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anthropology

The Anthropology of Emory and Ebola: Emory Healthcare Thinks Outside of its “Concrete Box” by Laura Jones

23 Dec, 14 | by BMJ

 

 

Two days after Halloween, I met with Dr. Bill Bornstein, Chief Medical Officer and Chief Quality Officer at Emory Healthcare.  I am a cultural anthropologist who has been conducting field work at Emory University Hospital (EUH) for three years, and Dr. Bornstein and I meet monthly to discuss hospital culture, specifically that of the operating room.  I asked him if I could write about Emory’s experience with Ebola, and he said yes but was curious about my angle.  I said I was unsure.

 

Before leaving, Dr. Bornstein asked about my Halloween. I told him I went as Natalie Portman’s black swan.  He replied, “Have you ever heard of Nassim Taleb’s Black Swan Principle?…” He explained that people once believed all swans were white, and had never conceived of a black swan simply because no one had ever reported seeing one.  The metaphor suggests that we have endless assumptions about finite evidence.  Outliers are rarely predicted, but always seen in hindsight as glaringly obvious.  Dr. Bornstein and I locked eyes and smiled, knowing I’d found my angle.

 

The Ebola virus was named the Lingala word “Ebola,” or “Black River,” for a waterway near where it first surfaced. I sought to understand how Emory predicted the black swan that had emerged from the Black River.  However I soon learned that it didn’t–the isolation unit, or what its associate director Angela Hewlett calls the “Concrete Box,” was built with tuberculosis in mind, not Ebola.  But it wasn’t because of luck that Emory has been able to successfully treat four Ebola patients.  The M.O. of Emory Healthcare is that it’s better to be over-prepared than underprepared.  This had me thinking–has paranoia been key to the survival of our species, and will it ultimately cause our demise?

 

When I conduct behavioral observations at hospitals, my research subjects–the clinicians, not the patients–understandably wonder if there’s a chance I’m going to ultimately get them into trouble.  I am often called “the spy” and sometimes “the interloper.” During the height of the recent media frenzy over Ebola, I was once called “the Liberian.” In what seemed like every surgical procedure I observed, clinicians were agonizing over other people’s stressing about Ebola. Despite being in the same hospital as the disease, I didn’t overhear a single conversation about Ebola in the operating room. Maybe EUH wasn’t paranoid?

 

When Thomas Eric Duncan died in Dallas, my postdoctoral advisor, primatologist Frans de Waal, and I had a few impromptu conversations about empathy and socieoeconomic status.  Never a light discussion, it definitely wasn’t so with the man who has repostulated our understanding of the evolutionary foundations of morality (they’re not in humans).

 

This led to a conversation with Emory Healthcare President and CEO, John Fox, about empathy in the medical community.  When I asked if he’d lost any sleep in recent months, he said generally no. “I think we did the right thing by our mission and values.  [We asked ourselves two] basic moral ethical questions. Can we do it better than the alternative? …Can we manage it [and keep our community safe]? He continued, “We adopted the highest standards from day one. There were ideas and discussions of adopting lower standards; we had people who said we could do this more cheaply … We just said no. If we’re going to err, we’re going to err on the side of being too cautious. I said it very clearly–this may have a bad outcome. We have to be able to accept that.”  So from the operating room to the executive suite, there was a sense of responsibility and confidence at EUH that the rest of the country seemed to lack.

 

“The media attention was off the charts,” President Fox lamented. “We thought it would be X. turned out to be 10X.  It was major sideshow [on campus].”  He explained a few of the public’s divergent perspectives, “Some had a vision of the Ebola patient coming in on a concourse at Hartsfield, getting off the plane , getting on the trains, sitting there at baggage claim, and getting in a cab and then coming here.”

 

The public imagination is boundless. It hungers for black swan stories and even apocalyptic plagues. We have become what sociologists Anthony Giddens and Ulrich Beck call a “risk society.” I call it an “obsessive-compulsive” society.  As both a social scientist and someone who has been professionally diagnosed with mild OCD since childhood, I do not apply the label lightly.  One of the ways I have managed my tendency to speculate ad nauseum is to stop ingesting sensationalism.  Simply by replacing toolbar links to websites that cover celebrities and shootings with those that feature healthier interests, like discoveries in archaeology and neuroscience, I have stopped visiting the damaging sites altogether.

