The Controversy of Female Circumcision Ethnography Review

Rain Daley

            In the case of female circumcision there are various controversial topics and multicultural opinions on the practice and, recently, there has been a significant influence from the Western world to abolish the practice in all the practicing communities. Ellen Gruenbaum explores the topic of female circumcision and the various topics of hierarchy, ritual, marriageability and sexuality associated with it in her ethnographic work summarized by the book titled The Female Circumcision Controversy: An Anthropological Perspective. In Gruenbaums writing there is a pretty explicit tone of agreement and support with the idea of abolishment, however, it does not spill over too much into the way she goes about gaining perspectives and other information on the practice. The writer did an excellent job of touching on all the significant topics involved in the practice in a very balanced manner to best inform her readers of the opposing sides of the practice. In this essay I will expose and explore the concepts written about in Gruenbaums book and delve deeper into explaining and understanding a select few of the more controversial topics she discusses.

            Throughout Gruenbaums writing on female circumcision there are several main ideas that she discusses. The first major topic she discusses is the topic of Patriarchy in practicing societies of female genital cutting or FGC. She addresses the fact that there is an argument against FGC on the lines of it being a tool for male domination and hierarchy. There is reason that this kind of statement could be supported but throughout the personal interaction and interviews executed there seems to be somewhat of a disconnect between that idea and the reality of the situation. From the scarce male perspectives that were derived from practicing communities there is a trend for the males to kind of brush of questions about FGC with a response such as it “being women’s business”. Judging from the male perspectives that Gruenbaum drew from various communities in Sudan there seemed to be a commonly passive attitude about the practice and none of the men really stated much more then they prefer women who are circumcised due to the fact that it means they will not have pre-marital sex and/or birth. However, when asked about their opinion regarding change related to FGC towards abolishment a small number of the men responded saying that they would not mind if their women were uncircumcised at the time or marriage and the rest tended to be undecided for the most part. Venturing into other topics of the book Gruenbaum also touches on the topics of ritual and meaning; exploring what significance the practice holds and what ritualistic processes can be involved in the practice, Marriage and Morality; a topic that can be associated with the previously mentioned topic of patriarchy in practicing societies, Ethnicity, Sexuality, Economic Development and how certain steps in medicalization could effect the future of the practice and finally what kind of change can truly steer the direction of the practice out from its traditional roots towards abolishment.

            Throughout the topics that are discussed in the writing I was attracted to a few due to my curiosity of insider perspectives (especially the contrast in the perspectives of alternate genders) and what seems to be an imbalance of the perspectives derived from given communities in regards to the gender ratio. Among these topics of particular interest to me personally was the topic of the ritual and meaning associated with the practice of FGC. In Sudan where Gruenbaum spent her five years of research regarding the topic of FGC she was able to witness many aspects of the ritual and the associated meaning of the practice. During a ritualistic ceremony of FGC there are certain members of the community involved as well as specific performances made by those members of the community. There is always a designated performer of FGC who is usually an elderly woman of a given community who is circumcised herself and possesses a certain degree of spiritual and ritualistic prowess. In the Sudanese tradition FGC is performed in the housing for the goats of the community using fairly crude ritualistic instruments. Before entering the barn to be operated on there is usually a gracing performed by the elderly members of the community as well as the male leaders. The young girls who are operated on are blessed with branches of certain plants and dressed and decorated with lines of beads and earrings before and after the cutting ceremony. There is a very important aspect to being operated on which is showing no signs of pain in reaction to the cutting and healing process. By showing no signs of pain the girls prove that they are strong and brave and deserve to be shown respect by their elders and the marriageable men of the community. After the operation the girls are asked to stand and walk themselves to their healing beds where they will spend the next few days or even up to a week or two healing from the wounds gained from the operation. During the healing process the only remedy for healing is goats milk to ease the pain. Medical painkillers are strongly condemned in practicing communities. Reason being that it will show that the women who take the painkillers are incapable of tolerating the pain of the operation thus proving them to be less brave and respectable than others.

            In terms of the meaning behind the practice there tend to be multiple reasons for the practice in Sudanese culture. Perhaps the most significant factor in the meaning of the practice is the idea of it being an induction into womanhood and the girls who go through with the operation are welcomed into the mature social circles of the community and respected by the elderly women of the community. From what Gruembaum was able to extract from the women of practicing communities the success of the operation draws them away from assumptions of them being too promiscuous because of the presence of a clitoris as part of their genitalia. There is a common belief in practicing communities that the presence of a clitoris makes women sexual fiends and drives them into promiscuity. Taking these ideas into consideration there is a great deal of social pressure from predominantly the female members of communities to have the young females be circumcised. If the females decide on their own or if the parents of them decide not to go through with the process of circumcision there are tremendous social ramifications resulting in total alienation from the community, the risk of not being married which is a sign of social status in practicing communities and constant harassment for their decisions.

