Medical anthropology for teachers of family medicine

1. Medical anthropology for teachers of family medicine

2. Aims At the end of this lecture the learner will: • Know the function of medical anthropology in medical education • Know how to perform a culturally sensitive consultation • Value the anthropological approach in teaching an learning family medicine

3. The challenge of emigration: Ethiopians in Israel • Emigration of Ethiopian Jews to Israel in 1984 and in 1991 • Isolated population, different culture language and customs • Unique pathology and health beliefs and practices

4. From Gonder to Jerusalem

5. Culture shock • Conflict in contact with the dominant culture • Differing expectations of behaviour • Lack of understanding goes beyond language • Need for cultural as well as linguistic interpreters

6. Uvulectomy

7. The case of uvulectomy • Patient request for uvulectomy • Doctor’s confusion over request • Recall of observation of phenomenon • Non-judgmental questioning about the need for the procedure • Negotiation of ways to cope with request

8. Focus group method • Efficient means of collecting data • Allows for group interaction • Members support each other • Allows for collection of different viewpoints • Transcripts are analyzed as in interviews

9. 1. Reasons for uvulectomy • "We used to have the child's uvula cut. • It helps the child suck better and if not cut the child is likely to die.... • Most babies undergo cutting of the uvula and it is few that don't.... • It is cut in most people. • But in some people it is not cut because there is a family drug against swollen uvula so they don't have to cut it.…”

10. 2. Traditional beliefs • “When we were in Ethiopia I used to have the uvula cut for my children and soon after my children were born at about the third day we used to take them to local healers and have their uvulas cut maybe because of fear of danger happening to them.” • “They used to come down with fevers, loss of appetite and changed behavior.”

11. 3. Acculturation to a new society • “For example soon after my last baby was born we were very worried thinking that if we are not going to cut the uvula for him then he will die. • So we took him to a hospital and there they said he is all right. • At first we were afraid. • We thought that something is lacking for this child. • But now we are happier.”

12. Patient centred care (Stewart) • Disease/illness • Whole person medicine • Finding common ground • Use of resources • Prevention

13. Patient Centred Care – Explanatory Model • Fears and feelings • Ideas • Function • Expectations

14. Kleinman's model • What name do you call your problem? • What do you think is causing your problem? • Why did it start now? • What does your sickness do to you? • How severe is it? How long will it last? • What do you fear most about it? • How can it be treated? • What results are expected?

15. BATHE: The psychosocial context (M. Stewart) • Background • Affect • Trouble • Handling • Empathy

16. Like’s ETHNIC model • Explanation • Treatment • Healers • Negotiate • Intervention • Collaboration

17. Conclusion • The anthropological method contributes tools to medicine that help us to adopt a patient-centred view. • This view can enrich our understanding and improve our efficacy as healers and educators.