 

People are always surprised that as an anthropologist, I work with hospital executives.  I give major credit to these leaders, especially Director of the Emory Center for Critical Care Dr. Timothy G. Buchman, for understanding the need to explore the culture of biomedicine, and the broader culture in which we practice biomedicine.  Emory may not have been able to predict the black swan from the Black River any better than anyone else, but the hospital understood that Ebola does not mean the Black Death.  It was prepared but not paranoid, unlike the unprepared and paranoid public.  Rather than entertaining irrational fears and compulsively consuming news that exploits those fears, we need to look to intelligent, informed leaders like those at Emory Healthcare–who prepare for the worst but expect the best.

 

Laura Kathryn Jones, PhD

Postdoctoral Fellow

 

Emory University

Department of Psychology

36 Eagle Row

Atlanta, GA 30308

 

lkjones@emory.edu

 

 

 

Widening the Lens: Guest Post by Brandy Schillace

11 Mar, 14 | by BMJ

Widening the Lens | Medical Humanities

Brandy Schillace

Author, Historian and Adventurer at the Intersection (http://brandyschillace.com)

 

Recently, I read and reviewed Identity and Difference: John Locke and the Invention of Consciousness by Etienne Balibar. One of the points brought up in the lengthy introduction by Stella Sanford is that the reception of the work in its first edition was hindered by transcontinental miscommunication. It is a point worth considering. Our cultural context deeply influences the way we perceive everything from philosophy to art—and so it should not be surprising that this same cultural frame of reference has impacted what we mean by medical humanities. It can even influence what “counts” in the discipline (and this notwithstanding our frequent disagreements about humanities themselves!)

 

In the US context, the medical humanities are often subsumed under medical education or bioethics initiatives. At the Cleveland Clinic Lerner College where I help to develop year two curriculum, medical humanities consists in history, ethics, literature and arts with the purpose of integrating “the human dimension into healthcare, medical education and research.”[1] The New York University School of Medicine defines medical humanities in a similar fashion, as “an interdisciplinary field of humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice.”[2] In both of these statements and countless others in the United States, a key focus is upon the humanities utility to the practice of medicine. It enriches the human perspective, but with only a few exceptions, the medical lens is still primary. This differs from perspectives in the UK where, for instance, the Centre of Medical Humanities at Durham considers medical humanities to be a field of enquiry where the humanities lens is brought to bear on the enterprise of medicine. The BMJ’s medical humanities are similarly situated, seeking to enhance the discussion of medicine in a forum that welcomes critical exploration in which the humanities are frequently privileged and primary.  On one hand, these two perspectives do not seem divergent. And yet, small differences do matter. We seek inclusivity—and medical humanities is a necessarily broad field—but certain perspectives still fall between stools.

 

Despite our aims at diversity, one aspect of the medical humanities easily overlooked is the one nearest to us—the same that influenced the reception of Locke and of Barber’s work about him—our cultural context. Nothing is so blinding as the screen of self; we cannot get outside our own heads to see with other eyes. Those most adept at translation are those most immersed in multiple worlds, which is why I so deeply value medical anthropology and social medicine as critical lenses. This is also why I value the historical perspective—anything that unmoors us so that we may look back at a distance and see more of the picture. To Victorians, animal magnetism, mesmerism, mediums, paramnesia, proamnesia and displaced memory were all more or less soundly scientific. Further into our history we find alchemists, and long before that, Greek philosophers experimenting with elements supposedly ruled by planets and by the gods. How much of what we believe today will be cast out in the future? And might not some of that past knowledge be resurrected? An oncologist friend of mine recently pointed out that humoural theory has begun to have a certain valence once again—“progress” is rarely linear, after all.

 

I will examine a case from the US context, and from my work at Culture, Medicine, and Psychiatry, an international journal of cross-cultural health research. Devon Hinton, of Harvard, works a great deal with Cambodians suffering PTSD after the Pol Pot period. What he discovered was that this group possesses a unique “bereavement ontology,” in which dreams of the dead play a crucial role.[3] In another work by Hinton a few years earlier, he similarly looked at somatic distress, and here, too, the findings were unique.

 

The Cambodians believe in a wind-like substance called khyâl; this “wind” is greatly feared and considered pathogenic; it may “surge upward in the body” to cause bodily catastrophes: neck soreness, rupture of vessels, dizziness  and weakness.[4] The psychiatrists understood these as post traumatic symptoms, but that does not make the khyâl less real, or the dreams of the dead less important. Cambodians frequently resort to coining and cupping as treatment—and just because therapists also want to use biomedical methods of treatment does not negate the positive benefits of these traditional healings. Their experiences are not less “true” because they are conceived of along different lines, because scientific and medical truth are relative to context and experience. Seeing the relevance of other cultures’ beliefs and practices is valuable to remembering that the truth we cling to is largely a product of our cultural underpinnings. Does coining work? Ask the Cambodians before you say no. It’s working for them.