            Another topic that caught my interest more than others is the concepts of how to go about influencing change in practicing communities. As it can be imagined the majority of influence for change is coming from outraged westerners who feel that the practice is a violation of human rights and poses far too many physical adverse effects for the social benefit to be balanced. In Gruembaum’s discussion regarding the methods of change and what is wrong with those current methods she includes the process of medicalization, Western eradication efforts and regional legislative outlawing efforts. In terms of medicalization there have been doctors in practicing regions who have taken it upon themselves to perform the circumcisions, sometimes in their own private offices, in an attempt to lower the likelihood of adverse effects following surgery. Many of these adverse effects include sever hemorrhage, infection, improper healing leading to future problems, childbirth complications, et cetera. Many of these adverse effects can lead to death due to the lack of medical facilities in practicing regions. In a way the medicalization of the practice, whether legal or not, can serve its purpose as making the procedure less traumatic with the introduction of painkillers and make the physical/social tradeoff somewhat more balanced, however, many would consider that to be malpractice in a medical field. Reason being the practice cannot be supported by claims of it being beneficial to the physical health of an individual in any way. Westerners have played a large roll in getting regions like Kenya to outlaw the practice. The issue with legislative moderation though is that if a girl is circumcised in Sudan and moves to Kenya she is at risk for prosecution because of the fact she is circumcised. In terms of the practicing regions themselves being affected there are arguments that it would drive the practice further underground rather than bringing it to a stop. People would, in a way, be forced to practice their traditional values in an illegal way and have to deal with the fear of prosecution for the remainder of their circumcised lives.

            In terms of Gruembaums stance on these topics of the circumcision issue I feel that she makes it clear that she supports the idea of abolishment but she does it in such a way that would encourage culturally sensitive methods of change such as sparking social movements in the practicing regions themselves, empowering women of practicing women and encouraging them to become teachers and assisting the Muslim population of practicing regions to encourage fellow Muslims that it is not pleasing to god or necessary to perform female circumcision on their young girls. I felt very fond of the fact that Gruembaum put such an emphasis on the need to incorporate the idea of change into the practicing communities themselves. I feel that cultural competence and sensitivity are absolutely necessary in this circumstance. Without that we can see the example of Westerners accusing practicing regions of their atrocities and basically telling the regions to stop the practice. Of course, with any preventative approach like that it is very likely to deter the opposing side from any aspect of your argument and drive them further away from the idea of listening to what opposition members have to say.

            In terms of actually extracting a bit of opinion from members of practicing communities I felt that Gruembaum did a very good job in discussing issues with the female members of the communities. However, the problem with this issue is that the male perspective is rarely present. Part of the problem lies within the anthropologists own study as well as the reluctance of the male community members due to their idea of the issue being one only women have to discuss. However, I do give Gruembaum credit for acquiring information from the females of the communities she was involved in to gain a complete understanding of what they females were doing to support or prevent the practice, the various roles of women in practicing communities and the contrast of elderly and younger women’s opinions. In that way I feel she did a good job of displaying a positive community representation with how she incorporated educated female members who were opposed to FGC into her research. I feel that westerners would perceive these practicing communities as uneducated, barbaric people with the bizarre beliefs about the benefits of FGC. In providing these insider perspectives I feel that outsiders looking into the issue through this source of study will develop a better perception of the people associated with the issue of FGC as well as develop a broad understanding of the issues and controversy surrounding the practice.

            In educating people on this topic through sources such as Gruembaum’s book I feel that ousiders will acknowledge it as a global health issue for the reason of it being a practice associated with a large region of Africa and attracting so much international attention I feel that this is a legitimate global health issue. The topics Greumbaum discussed in her book varied greatly and covered the main topics attached to the issue and provided good perspectives on the issue through the insider perspectives she drew from the Sudanese communities. The ideas that ran through the book were completely parallel to the ideas we have talked about throughout class lecture such as alternate perspectives constructing opinion on issues such as FGC, cultural competence, topics of medicalization, et cetera.

            Ellen Gruenbaum provided a very complete source of information with this book. She went about gaining the information in a very good way by incorporating herself into practicing communities and drawing information through insider perspectives while remaining culturally sensitive and proposing culturally competent methods of intervention and change for the future of the practice. She also provided a good comparison of how western opinion and interest has affected the path towards eradication of the practice and how it has affected the people who are actually practicing FGC and how western influence has made them resistant to change. In conclusion, I feel that this book is a very informative introduction to the topic of female genital cutting and I would personally recommend it to anybody with a remote interest in the topic.

Reference:

Gruenbaum, E. (2001). The female circumcision controversy: An anthropological perspective. Philadelphia: University of Pennsylvania Press.

Exorcising the Trouble Makers Magic, Science, and Culture Review

Qin Williams

In modern society, a lot of people do not believe in ghosts, but still are afraid of ghosts. Why would people would be afraid of things which they don’t even believe in? Why are there are still many people who believe in rituals? This is a problem worthy of study in the anthropology of religion. In “Exorcising the Trouble Makers: Magic, Science, and Culture”, the very human need for religion and magic as supplements to scientific and technological knowledge is the subject of this work.

