Five steps against cholera in Haiti

Two children receive oral rehydration treatment for cholera at La Piste camp. Credit: Amanda George/British Red Cross. Creative commons Flickr image.

Paul Farmer and colleagues published a plea for urgency and cooperation in Lancet. It involves five steps:

identify and treat all those with symptomatic cholera
make cholera vaccines available through a concerted effort
address water insecurity to promote prevention
strengthen Haiti’s public health system.
raise the goals for health in Haiti and deliver the means to achieve them.

These five goals move from the more micro and immediate to encompassing local, regional and global structural issues. Yet, the micro will be difficult if not impossible to achieve in any meaningful way without change at the macro levels.

As the authors state: “…the goods that are needed to respond effectively to the epidemic seem to be caught in customs” both literally and metaphorically.

Open access articles from Medical Anthropology

Medical Anthropology, a journal dedicated to publishing papers that examine human behavior, social life and health in an anthropological context, has recently made available a number of articles published since the inception of the journal in 1977. The journal provides a global forum for inquiring into and elucidating the social and cultural, ideational, contextual, structural and institutional factors that pattern disease, shape experiences of illness and wellbeing, and inform the organization of and access to treatments.

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Death, Modernity, and Public Policy

A Blog on Current Events, Commentary, and Cultural Critique about Death/Dying/Policy/Representation from George Washington University anthropology and international affairs students

http://deathanddyingpolicy.wordpress.com/

We are a group of anthropology and international affairs students who are writing a blog for our course, Death, Modernity, and Public Policy for the Fall 2010 semester at George Washington University in Washington, DC.

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Nuclear news, nuclear fears and the role of science

Guest post by Barbara Rose Johnston

I received last week copies of two very different publications reporting on outcomes from the scientific assessment of life in a nuclear warzone. These studies consider, first, the health experience of resident populations living in areas contaminated by nuclear weapons fallout, and, second, the health of people as affected by the low-level radiation that accompanies modern warfare.

The first is a set of eight papers published in the August 2010 issue of the journal Health Physics and reflects conclusions from US-government sponsored science about radiation and cancer risks.

The second, a study conducted by an international and independent team of scientists published in the International Journal of Environmental Research and Public Health, is about the health effects of war on the local population of Fallujah, Iraq.

Appropriate reading, since much news in the past few days has focused on the ceremonies surrounding the 65th anniversary of the bombing of Hiroshima and Nagasaki, and the human suffering associated with nuclear war.

Nuclear worries and concerns have been a major feature in world news for years, but especially so in this first decade of a new century.

A review of today’s global headlines finds reports of fear and accusations over the development of a nuclear weapon in Iran, as well as fears of nuclear war on the Korean peninsula and in Kashmir, the Himalayan territory that lies between Pakistan and India. Fidel Castro’s first address in four years to the Cuban Parliament warns of an imminent nuclear war if the US follows through on its threat of retaliation against Iran for not abiding nuclear-arms sanctions.

There are also hopeful reports on political promises and the potential progress in the struggle to further abolish nuclear weapons. Unfortunately, there are also reports on the lack of progress – for example, the news that the US Senate has again delayed its hearing on a new START Treaty.

The nuclear news also includes “peaceful uses” of atomic energy. The US is reportedly finalizing a nuclear cooperation agreement with Vietnam that would allow enrichment. There are reports of numerous proposals or approved plans for new nuclear power plants in Germany, Egypt, the US, Canada, the Philippines, India, Serbia, Bulgaria, and the UK.

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Tweetography: making cuts to save lives?

Guest post by Graham Hough-Cornwell

The XVIII International AIDS Conference in Vienna concluded on July 23. Twitter buzzed all week with updates from speakers and attendees, and comments from those who, like me, didn’t attend but followed from home.

The biggest stories of the week? Undoubtedly at the top are the speeches of Bill Clinton and Bill Gates. They each championed male circumcision as an effective method for preventing HIV transmission.

Some tweeters expressed relief at finally seeing circumcision receive serious attention as a possible preventive measure:

GLOBALHEALTHorg: Male circumcision, proven HIV prevention strategy, finally gets some attention at #AIDS2010 , http://tinyurl.com/37ha544

Others, however, doubt recent findings, particularly from activist groups Intact America and the International Coalition for Genital Integrity:

Intactamerica: New study shows circumcision would not halt spread of HIV in the United States: http://tinyurl.com/2evl3cv #i2 #AIDS2010 #humanrights #AIDS

Tweeters representing these groups contend that males who sign up for circumcision are under the impression they no longer need to use a condom.

