researching medical anthropology in different parts of India. A ques- tionnaire was circulated broadly centering around questions on teaching the subject at ...
Anthropology News • March 2007
ACADEMIC AFFAIRS
TEACHING MEDICAL ANTHROPOLOGY
Bureaucracy Continued from page 27
IN FOCUS standing and critique of “culture,” of cultural diversity, of tribal rights in the face of globalization and all the other trademarks of our field? Besides, don’t all departments regularly assess their programs, even before the new rituals of providing accountability of our teaching? We offer classes and programs that are in relationship to the perceived needs of student learning: we are mindful of the needs of creating a compassionate, broadly educated citizenry with marketable skills in the workforce. As professionals, we are constantly reviewing and revising our classes and programs. We are always developing new courses that keep up with the latest research in the field. A Return to Humanity Is Needed With these routine chair responsibilities, I have very little time to do what I thought I was here to do—work with my faculty on scheduling and improving the content of our many programs, advise students, and yes, entice them into the social sciences as exciting and relevant fields of study. At day’s end, I have little time for creativity—I’m too busy responding to the latest administrative dictate, memo, email or problem “knock” at the door. We need to have a paradigm shift of monumental order at this school and at undoubtedly many other state universities and colleges. We have become numbercrunching factories that bear little resemblance to our missions to open the doors of knowledge and let students walk through. Faculty need to demand more autonomy in developing the kinds of classes, programs and evaluations needed for their professions to address questions and problems in the world. Kroeber wrote about culture change and stylistic “saturation” points. I think we are fast-moving to the saturation point of too much bureaucracy; the pendulum needs to sway back toward humanity. Laurie Weinstein is professor of anthropology and chair of social sciences at Western Connecticut State University.
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“Teaching is what anthropologists do most of the time,” and for this reason perhaps it “should occupy a more central place in our publications and annual meetings,” suggested past AN Contributing Editor Susan Sutton, who helped initiate a series on Anthropology and Teaching in AN. This month, as part of the on-going series, we focus on challenges and opportunities in developing medical anthropology curricula in India and Brazil.
Teaching Medical Anthropology in India ARIMA MISHRA DELHI SCHOOL OF ECONOMICS
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his paper is borne out of discussions held at a special session on teaching medical sociology in universities in India during the All India Sociological Conference in 2005. Participants deliberated upon the need to redesign sociology through its teaching and research to address the critical concerns of a rapidly changing society. In a similar spirit of retrospection, the session on teaching medical sociology sought to garner feedback from colleagues teaching and researching medical anthropology in different parts of India. A questionnaire was circulated broadly centering around questions on teaching the subject at different levels (undergraduate, post-graduate), syllabi, teaching aids used and specific teaching experiences. Questions for the Future Unfortunately, medical anthropology is not taught at the undergraduate or even post-graduate levels in 14 of the 15 universities who participated in the survey. Instead of pondering over the reasons for the lack of teaching of the subject, the session more importantly discussed the present and future directions in teaching medical anthropology to ask: when offered as a course at the undergraduate/post-graduate levels what should the curriculum look like? What could be effective teaching aids in addition to the existing pedagogic practices in India that include classroom teaching, tutorials and student seminars? What would broadly teaching medical anthropology mean? What emerged from the discussions is the possibility of approaching the topic from three interrelated perspectives: 1) the need to