 In 1942, author Francis. K. Hsu witnessed a cholera epidemic in a small rural settlement in Yunnan province, China. He found that contrary to anthropological expectations, the Chinese responded to the crisis with a combination of conciliatory rituals and practical hygienic measures. More than thirty years later, he witnessed the elaborate ritualistic preparations for another epidemic in the Shatin sub-division of Hong Kong and found the supernatural and empirical response to be virtually the same as in 1942. The small town XiYue, a settlement of YunNan, is an area with little outside influence. They had limited education, technology and a harsh environment.  That people there have a lot of ghost-related beliefs and ceremony is understandable. In contrast Hongkong in the 1970s is a modern place with a large population, influence from the outside world, and highly educated. It is an area brimming with technology, communications and media. But the concept of ghosts is still popular there. The prevalence of rituals there again seems to be justified.

According to mainstream society, the view in general tends to be that magic and religion is a superstition, just there to fill in the gaps left by science.  It is taboo to use magic and region in modern biomedicine dominated systems. In contrast, Francis Hsu doesn’t think that way. He does a nice job in his book by using multiple data collection methods and research techniques to explore this cultural phenomenon.

Data and analytics seem boring, but good ethnography does not exist in isolation from data. By using case study, Hsu brings it to life. This study took an in-depth look at different groups: educated people, non-educated, the minority of wealthy families, as well as highly populated middle class. Among the ethnographic record, he not only takes field notes and photographs, also makes maps to show the common patterns of people's behavior: It doesn't matter if the person accepts western medicine or not, he or she will still participate in rituals. Through his daily participation and observation, random interviews, and surveys, these data show all observed behavior and describe all symbol-meaning relations. But, still, it is not the data collection techniques or what has been collected to determine whether the study is ethnography. Rather, it is by the lens through which the data are interpreted.  The way how he structures  all of this makes a substantial contribution toward the understanding of ritual as a reflection of the human need for spirituality. They create an aesthetic impact on the readers and express a credible reality. In order to avoid any personal casual explanations, he uses data to represent the point of view of the subjects that biomedicine is helpful but ritual is necessary to them as well.  Through his qualitative and quantitative study, these data not only captures the social meanings and ordinary activities of people in naturally occurring settings like working in the fields, but also give a more personal and in-depth portrait of the informants and the community. 

Yet, it’s unrealistic in ethnography to use work done on a small group and apply the findings to larger population. People may argue that both XiYue and HongKong have same culture background, and they are all Chinese. Nevertheless, Hsu finds common threads through his longitudinal analysis of similar phenomenon in the South Seas, East Africa, Indian and white America. He uses numbers from secondary research and documents around the world to illustrate his point and provide insight into this research topic. By comparison and contrast, the author argues again, in spite of technological and intellectual sophistication, the human psychic need for magic and religion persists. He explains that rituals are not contradictory with science; rather, they are supplements to scientific and technological knowledge.     

Good research is not just about methods. Cultural context is the essential key concept and principle of medical anthropology.  Good ethnography does not exist in isolation from it. Susan Scrimshaw says “Health and illness are defined, labeled, and evaluated, and acted on in the context of culture”. People define ethnography as “a means to… represent in writing, the culture of a people” (Wikipedia). France Hsu gives us the insight to look beyond the obvious. The power of his work is rooted in its ability to get past stereotypes, assumptions, and veneers to the complex inner workings.

For a long period of time, Western anthropologists understood superstition, religion and science through the theoretical framework of social Darwinism (France Hus); representatives such as Malinowski and others made a series of expositions.  Their view is that the difference between magic and religion is that superstition uses utilitarianism as its basis, and certain actions to achieve a specific purpose. It’s part of a culture’s original characteristics. Similarity religion and science are also different; with religion forming a culture’s organized beliefs and fixed values, while science is devoted to the rational and empirical. According to Malinowski and others, magic, religion, and science respectively represent three different forms of societies: primitive society, a civilized society and modern society. Hsu disagrees with this statement. He uses his field notes and analysis show that people’s response to the plague both in the town of West Yunnan in the 1940s or thirty years later in Hong Kong, is the combination of magic, religion and science. Facing an infectious disease, amulets for the expulsion of plague and a soul salvation ceremony came together spontaneously; at the same time, the representations of the scientific and rational drug treatments and quarantine measures are implemented without obstacle. “Every human society has its own shape, its own purposes, its own meanings... [The growth of society] is an active debate and amendment under the pressures of experience, contact, and discovery ... “(Raymond Williams) Hsu argues that there is no actual difference between primitive society, a civilized society and modern society. Rather, people from different places deal with things differently are because they have different experiences and different cultural contexts.  Rituals can be viewed as designed to satisfy the spirit, and exist without detriment to science.