Dan Bollinger, a spokesman for ICGI, argues that without “fully informed consent,” circumcisions are unethical, even for adult males. But no one is talking about duping men into the surgery. Rather, if the problem is simply a misunderstanding of necessary precautions and possible health benefits, then isn’t the solution more information and more options, not less?

In a press release from this week, Intact America scorches a straw man by claiming that the circumcision solution is just another desperate attempt to find a “silver bullet”.

But the speeches of Clinton and Gates – not to mention the many roundtables, conversations, research presentations, and blog posts of countless others – also highlighted major advances in a microbicidal gel that women apply before and after sex:

Gatesfoundation: microbicide trial: A turning point for women in #HIV prevention: http://nyti.ms/cufJ7B #AIDS2010

Everyone would love a “silver bullet”. In the meantime, some practical, implementable solutions might be the gold standard.

Graham Hough-Cornwell is an M.A. candidate in Middle East Studies at the Elliott School of International Affairs, The George Washington University and a Research Assistant for the Elliott School’s Culture in Global Affairs program.

Image: “Teaching scouts about HIV/AIDS 15,” from flickr user hdptcar, licensed with Creative Commons.

I can see clearly now…

Question: Who knew that marijuana can improve your night vision?

Answer: Many people around the world. For example, Jamaican fisherman who smoke cannabis or drink a tincture infused with it say that they can see better when they are out fishing at night. It helps them avoid dangerous reefs. But why believe what they and other cannabis users say?

Let’s hear from science which now offers a way to measure night vision: “Objective assessment of night vision has recently become possible with the development of a portable device, the LKC Technologies Scotopic Sensitivity Tester-1.” Hurray! If something can be scientifically measured, then it must be real. But let’s see what the Scotopic Sensitivity Tester-1 reveals.

Ethnobotanists (people who study the relationships between plants and peoples in particular contexts) took the technology to the Rift Mountain region of Morocco (a major cannabis producing area) and conducted a case study. They recruited three Moroccan men who were “kif-experienced” (kif is a cannabis product that is smoked). The men smoked kif and were then tested for vision.

Results: vision improved in each man after smoking kif.

In reporting their findings, the authors humbly comment that their case study is very small (true). Nonetheless, they say, further study is merited.

Any volunteers?

Image: “IMG_9576 copia” from flickr user realight, licensed via Creative Commons.

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.

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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.

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.

Recent sources on Haitian culture and social change

This list is intended to provide a guide to recent resources on culture and society in Haiti for people who wish to be better informed about the context in which the recent earthquake and its devastation are occurring. With apologies, most of the journal articles are not public access.

Furthermore, we really encourage everyone to visit InterAction’s Haiti response page, which includes a variety of ways to help out.

Benoît, C. 2007. “The politics of vodou: AIDS, access to health care and the use of culture in Haiti”. Anthropology in Action 143, 59-68.

Coreil, J. & Mayard, G. 2006. “Indigenization of illness support groups in Haiti”. Human Organization 652, 128-139.

Curci, S. 2008. “Mapping Haitian history: a photo essay”. Journal of Haitian Studies 142, 120-30.

Farmer, P. 2004. “An anthropology of structural violence.” Current Anthropology 453, 305-325.

Farmer, P. E. 2001. “The consumption of the poor: tuberculosis in the 21st century.” Ethnography 12, 183-216.

Farmer, Paul. 1992. AIDS and Accusation: Haiti and the Geography of Blame. Berkeley: University of California Press.

Farmer, P. E. 2008. “Mother courage and the future of war.” Social Analysis 522, 165-184.

Giafferi, N. 2004. The violence of relations in fieldwork: the Haitian example. Terrain 43, 123-40, 159.

Guilbaud, P., & Preston, M. 2006. “Healthcare assessment study in Les Cayes, Haiti: towards a framework for rural capacity development and analysis”. Journal of Haitian Studies 122, 48-69.

Hastings, A. 2007. “Eradicating global poverty: is it really achievable?” Journal of Haitian Studies 132, 120-134.

James, E. C. 2004. “The political economy of “trauma” in Haiti in the democratic era of insecurity”. Culture, Medicine and Psychiatry 282, 127-149.

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