On the Map

I try my best not to watch too much television, but it happens and despite having 200+ channels of cable I often find myself just hanging around the networks.  Since the new year, I have begun watching a new series on ABC – Off the Map. While the lack of creativity when it comes to plot themes is getting a little tiresome, I keep coming back week-after-week for its “professional” relevance (and I went to school with one of the stars!) Off the Map follows the trials and tribulations of a collection of doctors (mainly American) in the jungle “somewhere in South America” (a.k.a. Hawaii).  Characters’ personal drama and a relatively swanky built environment aside, each episode so far has touched on themes found throughout medical anthropology.

From the start of the show, the docs that have been “roughing it” for years already herald the “greatest medical resource on Earth” in which they find themselves.  And while not explicitly stated, there is a vague sense of cultural competency.  The newbies are chastised for not having learned Spanish before they arrived and for assuming everyone will want their help.  Example – the young plastic surgeon not grasping the nuances of treating TB in rural settings.

Following episodes have touched on medical pluralism (western medicine and ethnomedicine happily co-existing); shamans and local healers (and their significance in local health and acceptance of biomedicine); and medicinal botany’s legitimacy.  Without going into the complexities and significance of these concepts, the show has at least put them on the map and woven them into the sexiness of today’s global health – freak zip-wire accidents and anaconda attacks not included.

Image:  ABC’s Off the Map.

Dr. Ozzy

Over the weekend, The Sunday Times introduced Ozzy Osbourne as their new health advice columnist. Yes, you read that correctly…Ozzzy Osbourne…health advice. I admit, I let out a little chuckle on my Monday morning commute upon reading this, but I’ve been thinking about it (and read Ozzy’s first column) and I don’t see what’s so crazy about it.

Ozzy Osbourne

Ozzy is the first to admit that he has no medical training, very little formal education of any kind really, but he does have experience. The clichés about life making you wiser and experience giving you expertise (or whatever people say) aside, there is something to be said for what you learn from living life, and living through life. The amount of “stuff” Ozzy has lived through – both self-inflicted and by chance – is astonishing! His body has been abused, in every sense of the word, and yet he lives.

Personal narrative can have a huge impact on understanding illness. Whether that illness is an addiction, an injury caused by a freak accident, an STD, or a genetic disorder. Understanding the science behind why our body gets sick or injured, survives or parishes, is only half of the equation. How we as individuals experience, suffer, and survive is the other.

Our modern lives – while providing many of us with the opportunities to live longer and healthier lives than those before us – are harsh. We submit our bodies to a lot of “stuff”. And while I wouldn’t turn to Dr. Ozzy for ideas on preventing further AIDS transmissions or the best cancer treatments available (although he might have some interesting ideas!), I am looking forward to seeing what he has to say about being well, surviving, and living in these rockin’ times.

*Image originally from Ozzy’s first column.

Whoa Baby

Bayar from Babies

Babies seem to be all the rage these days, so much so they are the stars of a new feature film out next month. Babies, which chronicles the first year of four babies born in four different countries, looks to me like it will be a pure pleasure to watch. Hopefully it will highlight the universal joys of human life, but also examine how unique and fantastic our cultural differences can be (if you haven’t yet, you really should watch the trailer – it will put a smile on your face). One of these differences is how we come into the world – in the United States, we are increasingly becoming a society where cesarean births are the norm. The CDC released a report yesterday on the new statistic that 1/3 of all women who give birth do so through cesarean section, the highest rate in American history.

These rates have risen in every age-group (groups ranging from 20 to 54 year-olds) and all of the racial-ethnic groups included in the study. The rate of women having cesarean births between the ages of 20-29 (the lowest risk age-group when pregnant) between 2000-2007 rose by roughly 8%. Cesarean births are major abdominal surgery, which often have serious complications requiring stays in the ICU and the mother to be re-admitted to the hospital. And while it shouldn’t be a decision maker, they are almost double the cost of vaginal births. What used to be a procedure saved for high-risk pregnancies/births, is now becoming common-place. The NYTimes had a nice article summarizing the report and talking about some of the reasons and effects of such a drastic shift in our birthing practices.

Rising numbers of multiple births (twins, triplets, etc.), larger babies, larger mothers, and older mothers, all represent our cultural shift towards using some of the amazing fertility technologies now available. And they are all more likely to have cesarean births. The CDC study did not specifically state, but there are no doubt stark socio-economic differences between vaginal and cesarean births as well. Women have been requesting the procedure even when it has been deemed not medically necessary, creating a culture of ‘pushers’ and ‘non-pushers’. Doctor’s fears of lawsuits have been tossed around as a reason for the rise too, but we are going to stick with this larger cultural shift as a whole. What does this mean for mothers and babies and how does the U.S. compare to the rest of the world?

The U.S. and other developed countries medicalized childbirth decades ago, but now it could be argued that if the rise in C-sections continues, women will literally have no control over the birth of their children. This rise is occurring in developing countries too, with China and countries in Latin America reaching nearly 50% of births through cesarean. Maternal Mortality Daily states that nearly 550,000 women die a year from complications from pregnancy – 99% of these occur in the developing world where simple aspects like clean water and sterilized equipment are scarce. The contrasts in birthing around the world are stark, and while women should have the right to choose the birth they feel is best for their child and themselves, we should recognize that the human universal of childbirth is far from a universal experience.

*Image from the upcoming feature film Babies.

Information Overload

The snow seemed like it would never stop falling here in DC…while getting a work-out in, shoveling, I pondered the information overload the capital area is currently experiencing. News channels have been running non-stop coverage of the storm since noon Friday with no sign that they are going to stop any time soon – how much, really, can be said about a lot of snow?!

With this on my mind, I was perusing the Sunday Washington Post a little early (online of course, there is no-way it’s getting delivered!) and there I found a book review of Medicine in Translation by Dr. Danielle Ofri. The book seems to chronicle the experiences of patients through the eyes of their physician (Dr. Ofri) and the physician’s experience working with a broken health care system and patients from an array of cultural backgrounds. Part of her job, as a physician, is to translate for her patients – to expand their “health literacy” with her knowledge of biomedicine and the system.

As a country, what resources do we have to be health literate? Are we experiencing information overload in an attempt to in fact be more informed? This past week, Oprah did a show on America’s Silent Killer: Diabetes. Diabetes, especially Type II, is a major and growing concern for Americans, there are nearly 80 million people with or on the verge of having it. Questions of cause and treatment aside, is Oprah spreading the word better than nothing?

A Harvard Poll, reported in a NY Times article, finds that the majority of Americans think the H1N1 (swine flu) pandemic is over. They feel there is now no need to get vaccinated and that the whole thing was blown out of proportion. Do they think this because their doctors have told them it’s over or because it is no longer being reported on the news? On international health as well we are inundated with a variety of information – for example, the 2011 Federal budget has several budget cuts for global health programs – but it is often the filtered, bare minimum. Having public discussions about diabetes, health care, and global health is great, but finding the right mixture of information, translation, and literacy is hard. Hopefully, our health information overload isn’t making us illiterate.

*Image is author’s own.