The Assimilation of Culture and Biomedicine

Culture is an important aspect to reflect upon in the context of healthcare work because it influences how doctors, caregivers, patients and their dependents view illness and consider treatment. Previously, I have always thought there were two standards of health to consider; a biological standard according to scientific studies and a cultural perception of health. However, after reading numerous articles about the implementation of biomedicine, I have come to characterize biomedicine as simply a foreign culture; worthy of equal attention and the process of discourse is simply issues with assimilation into the material world. For the sake of this article, I will attempt to name numerous health perspectives and the motivations that influence them.

In Margret Lock’s essay “Medical knowledge and Body Politics”, Lock explains the discourse of medicine and culture in relation to historical narratives. “People everywhere have amassed knowledge and practices designed to preserve health, account for the occurrence of illness, and provide therapeutic relief” (Lock: 190). Lock argues that medicine has currently become a part of society and its form and purpose is shaped by societal values. This view is further expanded in Susan Scrimshaw’s article, “In International Public Health”. She explains that all countries employ biomedicine and indigenous practices into health programs. Failure to consider other means of healing would result in disaster. She states, “Experience has shown that health programs fail to recognize and work with indigenous beliefs and practices and also fail to reach their goals” (Scrimshaw, 43).

Culture is defined as shared beliefs, customs, and social behavior of a particular group and much like other societies; biomedicine has its own set of distinguishable notions that separate it from indigenous medicine. Biomedicine is concerned with single causes while the concept of health, as understood by indigenous peoples is an individualized endeavor and tied to their relationship with the land. Biomedicine characterizes health with such rhetoric as “the absence or presence of health” by definition of generalized symptoms (Lock: 193); and whereas East Asian healers describe health as a continuum with the disease on an individualist basis. Biomedicine is a community defined by shared cultural convictions that it has no shared cultural convictions only timeless universal truths. It is essentially a culture of “no culture” or a culture with perceived universality. These notable differences may be just cause for categorizing biomedicine as its own cultural practice. Scrimshaw explains that perspective is vitally important to treatment, she declares that “research to plan and evaluate health programs must take cultural beliefs into account if researchers expect to understand why programs are not working, and what to do about it” (Scrimshaw, 43).

African mother awaiting delivery. As you can see, she sits alone on the floor. Her face is calm, a reflection of her cultural beliefs that childbirth is a womanly duty.

In Hannah Brown’s article “If we sympathize with them they’ll relax”, Brown examines nursing practices in Kenya that would be considered harsh to the western world. However, the relationships in this Kenyan hospital are shaped by relationships beyond the clinical setting. Nurses and patients understand care relationships in maternity ward in relation to norms of Luoro care. Luoro care is a Luo term meaning both fear and respect. Luoro care is a societal standard that characterizes a child’s relationship to his or her parents, teachers, and other adults. It also characterizes the relationship between patients and nurses and clinicians. (Brown: 125).

 

Figure 1.2: African Midwife attends to newborn shortly after birth. As you can see in the picture, gloves are absent. This is due to a shortage in the hospital facility.

 

The apparently “harsh’ treatment of birthing women is meant to produce the outcome that all parties desire, the healthy birth of a child, an uncertain prospect in the context of labor. The women of the Luo culture are verbally abused, shamed if they scream during childbirth, and slapped if they are incompliant. (Brown: 127,134). There is no showing of concern or touching while the women is in labor, the nurse simply waits for the women to get through it. (Brown: 127). Waiting for the emergence of the baby before donning one pair of gloves; seems harsh in the context of a women suffering through the pains of labor but in the broad context, but it makes sense considering the limitation of resources. Although this is a form of cultural adaption to biomedicine, but it is still biomedicine, nonetheless.

Although the practice of medicine in regards to health is immensely important, I would argue that the education of prospective medical professionals is also equally important to consider. By examining structural issues that characterize the practice and education of biomedicine, we can see that the medical education system in Malawi is very different from the medical system in the United States. In both the US and Malawian culture, becoming a doctor is an initiation into an elite social standing; it means better access to medical care for your dependents.

Figure 1.3: Doctor in Malawi examines a child with assistance from the child's mother

In Malawi, it is important to note that medicine is not the path to wealth, as it is commonly referred to in the United States. Malawian students study the same material in school but much of that information is useless because there is a severe shortage in the material conditions of the work, she expressed the frustration of clinical students as  their “beliefs in technology as the ultimate means of healing were frustrated by technology’s absence” (Wendland: 201).

In the case of Malawian doctors in Clare Wendland’s book, “A Heart for the Work: Journeys through an African Medical School”, the doctors have a cultural understanding that their patients victims of circumstance and face impossible odds. With a neglectful government and little to no access to basic necessities, the idea of health in Malawi is much different than health in westernized countries. “Students were unable to maintain biomedical assumptions about the individual locus of pathology once confronted …by human suffering that results from severe poverty is met with state and supranational neglect” (Wendland: 201). In the face of severe neglect, the doctor operates on a transnational stage, treating more than individual pathology but the entire body politic, which can be argued as a cultural adaption to the inadequacies of biomedicine.

Biomedicine and culture become assimilated in the clinical setting but it is important to note that both parts represent contrasting values, customs and social behavior. Culture dictates our response to biomedical diagnosis and in turn, affects our willingness or reluctance toward treatment.  Although in class we discuss the discourse that exists between the two, after meticulous research, I argue that it is not the work of two independent factors working toward discourse; it is the issue of assimilation within the clinical world.

                                    

Sources

1.      Hannah Brown, 2010, “’If We Sympathize With Them They’ll Relax’: Fear/Respect and Medical Care in a Kenyan Hospital” Medische Anthropologie 22(1):125-142

2.      Clare L. Stacey, 2011, “The Costs of Caring,” and “Doing the Dirty Work,” chapters 1& 2 in The Caring Self: The Work Experiences of Home Care Aides (Ithaca: Cornell University Press), 24-84

3.      Margaret Lock, 2002, “Medical Knowledge and Body Politics.” In Exotic No More: Anthropology on the Front Lines, ed. Jeremy MacClancy (Chicago: University of Chicago Press), 190-208.

4.      Claire Wendland, 2010, A Heart for the Work: Journeys Through an African Medical School (Chicago: University of Chicago Press)