Yes, “People around the world have beliefs and behaviors related to health and illness that stem from cultural forces and individual experiences and perception”. (Susan Scrimshaw)  The theory of ethnography is essentially a cultural context. In the long history of mankind, disease and health as a universal life experience have gone hand in hand. In different cultural backgrounds, people have different interpretations of the causes of disease. And the perceptions of an individual or group can be shaped by information, practicalities of everyday life, and previous experiences. “You cannot just treat diseases, you have to treat bodies, and you cannot just treat bodies unless you understand the lives bodies have become accustomed to living.”(Nitcher) Across cultures, perceptions of health, healthcare, and treatment are very different. Treating people today and tomorrow may become more difficult as climate change, rapid transportation and cross-cultural marriages. All of these can create new challenges for the medical community.  It is interesting to see how “cultural context” leads readers to different interpretations.  This also reminds me the term “cultural relativism”.  Cultural relativism plays an important role in why people act so differently. It provides easy ways to understand why different cultural backgrounds have derived different disease awareness and different etiology interpretation.

Because of the history of Western colonial expansion, missionary efforts, transnational migration, and capital flows, Western medicine treatment methods and ideas have spread around the world. It has become the dominant worldwide health care system. But through the lens of cultural relativism in anthropology, Western medicine itself is a very broad and very vague concept. It actually includes Western faith healing, witchcraft, allopathy, homeopathy, and so on. Contemporary molecular biomedical is just one type of Western medicine. So, instead of "Western" medicine, biomedicine is more appropriate.  Hsu, from a point of deep reflection disagrees with the separation of magic, religion and science. He holds "cultural relativism" reminds us that it’s erroneous to regard Western biomedicine as the correct system. This historical error amounts to a kind of “ethnocentrism” and does little more than pose a barrier, as other cultures are sometimes skeptical of biomedicine. It’s easy to understand why magic, religion and science are sometimes in conflict with each other.

 “Cultural relativism” in anthropology refers to the idea that each culture has developed its own ways of solving the problem.” Examples of this are how we live together, how we obtain the essentials of life, and how we explain phenomena. No one way should be viewed a better or worse; they are just different. The basic argument is that the cultures of different ethnic groups are equal. Every culture has its own cultural logic and cultural significance. Every cultural system is historically formed with its own originality characteristics. Therefore, Hsu suggests one must abandon the concept of science or biomedicine as the center, and learn from the point of view of "cultural relativism" to understand medical culture. In the same way that different cultures cannot be viewed as best, better, or worse, medical knowledge systems should likewise not be categorized the same way.  This kind of cultural supremacy is counterproductive and prejudicial. Therefore, we must particularly stress the necessity of diverse medical and cultural systems, and allow a variety of medical and cultural knowledge systems to coexist.  Only then can we expect the mutual understanding and mutual respect required for successful treatment. 

Hsu is not satisfied with the practice of Western anthropologists completely separating magic and religion.  He believes that the way Fraser, Durkheim and Malinowski pigeonhole magic, religion and science into disparate categories does not withstand the test of field facts, or common phenomena around the world. His conclusion has important significance: culturally competent medicine should not focus strictly on one side of the equation.  The phenomenon of magic, religion and science being used at the same time is not because different cultures lack rational thought, but because people's behaviors are largely influenced by their social organization and beliefs in their cultural systems. The way people think and the pattern of their behavior are established on the basis of their traditional concepts and beliefs.  As anthropologists or ethnographers, the meaning in the context of people’s daily life, and connections between personal experiences is critical. As it turned out, Francis Hsu’s book made for excellent reading on my trip, and did indeed contribute to my understanding of medical   anthropology and the work of ethnography. Seeking to understand the relationship between culture and behavior is the main goal. But more valuable still, the writing of the book brings the topic to light. It fosters many other people like me to have a better understand of ethnography. Cross culturally, there should be no distinct line that separates Magic, religion and science into separate boxes; rather, it’s significant to recognize the importance of diagnosing people, their needs, hungers, and excesses, not just diseases.

Bibliography

1: Frances Hsu. “Exorcising the Trouble Makers: Magic, Science, and Culture”. Greenwood Press, Westport, Connecticut. London, England, 1983.

The very human need for religion and magic as supplements to scientific and technological knowledge is the subject of this work. The phenomenon of magic, religious and science being used at the same time is not because they lack rational, but because of the people's behavior are largely influenced by their social organization and their formation of beliefs in the kind of cultural patterns. The ways of how people think and pattern of how people behavior are established on the basis of their traditional concepts.

2: Nichter, Mark.  Global Health: Why Cultural Perceptions, Social Representations, and Biopolitics Matter. University of Arizona Press, 2008.

 The book provides an excellent review of the last few decades of international health research as well as suggestions for where future research should lead. While the author suggests the importance of perception, he also paints an accurate picture of the current challenges posed to both social scientists and field practitioners for improving public health in the developing world as well as encouraging the field to develop in productive ways.

