Jen Pylypa

Latino Immigrants: Self-Medication Practices in Two California Mexican Communities

Although social scientists have taken up the study of medication use in both developing and developed nations, the medication practices of immigrants remain largely unstudied. In this study, qualitative research was employed in order to describe and compare self-medication practices in two California Mexican immigrant groups: families living along the border near Tijuana, Mexico, and migrant farm worker families residing in illegal encampments and substandard housing in San Diegos North County. Medication and health seeking practices were found to vary according to the specific political–economic, sociocultural, and geographic contexts in which different subpopulations of California Mexicans live. The California–Mexico border area was examined as an important context for considering self-medication behaviors, since it permits border-crossing into Tijuana for the purpose of buying Mexican pharmaceuticals at low cost without a prescription. The popularity of injections among California Mexicans and the cross-border purchasing of injectable antibiotics and vitamins are discussed as issues of particular relevance for immigrants living along the border.

Mot Luuk problems in northeast Thailand: why women's own health concerns matter as much as disease rates

In this paper, we consider womens illness experiences, above and beyond the presence of clinically identifiable disease. In Northeast Thailand, epidemiological data suggest that the prevalence of major womens reproductive tract infections is relatively low and not a cause for significant public health attention. Conversely, we found that self-reported rates of gynecological complaints are high and a significant womens health concern in rural Northeast villages. Womens embodied experiences and interpretations of these complaints affect their lives dramatically. Moreover, womens responses to gynecological problems (regardless of diagnosed morbidity) constitute an important health issue in their own right. In this regard, we document the dangers of womens self-treatment practices that rely largely on small doses of medically inappropriate antibiotics, the manner in which family life and sexual relations are disrupted by fears that gynecological problems will progress to cervical cancer, health care seeking patterns and expectations from health staff, and most importantly, how womens concerns about the seriousness of recurrent ailments result in substantial suffering. This study demonstrates why attention to womens own health concerns is as important to address in health programs as rates of disease, and why common gynecological problems and work-related complaints are important to take seriously rather than dismiss as psychological or routine and expected. We argue that there is a strong need to conduct ethnographic research on womens health problems as a complement to, and not merely a support for, epidemiological research. An evidence-based approach to health policy needs to be accompanied by a more humanistic approach to understanding health care needs.

Local perceptions of dengue fever in northeast Thailand and their implications for adherence to prevention campaigns

The government of Thailand has invested heavily in community-based dengue fever prevention campaigns, yet community participation has been inadequate to prevent transmission. This ethnographic study explored local understandings of dengue in rural northeast Thailand, and their implications for adherence to government-initiated prevention measures centred around mosquito control. While community members recognised the most severe manifestation of the disease – dengue haemorrhagic fever (DHF) – as life threatening, they were unaware of the existence of the milder form of dengue fever (DF) that makes up the majority of cases. Consequently, milder fevers were believed to be something other than dengue, such that dengue was perceived as a rare illness, hindering participation in prevention. Furthermore, a local illness category, khai mak mai (‘fruit fever’) complicated the diagnosis, treatment and prevention of dengue fever, as people viewed it as both difficult to distinguish from dengue, and untreatable by biomedicine.

Women's Health in Northeast Thailand: Working at the Interface Between the Local and the Global

SUMMARY An important first step in translating global statements about womens right to health into action programs is an assessment of the interface between local health culture and public health/medical practice. In this paper, we present the findings of an ongoing research project focusing on womens sexual and reproductive health in Northeast Thailand. The project is a prototype illustrating how formative research may be used to guide intervention development as well as midcourse correction. Examples are provided which clearly illustrate why cultural understandings of gynecological health are important to consider before introducing womens health programs. One case featured describes how an iatrogenic fear of cervical cancer has emerged from public health messages and screening programs. A hybrid model of cancer has evolved from preexisting local ideas, resulting in an exaggerated sense of risk wherein women fear that a wide range of common problems may potentially transform into this fatal disease. We argue that public health needs to be held accountable for what transpires when health messages are introduced into a community. Monitoring of community response is necessary. In the second half of the paper we describe efforts to increase community understanding of womens health problems, create gender and culturally sensitive health care services, and enhance the technical and communication skills of health staff.

Elder Authority and the Situational Diagnosis of Diarrheal Disease as Normal Infant Development in Northeast Thailand

Research was conducted in rural Northeast Thailand to understand how mothers perceive childrens acute illness episodes, and their resulting illness management strategies. Although diarrheal disease is one of the leading causes of illness among young children in Thailand, interviews revealed that mothers frequently do not classify infantile diarrhea as an “illness.” Infantile diarrhea is commonly labeled thai su, a type of diarrhea believed necessary to “lighten the body” so that the infant can attain a new developmental stage, such as sitting up, standing, or walking. Consequently, mothers do not perceive infection-related diarrheal illness as common in infants, and therefore do not direct much attention to prevention, nor manage diarrheal cases in a manner consistent with biomedical recommendations. In this article I describe local explanatory models of diarrheal illness, and discuss the role of situational factors and elder authority in determining how illness episodes are assessed and managed.

Talking About Culture With Internationally Adoptive Parents: An Anthropological Perspective

ABSTRACT Parents who adopt internationally are commonly implored to expose their children to their “birth cultures.” While this celebration of origins is praiseworthy, the approach to “culture” that it typically involves is arguably problematic. This article discusses what anthropologists mean by culture and how this differs from the way culture is treated in international adoption. It then considers what medical anthropologists have learned through decades of evolving discussions about how to teach “cultural competency” to health care providers and suggests that the insights from these debates can be applied to encourage a more nuanced approach to “cultural competency” among adoptive parents.