integrate the increasing body of research in medical anthropology in developing the curriculum; 2) designing medical anthropology courses with an interdisciplinary orientation with potential scope for its direct application in health care practices and 3) teaching medical anthropology to medical graduates. Linking Research and Curriculum Developing a curriculum on medical anthropology at the undergraduate and postgraduate levels must take into account the recent developments in the field of health and health care. As part of the global trend yet unique to many developing countries, India is witnessing rapid epidemiological transition confronting the double burden of diseases—lifestyle related disorders, on the one hand, and resurgence of diseases like chikungunya, polio, on the other. From the policy point of view resurgence of diseases like polio are looked upon as the unfinished agenda of the government of India, the reason why it underscores the incidence of lifestyle-related diseases. Medical anthropology curriculum hence needs to address universal with local issues. As is well known, theorizing chronic non-communicable diseases in biomedicine (or preventive medicine) has far more significant implications than merely conceptualizing the etiological shift from mono-causal to multicausal (or multi-risk factor) kind of explanations. It accompanies a baggage of questions relating to existing understanding of health, illness and health care in medical anthropology. Consequently if any syllabus on medical anthropology in the 1980s treated the distinction between disease and illness as the entry point to introduce the
subdiscipline, now it also has to confront emerging notions of illness and health through concepts of preventive health and self care (prescribed lifestyle modifications) that perhaps redraw the boundaries between health and illness. In a similar vein, one witnesses a resurgence of interest in indigenous healing, traditional medicines under the rubric of complementary medicine and holistic health. While academics and research scholars are undertaking research on many of these aspects individually, there is a need to integrate the growing body of such research with the curriculum. Making Curricula Relevant In their 1988 Anthropology and Education Quarterly article on teaching anthropology, Steadman Upham, Wenda Trevathan and Richard Wilk rightly suggested that one of the solutions to the decrease in student enrollments in anthropology in the US is to structure anthropology curricula in a way that addresses the needs of the job market. In India, Loyala College, University of Madras introduced such a program in medical anthropology in 2004–05. The course is oriented to address the need for a sociologically-informed technical manpower in health care services. The syllabus is designed in a way that trains students both in medical sociology and medicine (one paper is devoted to how medicine as a discipline constructs the human body), medical ethics and law. In addition to the classroom teaching, it offers experiential learning through internships in a multi-specialty hospital for six months as a course requirement for completing the program. Teaching Medical Graduates In India the acknowledgement of contributions of anthropologists to the field of medicine is only a recent phenomenon. Unlike medical schools abroad, the collaborations between anthropologists and med-
March 2007 • Anthropology News
ACADEMIC AFFAIRS
ical scientists is not so organized and at this stage is mostly limited to one or two medical colleges appointing a sole anthropologist or involving senior anthropologists in undertaking qualitative research components of various projects directed by biomedical scientists, including many epidemiologists. However scattered and sparse it may be, anthropologists teaching medical graduates in medical schools shared their experiences during our session, which pointed towards the importance of the idiom of communication. One anthropologist shared his experiences of how one teaches phenomenology to medical students without using the term phenomenology. The challenge is to convey the significance of the causal linkage between biology and the sociocultural matrix including social networks, behavior cognition, how patients emotionally experience illness and health (including experiencing recovery from specific illness) in everyday life. My own experiences of working with medical scientists reinforce the importance of how we communicate our knowledge. While “illness narrative” fascinates biomedical scientists, they are equally suspicious about what constitute data differentiating such particular narrative from the idea of story in folklore. Documenting thick description—though valued—is considered less scientific by these professionals. Translating medical anthropology to medical graduates and scientists is very important but a challenging task. Increasing documentation of experiences of such collaboration would be beneficial for anthropology. Through these three interrelated perspectives, the session in India defined teaching that went beyond students in the classroom. It envisions translating anthropological insights to reach a much larger audience beyond our own academic community. It raises concern, however, about uncompromising disciplinary rigor both in teaching and research in the process of such translation. Arima Mishra is a research associate in the department of sociology, Delhi School of Economics, University of Delhi, Delhi, India. Xavier Vedam and Nagendra Prakash contributed to the session on the teaching of medical sociology during the 2005 All India Sociological Conference, on which this article is based.