3: Scrimshaw, Susan C. “Culture, Behavior, and Health”, 2006

Culture permeates everything about how each of us views and approaches health, illness, prevention, and healthcare systems. Everyone—health care provider, patients, families and, community members—brings cultural understanding and experience to their response to health maintenance and illness. In the article, the author gives some key definitions of concepts such as culture, culture change, and ethnicity, and goes on to illustrate the importance of culture influence in health care.

4: Williams, Raymond. Originally published in N. McKenzie (ed.), Convictions, 21958, in class lecture, 2012.

5: Wikipedia, online web, 2012.

Ethnography Review: Pathologies of Power

Ethnography Review
Section AH

Introduction:
The poor are usually the victims in human history, they are the ones who will always be struggling for human rights, raise above poverty and fight against repression from the power and wealthy. Poverty is usually the results from the actions of other human beings, the result of man-made structural violence and the cause of suffrage among the poor and powerless. For this ethnography review, I read Paul Farmer’s  Pathologies of Power: Health, Human Rights, and the New War on the Poor.  I will analysis this ethnography base on strength and weakness of the issues addressed in the book, how this work has contributed to the depiction of a group or community as a whole and these issues will continue to be a global health issues base on the structure of power and inequity of the society Paul Farmer witnessed.

Body:
Health disparities, inequality gap between the rich and poor, structural violence that denies opportunities to those who need most are some of the many concerns that global health and public health encounters each day.  It is problematic from the starts of the century and requires tremendous amount of work and dedication for social changes.  In the book Pathologies of Power: Health, Human Rights, and the New War on the Poor by Paul Farmer addresses many social, economic and political violence against the poor, powerless individuals. The main points that this book also addresses human right, ethics and public health issues in each chapter.  What I like about this book is that is breaks down of the book compose of different issues or problems that are addressed in each chapter with narratives of the poor to demonstrate precisely how their illnesses relate to larger structures of power. Paul Farmer not only break down the issues into chapters but also into two parts, having the first half of the book rely heavily on his own experiences in Latin America and Russia which he witnessed many situation where peasants dealt with extreme structural violence and human rights violations. This part of the book are like his “postscript” that follows those events and describes the declining of health of peasants. The second part of this book inquiries more into human rights theory in light of Farmer’s work in anthropology and medicine. As Paul Farmer stated, “The second half of the book also draws on this experience, but it aims to lay out the framework of a critique of “liberal” views on human rights, since such views rarely serve the interest of the poor,” implies that social justice usually favors those who are powerful and wealthy, but rarely favors the poor.  I think this ethnography stated many interesting and important issues in society and world wide in larger scale. This ethnography, to me, hopes to establish a connections between the general public about anthropologist work in healthcare and medicine to understand the roots of inequity, poverty and illness that relates to the larger structure of power and wealth. Paul Farmer was able to address many issues and problems in different ways and then relates to the larger scale in general of how it affect the poor in terms of hierarchy of suffering, structural violence, comparing charity development in third world countries and concludes with reflections on the implications for changes.

Basic theme of the book:
The first part of the book argues that “social determinants of health outcomes are also, often enough, the social determinants of the distribution of assaults on human dignity,” which implies that the inequity between the human beings with power and wealth to those who have neither, they are often left behind (Farmer 20).  When medicine and policy intertwined, it is inevitable that hierarchy of suffering beings to take shape, for it is impossible to resolve everything at once. Most of the first half of the book address how peasants who were poor poor dealt with the pain of deep poverty which shapes into social issues such as racism or societal down look of social class. The strength of this part of the book is that it would first address the issue by narrating a short story of individuals who were at the moment experience structural violence, and then goes in depth of the how the situations relates to larger social, economic and political violence that worsen poverty in the hemisphere. Those who are poor, hunger and ill will remain the same or worse over time while the powerful, wealthy and healthy continues to thrive in their throne. The examples and the narratives helped strengthen the ethnography as readers are able to visually understand the situation and then analysis it base on the author’s argument. An examples of the narratives of one individual, Acephile, who was born poor and continues to suffering due to her state of poverty. “ You get up in the morning,” observed one young widow with four children, “and it’s the fight for food and wood and water.” If initial struck by the austere beauty of the region’s steep mountains and clement weather, long-term visitors come to see the Central Plateau in much the same manner as its inhabitants do: a chalky and arid land hostile to the best efforts of the peasant farmers who live here. Landlessness is widespread and so, consequently, is hunger?...(Farmer 32). Paul then argues that the reason of her health declining was due to the fact that she is a peasants in Chiapas, the result of poverty but also a historical product of the Spanish colonialism, underdevelopment by the Mexican state, and more recently, destruction of livelihood caused by the NAFTA agreement. Peasant’s lives like Acephile are not only due to poverty itself but due to the political structures that continues to worsen her condition. The narrating also creates a tone or a voice and call from the hopeless which empathize the condition of the poor and powerless. It creates a soft tone to the ethnography as the audience reads the narratives but a very strong, defensive tones for the powerless when Paul argues and address the concerns of poverty and inequity.

