L48 Anthro 3283 Study Guide - Quiz Guide: Commodity Fetishism, Medical Anthropology, Global Health
10-5-16 Cultural Competency
The Problem of Cultural Competency and How to Fix It – KLEINMAN and BENSON
• Problems with cultural competency
o Suggests culture can be reduced to a technical skill
o “Do’s and don’ts” of a culture can lead to dangerous stereotyping
o cultural factors are not always central to a case, might hinder a more practical
understanding of an episode
• need to train clinicians in ethnography – what like is like in the local world
• this is different from cultural competency – emphasizes engagement with others and their
local worlds and their feelings as a result vs. just looking at a “trait list”
• explanatory models approach – open clinicians to human communication and set their
expert knowledge alongside the patient’s own expectations
• Explanatory Model – 6 steps
o Ethnic Identity –
▪ ask about it and determine whether it matters for the patient; affirm their
experience of ethnicity and illness
o What’s at Stake? –
▪ Evaluate what is at stake as patients and their loved ones face an episode
of illness
o The Illness Narrative -
▪ Ask questions to acquire an understanding of the meaning of illness
o Psychosocial Stress –
▪ Consider ongoing stresses and social supports that characterize people’s
lives
▪ Record psychosocial problems associated with the illness and treatment
o Influence of Culture on Clinical Relationships –
▪ Self-reflection on experience
▪ Consider the effects of culture of biomedicine as always the best answer
o Problems of a Cultural Competency Approach
▪ Take into account the efficacy – does this intervention work in this
particular case?
▪ Take into account side effects → overemphasis on cultural difference can
lead to the mistaken idea that if we can identify the cultural root of the
problem, it can be resolved
• Don’t stigmatize or stereotype patients
• Understand the life of the patient and the moral what is at stake for the patient; what the
patient, at a deep level, stands to gain or lose
• EM doesn't ask “What do Mexicans call this problem?
o It asks what do you call it?
• Focus on the patient as an individual and what matters most to them
Medical Schismogenics – Article – Ian WHITMARSH
• Increase levels of asthma
• Asthma related hospitalizations have increased dramatically
• Educating mothers and families on asthma treatment, inhalers
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• Rather than focusing on prevention and public policy, they do treatment programs
A Salvage Ethnography of the Guinea Worm - Amy MORAN-THOMAS (Case Study)
• Carter politicized the worm, focused only on technology
• Different cultural interpretations
• Low uptake
• Focused on something very specific and non-fatal rather than other diseases or things like
poverty
“Doctors Don’t Know Anything” chapter from book Fresh Fruit, Broken Bones – HOLMES
• No sabe nada – the doctors don't get it, doesn’t understand; there are circumstances that
make missing appointments inevitable, stigma from missing an appointment, asked to
provide medical records, and they don’t have any
• “cultural competency” as a means of creating new and improved forms of healthcare
delivery is viable ... but it must include an evaluation of structural constraints and avoid
victim-blaming
• stereotyping a class of people that have different idioms
• Language of culture – “Mexican people are like this” is a diminishing treatment of them
10-7-16 Structural Violence
The Suffering Stranger: Medical Anthropology and International Morality – Leslie BUTT
• Suffering stranger – iconic figures who first hand experiences of suffering are presented
o Human rights culture
o Becomes icons for a “public” wracked by poverty and ill health
o Serve an emotive function
o suffering stranger generate a muted, detached concern in the reader and are meant
more to legitimize the accompanying arguments than to compel her/him to real
commitment and action
• problematic aesthetics – goal of much scholarship is to “enhance descriptions of
suffering”
o how beautiful can you make the language of suffering?
• “suffering strangers” “sympathy from afar”
o anthropologists produce sympathy from afar
o anti-politics – instead of producing descriptions, should articulate social justice
and call upon action
• rather than presenting interesting stories, scholarship should advocate for concrete actions
in the areas of social justice and policy
• use the image of the suffering stranger gives weight to their claim to “listen to the voices
of the poor”
• we need to view social justice concerns within medical anthropology as a courageous
move to- ward a new theoretical positioning
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find more resources at oneclass.com
The Tyranny of the Gift: Sacrificial Violence in Living Donor Transplants – Nancy
SCHEPER-HUGHES
• in movies – don’t see the people, it’s a gift, a sacrifice, don’t see the person
• gender bias
o male dominance in organ giving;
o poor females are pressured to ‘volunteer” as donors
• “the tyranny of the gift”
o ‘The gift the recipient has received from the donor is so extraordinary that it is
inherently unreciprocal. It has no physical or symbolic equivalent
o families may find themselves locked in a creditor-debtor-vise that binds them to
each other in a mutually fettering way.’
o weaker family members are recruited to sacrifice themselves in the interests of the
family good.
• obligation to sell a kidney to provide basic necessities for one’s family initially fell on
mature male heads of households
• Kidney selling had become a rite of passage among adolescents, and a kidney scar across
the torso of a teenager was as common as a large tattoo
• long scar across the torso symbolized machismo, courage and family loyalty, indicating
the boy’s attempt to support his parents.
• an increase in living donation by adult children and grandchildren for their parents and
grandparents
• ‘A fresh live organ is the most natural, the best choice’
o would put more pressure on living donors to rescue disqualified loved ones, and
on very sick or very old patients to search for illegal transplants abroad
• Living donation, however, should be consigned to a back seat as an exceptional back-up
to deceased donation.
Commodity Fetishism in Organs Trafficking – Nancy SHEPER-HUGHES
• Bellagio Task Force on Transplantation, Bodily Integrity and Intl. Traffic in Organs
o organ and tissue theft
o global trafficking in kidney purchased from living donors
o use of executed prisoners in Asia as convenient and lucrative sources of organs
and of foreign capital
• Bellagio Task force was disbanded
• Organs Watch
o Race, class, and gender inequalities and injustices in the acquisition, harvesting
and distribution of organs
o Violation of laws against the sale of organs
o Debt peonage in which the commodified kidney occupies a critical role
o “compensated gifting” of kidney within extended families and “coerced gifting”
of kidneys by domestic workers and by prisoners in exchange for secure work or a
reduced prison sentence
o kidney theft from vulnerable patients, mostly poor and female
• Laudiceia’s ‘missing kidney’
o Was it a gross medical error or a criminal case of kidney theft
o Her kidney was removed illegally
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Document Summary
Increase levels of asthma: asthma related hospitalizations have increased dramatically, educating mothers and families on asthma treatment, inhalers, rather than focusing on prevention and public policy, they do treatment programs. The tyranny of the gift: sacrificial violence in living donor transplants nancy. Commodity fetishism in organs trafficking nancy sheper-hughes: bellagio task force on transplantation, bodily integrity and intl. About 10 percent of all indigenous australians are considered to be deeply excluded from material resources, education, and healthcare. Political violence, ethnic conflict and contemporary ways: health and social well-being . No, the doctors did not tell me anything but everyone said that my milk was not good because of the disease: suggestions and counter-suggestions came from all directions you did not know who to trust. The abc approach ignores vulnerable populations, such as sex workers and those who lack the ability to negotiate safe sex. Experiences of stigma and access to haart in children and adolescents living with.