Teaching Medical Anthropology to Health Professionals in Brazil EUNICE NAKAMURA NURSING SCHOOL SAO PAULO U DENISE MARTIN CATHOLIC U SANTOS FEDERAL U SAO PAULO JOSÉ QUIRINO DOS SANTOS FEDERAL U SAO PAULO
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n Brazil, medical anthropology has been fundamental in preparing undergraduate and graduate public health students. It is also important in training health professionals who work in the public health services which make up the Unified Health System (SUS in Portuguese), implanted in Brazil after the 1988 constitution. Public health services in Brazil are the only health services available to the poor in outlying urban districts. Health professionals are attending to prevention, treatment and compliance with renewed attention, noting that not everyone in the Brazilian public shares biomedical concepts and practices about disease. This realization places medical anthropology programs in a unique position where they can both meet the expectations of students and allay the growing frustrations of health professionals who find that biomedical models are limited in providing health services to a diverse public. Brazil’s Challenges Brazil has one of the most unequal distributions of income and wealth in the world, and this is clearly reflected in the health of its population. Thus, the study of medical anthropology in Brazil includes teaching and research on the inequality of medical services, the distance between doctors and their patients, and equally important, the study and dissemination of pseudoscientific terminology that is popularly spread to the detriment of medical services. In Brazil the teaching of medical anthropology is the responsibility of different disciplines seeking to set standards for educating health professionals in necessary theories, concepts and methods for their field. Through these standards, courses are designed to supply the minimum knowledge necessary for these professionals to: understand that health
and disease are biomedical categories and that they differ in meaning from that of the public; promote interest in identifying and understanding the different concepts and practices related to health and disease by employing anthropological research. Critical Medical Anthropology Despite efforts to implement these courses, there is still resistance from health professionals strongly influenced by their biomedical background. Many see medical anthropology as a means to better understanding the public, while maintaining intervention and treatment methods, based on biomedical principles. Yet, this challenge also enables a critical approach to teaching. A small group of Brazilian anthropologists has dedicated its efforts to consolidating, through teaching and research, a critical medical anthropology, maintaining the specific nature of the field of anthropology while also meeting the needs of health professionals. They start with the idea that health and disease are categories developed by the biomedical field, which correspond to specific practices. They recognize that biomedi-
mental concepts are proposed for teaching medical anthropology in Brazil: culture, ethnocentrism and ethnography. A theoretical approach to the origin of concepts on culture and ethnocentrism enables us to show that what is said about health and disease is so closely related to culture that they are in fact indivisible. This approach is based on concepts of cultural relativism and otherness: it is necessary to learn to deal with the fact that all social groups, as strange and as different as they may appear, belong to humanity. In teaching research methodology, the syntheses of these concepts are found in ethnographic research, where social phenomena, including health and disease, are understood through the meaning they acquire for those that experience them and through the interpretation and analysis made by the anthropologists that observe them. What has been sought with this approach is to provide students with a way to critically reflect upon situations, especially health and disease phenomena, when returning to the study of societies and different cultural groups’ health issues. Medical
Medical anthropology is not restricted to merely the tools of health practices, but provides a deeper understanding of social and cultural aspects of medicine, little understood by health professionals ... cine is a cultural construct but also recognize other ideas and practices regarding health and disease based on specific cultural meanings. In this sense, some problems resulting from the meeting of biomedical and popular knowledge are shown to be cultural rather than natural, and thus explainable by medical anthropology. Through such teaching and research, terminological improprieties that suffer from local connotations are highlighted along with the diversity of ways of dealing with diseases. Teaching Culture To show the expression and coexistence of these different concepts and cultural practices, three funda-
anthropology is not restricted to merely the tools of health practices, but provides a deeper understanding of social and cultural aspects of medicine, little understood by health professionals, which will serve as the basis for enriching their practices. Eunice Nakamura teaches and researches on the relation between culture and health-disease. She is particularly interested in child mental health, populations’ health needs and care. Denise Martin is an anthropologist particularly interested in mental health, and teaches qualitative research methods. José Quirino dos Santos studies mental health, health economics and the relation between culture and health-disease. He has also contributed to the theoretical and methodological issues on medical anthropology in Brazil.
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