Power and Inequity:
One of the chapter addressed the structural violence as  human right issues. ““A Plagues on All Our Houses?” exposes prison epidemics of tuberculosis in Russia, showing that structural violence is again central to determining who is most likely to be imprisoned, who is most likely to be infected and sick once detained, and who is most likely to receive delayed or inappropriate treatment. This largely overlooked epidemic of multitude-resistant tuberculosis will soon be too large to be hidden. The only way to halt what amounts to tuberculosis-as-punishment is to provide prompt and effective treatment to tall prisoners. Even amnesty will be inadequate, if prisoners are released to a dismantled public health system cannot cure them (Farmer 120).” This is an example of a peasant by the name of Sergei, whom struggled to survive and tried to set himself free from poverty by writing fake checks. This small crime has placed him in prison and be waited for trial. During the chaotic of government structure of the fall of the Soviet Unions, he was placed into a crowd, overflow of sick and victims of tuberculosis prisoners which he soon caught the disease himself.  Because he had no wealth or power, his small crime was never brought up to social justice until he eventually fell extremely ill and died.  This demonstrates that the poor are not only unable to have access to health care but also adequate nutrition and living condition to live.  Many of these examples and stories are very practical to demonstrates that without social, economic and political changes, those who are born poor will continue to experience injustice and ethical issues that could be resolved.  It could also allow the general public to acknowledge the root of many global health, public health and social issues are due to structural violence, the destruction of chronic cultures by industrialization and colonialism and the conflict of interest in politics.


Public Health and Possible Solutions:
The right of health is perhaps the least contested social rights and yet, it is possible the solution to both preventable ill-health and human right violations. For global issues, we can see that health advocacy has failed miserably due to politics interest discussed in lectures and the articles such as the What is Global Health.  It address the concerns of health issues and global crisis that were prolonged due to hidden political, social and economic agenda. Paul Farmer linked public health to social justice. With no access to treatment, pneumonia or TB is more lethal than AIDS. These were the issues for the poor. Even when charity groups and organizations were able to give a helping hands to these unfortunate individuals, the help were always second-hand, leftover medicine. This is true. When I go on medical missions to third world nations to give free medical and dental care, the medical material and medication are often donated from companies because it will soon be expired. Often we would try to fundraise enough money to purchase quality medication, but sometimes we also gather and collect with what we can because any help is appreciated by the poor. I can definitely confirm with this point that even charity work does also provide quality care for those who need most.  Just like the film we watched in class about clinic trial on third world nations, the poor and powerless are often second priority and deserves only what’s left. But this isn’t be the case. Health care can be a commodity to be sold or it can be considered a basic social right; it cannot be both. Ergo, equity also is the central challenge for the future of public health. Even Paul Farmers speaks of the “pathogenic role of inequity” and hence of a ‘right to equity’.

Some method that was addressed by Paul Farmers were:
1. To make health and healing the symbolic core of the agenda: He calls for engaging health
professionals in human rights work so as to ensure health for all and to decrease health
inequalities.

2. To make the provision of services central to the agenda: He asks us to listen to the abused
when providing services; to distribute interventions equitably; to closely work with community-
based organizations to improve access. He reminds us that States are best placed to protect the basic rights of poor people; that State failure cannot be rectified by human rights activism by
NGOs; that the search for (economic) sustainability is often at odds with social justice approaches to health; that efficiency cannot trump equity in the field of health and human rights.

3. To establish new research agendas: He thinks we need to examine why some populations
are at risk and others are spared human rights violations. Farmer fittingly reminds us, however,
that research should remain secondary and be designed to improve services and social justice.

4. To assume a broader educational mandate: Do not preach only to the converted, he tells us;
also, do not try to teach lessons to recalcitrant governments and reluctant international
agencies; simply more education will not do for them.

5. To achieve independence from powerful governments and bureaucracies: A central irony
of human rights law, he reminds us, is that it consists largely of appeals to the perpetrators;
collaboration with communities in resisting ongoing violations of human rights is the way to go.
And finally,

6. To secure more resources for health and human rights: States have become less able to
help their citizens attain social and economic rights even though they have most often retained
their ability to violate these rights. It is easy to demand more resources, what is hard is to produce them.

 Conclusion:
Overall, the author concedes his book is principled, but extreme. It is not harsh though; the realities it describes are; the crimes it unveils are predictable and ongoing. What all the victims have in common and share is poverty and an unwillingness to knuckle under. Pathologies of power damage everybody, but kill chiefly the poor. We cannot, therefore, stay in our comfort and
innocence. This ethnography allows readers to understand and see the perspective of anthropologist about global health concerns and ways to address it that are more feasible. It is good that people like us acknowledge the problems but it also equally important to act on it. You have read about the problems of structural violence, you may understand from the perspective of Paul Farmer and my analysis and so now it is your turn to voice and take actions to help those who are repressed by the power and wealthy.


