Medical anthropology for teachers of family medicine

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Medical anthropology for teachers of family
medicine

• Dr. Yonah Yaphe
• Department of
• Family Medicine
• Rabin Medical Centre and
• Sackler Faculty of Medicine
• Tel Aviv University, Israel

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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

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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

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From Gonder to Jerusalem
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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

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Uvulectomy
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The case of uvulectomy

• Patient request for uvulectomy
• Doctors confusion over request
• Recall of observation of phenomenon
• Non-judgmental questioning about the need for the
  procedure
• Negotiation of ways to cope with request

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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

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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.

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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.

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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.

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Patient centred care (Stewart)

• Disease/illness
• Whole person medicine
• Finding common ground
• Use of resources
• Prevention

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Patient Centred Care Explanatory Model

• Fears and feelings
• Ideas
• Function
• Expectations

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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?

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BATHE The psychosocial context (M. Stewart)

• Background
• Affect
• Trouble
• Handling
• Empathy

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Likes ETHNIC model

• Explanation
• Treatment
• Healers
• Negotiate
• Intervention
• Collaboration

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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.