effectiveness against infective-stage larvae of a species of hookworm. Four of the 12 plants demonstrate inhibitory behavior against hookworm.

In rural Haiti, commercial deworming medicines are not widely available. If available, their price puts them out of reach of most people.

Vodou practitioners thus are providing valuable health care services for the poor. Additional research on the effectiveness of various plants used could help traditional healers improve their treatments and the health of their patients.

Image: “Hookworm,” from flickr user AJC1, licensed with Creative Commons.

Keeping our promises to children

In the words of Nicholas Kristof, “The late James P. Grant, a little known American aid worker who headed Unicef from 1980 to 1995 and launched the child survival revolution with vaccinations and diarrhea treatments, probably saved more lives than were destroyed by Hitler, Mao and Stalin combined.”

The legacy of this “little known American” was the focus of the James P. Grant Lecture at the George Washington University on March 23, a tribute to Grant 15 years after his death. Dr. Jon Rohde delivered the keynote lecture, entitled “An Unfinished Agenda for Children.” Rohde is a professor in the James P. Grant School of Public Health, BRAC University, Bangladesh, and former representative of Unicef in New Delhi, from 1993 to 1997.

Rohde first offered highlights of Jim Grant’s work with Unicef: putting children on the political agenda of countries around the world, promoting a focused four-point program called GOBI (growth monitoring, oral rehydration therapy, breast feeding and immunization), pursuing universal reach to all children, initiating cease-fires in war-torn countries to allow a few days for immunization of children, and unrelenting energy in carrying forward his vision to put “children first.”

A subtext running through the speech was that UNICEF, since James Grant’s death, has failed to keep his vision alive. The United States, through its lack of support for the United Nations, has turned its back on the world’s children.
Today, we have new hope for a re-commitment to children with Unicef once again taking a strong position under the leadership of Tony Grant. What would James Grant say to Tony Lake as he assumes his new position? Here are Rohde’s thoughts about what he would emphasize:

1. Focus on the unfinished agenda: reach those who are left out in order to erase social disparities in child survival.
2. Keep resources focused on children rather than on particular diseases.
3. Restore UNICEF to what it was: get UNICEF staff out into the field rather than spending most of their time doing paperwork.
4. Defend the rights of children with the same energy as adult rights are defended.
5. Promote community participation to define activities that will respond to local threats and priorities.
6. Strengthen UNICEF’s support for education, especially of girls.
7. Build alliances among all partners to eliminate competition by taking children as the integrating catalyst.
8. Plan now for the next development decade to 2025.
9. Bridge political differences in the US so that Americans can speak in one compassionate voice.
10. End the stranglehold that the military and industrial partners have over our lives and redirect the vast resources now expended on war to keep our promises to children. Rohde commented that Grant typically steered clear of issues not within his mandate for children. “Children first” was one of his mantras. Yet he knew that putting children first was incompatible with a world in which the richest country continues to dedicate vast resources to war.

In closing, Rohde remarked: “Jim Grant saw through children the chance of peace and decency for everyone. Indeed, children are a valid aim in themselves, but even more so as a means to uncover the humanity in us all and bring about a better world in the process. This is the legacy he left us – the challenge lives on.”

Blogger’s note: In a side conversation with Dr. Rohde, I asked him, “How would the US deal with all the soldiers if they are not at war?” His answer: “They can get to work rebuilding America.” Imagine soldiers helping to build schools, providing security in poor neighborhoods so that children can come and go to school without fear, participating in social programs, and providing outreach to those on the social margins. A demilitarized military working for life not death, for child survival and humanity.

Image: “Return to Innocence,” from flickr user sytoha, licensed with Creative Commons.

Cultural anthropologist opens Pandora’s box

The Internet has been labeled a modern day Pandora’s box. It can let loose on the Internet viewing public any and all knowledge and opinions. Anna Kata, a graduate student in anthropology at McMaster University, mined several Internet sites for the “social discourse” they establish concerning the dangers of vaccination.

As context, she reports that around 74 percent of Americans and 72 percent of Canadians are online. Of them, between 75-80 percent of users search for health information. Of them, 70 percent say that the information they access influences their medical treatment decisions.

Using Google as her search engine, Kata used inclusion criteria to label a particular website as “anti-vaccination.” Of these, she examined eight American and Canadian sites for content analysis.

Some of the prominent themes that emerged are:

•safety and effectiveness (vaccines are poisons; vaccines are not effective)
•alternative medicine endorsed in place of vaccines (“back to nature”)
•civil liberties (parental rights); conspiracy theories (accusations of cover-up)
•morality, religion, and ideology (go with god-given immune system)
•misinformation about vaccine studies
•emotive appeals (personal testimonies)

In conclusion, she returns to the metaphor of Pandora’s box in pointing out that the Internet releases a wide array of misinformation that is difficult to combat. Combating vaccine misinformation, she argues, with education is necessary but not sufficient. Analysis of the social discourse on the Internet can help pinpoint areas that need countering.

Image: “Vacuna influenza,” from flickr user alvi2407, Creative Commons.

Anthro connection: beauty in Japan

Today’s Washington Post carried an article called “Big in Japan? Fat chance for nation’s young women.” Among other points, we learn that young women in Japan are slimmer than they were two decades ago. Young men, however, have become heavier.

In the United States, more than one-third of the population is categorized as “obese” on the basis of BMI (Body Mass Index). In Japan, the obese population is four percent of the total.

Media messages about thinness abound. In addition, peer pressure is strong. Japanese women are outspokenly critical of each other’s looks, according to a researcher in the Keio University School of Medicine. Thinness among young women is reaching unhealthy levels. Eating disorders are becoming more frequent.