Work Cited

Beaglehole, Robert, and Ruth Bonita. "What Is Global Health?" Global Health Action. CoAction, 2010. Web. 1 Oct. 2012.
<http://globalhealthcenter.umn.edu/documents/whatisglobalhealth.pdf>.

Farmer, Paul. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California, 2003. Print

Ethnography review of “In search of respect: selling crack in El Barrio”

ETHNOGRAPHY REVIEW

This paper is an ethnographic review of the ethnography about “In search of respect: selling crack in El Barrio” written by Philippe Bourgois. In this review, I will talk about major points of the book, and compare them with what I learn from the lectures and reading. I will also discuss the correlation between the book and global health issues.

In the ethnography “In search of respect: selling crack in El Barrio”, a book written by Philippe Bourgois, the author talks about his experience living in East Harlem, also known as El Barrio in Spanish. This section of Harlem, located in the northeastern of Manhattan, is notorious for having the highest violent crime rate and jobless rate in the entire New York City. The area also faces many other social issues such as teenage pregnancy, AIDS, drug abuse, and homelessness. Most of the residents who live there are Latino such as Porto Ricans, Mexicans, and Dominicans. As stated by Philippe, the main point of this book is not about crack or substance abuse, it is about his first hand experiences with the culture and poverty of East Harlem. It is about the struggles that people there have to go through in order to survive in an extremely poor area of one of the riches city in the world.

In order to write the book, Philippe had to observe and participate in real life events in East Harlem. He and his wife moved to the East Harlem and lived there for three years. The first thing that caught Philippe’s attention was that based on the data of 1990 census, 38.9 percent of local residents lived below the federal poverty line and 62.1 percent of them receiving less than twice official poverty-level income. The numbers were astounding because they suggested that over half of East Harlem residents wouldn’t be able to meet their basic needs. However what he observed was totally the opposite. Most people there weren’t starving or living in the street. In fact, most of them were adequately dressed and healthy. He questioned about the hidden resources that helped those people to maintain their basic needs. What he discovered was an enormous underground economy running in East Harlem. The economy involved around cocaine and crack selling. It was a huge job opportunity for most men in East Harlem and incomes generated from it outcompete every other job opportunities.  In fact, the incomes generated from selling drug were so attractive that the author was surprised that many people still maintained their legal jobs. In order to learn more about the system of the underground economy, Philippe had to be a part of it. He got to know and become friends with drug dealers, thieves, drug addicts. Those were the ones that granted him easy access to a crack house near his tenement. The crack house, also known as “game room” in the book, was where he did most of his observations in his book. He also went further as getting to know their parents, spouses, children, and friends to learn more about their lives and personal struggles. At the beginning, his white skin and accent gave him difficulties to become part of the community. The way he talked and acted were so different from the rest of East Harlem residents. The dealers and addicts would avoid him because they thought he was an undercover cop. The cops would assume that he was an addict and searched him in many different encounters. However, later it was revealed that his white look and accent actually gave him an advantage. His look became his protection against thugs because most of them would think that he was an undercover cop. It also helped him become close friend with Primo, Caesar, and Ray. Those people helped him in the process of writing the book and they played a key role in it.

The characters such as Primo, Caesar, and Ray were the different voice and perspective came through in the work. Primo’s voice was depicted as a helper in each story. He helped the author to understand more about the street culture of East Harlem. He accomplished it by introducing Philippe to people who played important roles in drug business like Ray who was a crack entrepreneur and owned the crack house where Philippe did the research. He warned Philippe about the danger and consequences of his actions. Primo, in a sense, was used to represent the East Harlem residents who were forced into the drug business because that was the only for them to survive. The voices of characters such as Benzie and Caesar were used represent the drug addicts working for the drug dealers. The more I went deeper into the book, the more I realized that they were actually victims of the vicious drug cycle. Character like Ray represented the powerful drug dealer who had power and authority in the underground world. He used fear and violence to run his crack house successfully. I can also see the vulnerable side of him in the book. He couldn’t read and was unable to deal with any form of legal paper work. Every small business he created resulted in failure. The powerful authority figure he created was used to hide his weakness and his vulnerable side. Each character in the book had a different voice, but their voices were all used for a single purpose, that is to portray the street culture of East Harlem and to create a sense of sympathy toward the people there.

