Medical anthropology for teachers of family medicine

AimsAt 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

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

From Gonder to Jerusalem

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

Uvulectomy

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

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

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.…”

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.”

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.”

Patient centred care (Stewart) Disease/illness Whole person

medicine Finding common

ground Use of resources Prevention

Patient Centred Care – Explanatory Model

Fears and feelings

Ideas Function Expectations

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?

BATHE: The psychosocial context (M. Stewart)

Background Affect Trouble Handling Empathy

Like’s ETHNIC model Explanation Treatment Healers Negotiate Intervention Collaboration

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.