How to gain a deeper understanding of all this? I highly recommend a book called Beauty Up: Exploring Contemporary Japanese Body Aesthetics by cultural anthropologist Laura Miller.

One chapter takes you to an aesthetic salon where various procedures on the body promise to make you beautiful. Another explores breast mania. Even though young Japanese women want to be slender, they also desire larger-than-A-cup breasts and are willing to spend a lot of money on massage, pills and other ways to increase breast size.

Another chapter explores appetite and dieting of young women. Miller comments on the recent explosion of new products to help women achieve the desire for a thin body: weight-loss services, diet goods and diet fads like the Hot Pepper Diet or the Karaoke Diet in which the dieter sings and dances to her favorite hit song at least once a day. All this in response to what Miller sees as a surge in the desire for female thinness starting around 1980.

At the same time that young, modern women are rejecting a body shape associated with fertility and nurturance, they are also rejecting marriage and motherhood. The beauty industry claims to sell young women agency and power, along with thinness. But, as Miller says, “this process rests on a mythology of transformation created by domestic and transnational corporations” (p. 206).

Photo: “Different walk of life,” creative commons licensed content by Flickr user colodio.

Preventing cervical cancer in Appalachia

In the United States, cases of invasive cervical cancer have declined in recent decades due to earlier detection through the Pap smear and improved forms of treatment. Significant regional variations exist across the country in mortality rates from cervical cancer, and the Appalachian region stands out as having high rates. It is also an area characterized by poverty, lack of transportation, and low rates of health insurance.

Faith Moves Mountains (FMM) is a health care project supported by the National Cancer Institute which seeks to reduce cervical cancer mortality in southeastern Kentucky. FMM targeted women aged 40-64 years, an age when women in the region typically stop getting Pap smears. The program followed a community-based participatory approach that is implemented through churches. Its aim is to increase cancer screening (Pap tests) through educational programming and health counseling. FMM was initiated by a team of medical faculty at the University of Kentucky.

Since many of the factors that serve as barriers to cervical cancer prevention cannot be changed, FMM took an “assets approach.” In Appalachia, two major assets are churches and social networking. The researchers arranged dates for educational workshops through churches. In order to forge links between the local people and medical care providers, they implemented a lay health advisor (LHA) program which involved local women as peer advisors. So far, the program has recruited 421 women who were rarely or never screened. While this number may not seem impressive to readers, given the logistical difficulties of working in Appalachia and the relatively sparse population, it is actually substantial.

Along the way, the researchers learned valuable lessons about how to work with the culture rather than in an outsider-driven way. For example, invitations mailed to churches asking them to participate were “returned to sender” or left unopened on the preacher’s desk. So, the researchers learned that they had to do door-to-door visits and build relationships. Also, taking notes on a laptop computer had to be abandoned as it distanced the researchers from the participants.

Image: “Blue house,” from Flickr user dok1, licensed with Creative Commons.

Hope for reshaping U.S.-Haiti relations?

If Paul Farmer were to have his way, the answer is yes. Farmer–cultural anthropologist, medical doctor, and health advocate for the poor–testified on January 27 at the U.S. Senate Committee on Foreign Relations hearing on Haiti. Farmer is also now the U.N. Deputy Special Envoy for Haiti, working with the Special Envoy, President Clinton.

Farmer first described the Haitian people’s tragic loss of life and loved ones, their new fear of sleeping inside buildings, the massive logistical challenges in providing for basic needs including food and water and toilet services, the need for emergency health care now and rebuilding clinics for the future, restarting schools that still stand and rebuilding those that collapsed, and enabling farmers to plant their spring crops by replacing tools and providing fertilizer.

He then turned to the financial resources needed from donors and how they should be managed. He suggests the “potential for an entirely reconsidered relationship between the two oldest independent countries in the Americas.” Such a newly imagined U.S.-Haiti relationship would include the following:

• Disbursement of funds that are pledged: Only about 15% of the $402 million the U.S. pledged in April 2009 to support the Haitian government’s Economic Recovery Program have been disbursed.
• Reform the structure and goals of U.S. aid within Haiti: lower the overhead charged for operations and trim back NGO involvement unless related to the public health and education sectors; focus on creating jobs for Haitians through “cash-for-work” programs and building infrastructure; work to reduce dependence on aid.
• Debt forgiveness to ease the financial drain.
• Creation of a recovery fund managed in Haiti by the Inter-American Development Bank.
• Share the goals of the Haitian people: social and economic rights, job creation, local business development, watershed protection, access to quality health care, and gender equity.
• Provide cash transfers to women.
• Build resilient housing and provide communities with access to clean water.
• Reforest the countryside.

Near the end of his remarks, Farmer said: “As a doctor, I can tell you that bad infrastructure and thoughtless policy are visible in the bodies of the poor, just as are the benefits of good policy and well-designed infrastructure.”

Image: “Paul Farmer and crowds I,” from flickr user Mira (on the wall), licensed with Creative Commons.

A very expensive health question

The Bill and Melinda Gates Foundation has awarded $8.4 million over four years to Boston University’s Center for Global Health and Development to study whether using an antiseptic wash to clean a newborn’s umbilical cord stump, compared to just letting it dry, improves newborn survival rates in Zambia. The Gates Foundation website doesn’t provide many details, nor could I locate details on the BU website.

Yes, it’s true that the first few days of life are very risky for newborns especially in low-income contexts. And yes, it’s true that something seemingly so manageable as care of the umbilical stump can lead to a baby’s death through infection. And yes, there is more to it than using an antiseptic or opting for a dry approach, as a recent study conducted in Bangladesh shows.

So the question is important and more complicated than it appears to be. But $8.4 million dollars?