The book does an amazing job at depicting East Harlem community. It mentions every aspect of the community. Both the lives of normal residents and of those who involved in drug market are depicted in it.  All the characters of the book are based on real life residents of the community. The author uses his first hand experiences and observations of real life events to tell his story. Those experiences include the interactions between him with people in East Harlem, his observations of the underground drug business and the conversations he had with family members of the people who involved in the drug market. His book portrays the street culture of East Harlem. This ethnography should be used as a primary example of what happen in a poor neighborhood. Through what happen in East Harlem, we can analyze the causes of crime, violence and drug abuse. Based on that, we can come up with an effective way to reduce those social problems. What we learn from East Harlem not only apply to poor neighborhoods but it can also apply to the whole country. We learn from the book that the number of drug dealers has a correlation with the loss of jobs of East Harlem residents. Losing jobs prevents people from provide basic needs to themselves and their family. It leads to illegal activities such as selling drugs. Based on that, we can attempt to reduce the unemployment rate in order to reduce the crime rate. We also learn that culture barrier plays a big part in keeping East Harlem from getting legal jobs. Most people in East Harlem lack the necessary social skills to interact with people outside of their community. The only legal jobs they can get are low paying jobs with little respect. This is the motivation that leads to illegal activities and illegal activities lead to violence and crime.

 “In search of respect: selling crack in El Barrio” is about global health issue even though it doesn’t focus on health and illness aspects of East Harlem community. The main focus of the book is the street culture of East Harlem and the people in that community. We learn from lecture that global health is the health of populations in global context that transcends national boundaries. In the reading Scrimshaw 2006- culture behavior and health, it states that health and illness are defined, labeled, evaluated, and acted on the context of culture, and that people around the world have beliefs and behaviors related to health and illness that stem from cultural forces and individual experiences and perceptions. We learn that cultures have a big impact on how we perceive things. People from different cultures perceive health and illness differently. Therefore, in order to improve the well being of a particular population, we need to know the context of their culture. And studying about health of populations is one of the main goals of global health.

Philippe discussed three major points in this book. The first point was that the underground drug dealing business was a result of people losing their legal jobs in East Harlem. The second point was that even though East Harlem was notorious for violence, it rarely occurred to the people who weren’t involved with drug. Only those who were part of the drug business encountered violence. His third point was that legalizing drugs would lead to the reduction of crime rate and violence in the community.

Philippe argues that the high unemployment rate in East Harlem caused people to take part in producing and selling drug. The census data given in the book shows that more than half of East Harlem residents should not be able to meet their basic needs, and yet people are not starving. In order to meet their needs, these people have to resort in underground, untaxed jobs. Crack and cocaine selling provides the necessary income for them to survive. However, it is surprising to find out that the high unemployment rate is not because people there are lazy and refuse to get jobs but because they are unable to find ones. East Harlem residents lack the social skills and knowledge required for most jobs in the city. The only jobs they can compete for fail to provide them adequate incomes to meet their basic needs. Drug selling provides them with income doubling or tripling the amount they got paid from legal jobs. It is a no brainer that most residents end up involving in the drug market. However, Philippe’s calculation shows that income from drug is not stable and often time they only account the day when they make a lot of money. On average, it is almost equal to minimum wage income.

His second point is that only the people who involved with drug selling encounter violence. The normal people don’t usually encounter violence. In fact, it is safe to walk around East Harlem during the day and even early in the evening. Philippe has only been robbed once during 3 years living in East Harlem, while his friends who live in safer neighborhood have been robbed multiple times. We learn from the book that violence occur mostly in drug business is because drug dealers use it as a defense mechanisms. They act tough in public to gain respect from their peers. By creating fear or a “reputation” among people in the underground community, no one would dare to try to harm them. It not only helps them protecting themselves, but it also helps them run their business smoothly. In the book, Ray abuses this tactic to run his crack house successfully for many years.

The third point that the author tries to convey in his book is that decriminalizing drugs can reduce the crime rate and violence in this area. His second point shows us that violence mostly occur in the group of people involving in the drug market. If we decriminalize drugs, the drug dealers no longer have the monopoly over the drug supply. It will inflict a big blow on drug dealers, and thus reduce their numbers. Violence and crime rate will also decrease as a result. Some might argue that decriminalizing drugs is wrong because of the negative impact drugs such as crack and cocaine inflict on human body. But it is obvious to see that even if drug is illegal, people still manage to produce, sell, and consume it on a daily basis regardless of the laws. It is impossible to stop people from abusing those substances and by legalizing them; we take away the monopoly drug dealers have.  

The solution of the author for the violence in East depends on how we perceive it. We learn from the lecture that perception is a process of gathering information through any or all of our senses, followed by the acts of organizing this information and making sense of it. And perception is shaped by a lot of factors such as practicalities of everyday life, culture, economic concerns, and social position. In order to understand the main points of “In search of respect: selling crack in El Barrio”, we need to put ourselves in the position of people living in East Harlem and see how the street culture shapes our perception.

Philippe did an amazing job in portraying a vivid street culture of people in East Harlem through “In search of respect: selling crack in El Barrio”. In this book, we learn more about the people and their motivation behind their actions. Through that, we can feel our sympathy toward those people. It is also a message to us about poverty in many parts of our country.