 

How does this relate to the medical humanities? The connection I draw between medical anthropology and our shared discipline is bridged, in part, by social medicine. As yet one more useful lens, social medicine studies intersections of medicine and society, the ethical and social contexts of medicine’s larger enterprise. Taking these perspectives together, we may be able to re-see ourselves, stepping away long enough to recognize that health is intimately bound up with the human, knit together as close as the bodies that contain us. The useful distance of history and place should also force us to recognize that there is room enough for medical understanding and for personal truth. Lastly, the social dimension should remind us that there are consequences to all we do—including the boxes we draw around ourselves and others. Will that make us too broad? I can imagine the question being asked, but for me the answer is necessarily yes. In fact, medical humanities ought not only to be broad, it ought to facilitate breadth. Only in so doing will we remove obstacles and be truly interdisciplinary—and in fact international—in scope.

 

As with so many things, we always see more when we widen the lens.

 


[1] Martin Kohn, Director. Medical Humanities/ Information Page. Cleveland Clinic Lerner College. http://my.clevelandclinic.org/about-cleveland-clinic/ethics-humanities-care/medical-humanities.aspx

[2] Felice Aull. “Mission Statement” Medical Humanities New York University School of Medicine

[3] Devon Hinton, et al. “Normal Grief and Complicated Bereavement among Traumatized Cambodian Refugees: Cultural Context and the Central Role of Dreams of the Dead.” CMP (2013) Volume 37(3):427-464

[4] Devon Hinton, et al. PTSD and Key Somatic Complaints and Cultural Syndromes among Rural Cambodians:

The Results of a Needs Assessment Survey.” Medical Anthropology Quarterly (2012) 26(3):383-407

MASK:MIRROR:MEMBRANE-A Deborah Padfield Exhibition, London 6-16th July 2011

15 Jun, 11 | by Deborah Kirklin

Here’s one for your diary, an exhibition of images by Deborah Padfield, in collaboration with patients & clinicians at University College London Hospitals NHS Foundation Trust, entitled Can you see Pain? Anyone who knows Deborah’s work from her previous exhibition and book entitled Perceptions of Pain won’t want to miss this.

http://www.dewilewispublishing.com/PHOTOGRAPHY/Perceptions.html more…

2011 International Symposium on Poetry and Medicine

17 May, 11 | by Ayesha Ahmad

I recently attended the 2nd Annual Hippocrates Poetry and Medicine Symposium, which was held at Warwick Medical School and hosted by Professor Donald Singer and Associate Professor Michael Hulse. During the day, a group of researchers and clinicians from a variety of backgrounds gathered to explore the role of poetry in the discourse of medicine, including renowned poets, Marilyn Hacker and Gwyneth Lewis.

more…

Stories of the Land

29 Jan, 11 | by Ayesha Ahmad

Having recently visited some of the most modern hospitals in the world, I have been struck by the style of their architecture. There seems to be a changing face of medicine, whereby the expressions of the building housing the body of medicine mirror certain conceptualizations of the human body. I began to wonder how does this affect our experience of ourselves in both health and illness. From the compartmentalized, sterile structures of cosmopolitan cities to the shacks of mountainside shamans, what are the similiarities and differences to be found?

more…

Hearing Voices

1 Oct, 10 | by Ayesha Ahmad

Perhaps, one form of illness where telling a story of the body is most evident is in respect to mental health.

Yesterday’s ruling by the High Court’s Court of Protection, that a 69 year old lady with severe schizophrenia must receive the medical treatment for a prolapsed womb, which she has been strongly refusing and protesting against, reveals the battle that one person’s voice can hold.

Is it pathology to not fight the presence of pathology in the body?

more…

Fasting: Unto Life and Until Death

9 Sep, 10 | by Ayesha Ahmad

The month of Ramadan is drawing to a close. During this time, Muslims from every terrain, from the hottest countries, to the most Westernised societies, have been involved in a shared yet equally an exclusive passage of religious rites.

Ramadan is a unique time in the Islamic year. For a period of one month, the spiritual attire of a pious Muslim is found in the exercise of fasting. With the exception of the sick, a Muslim is forbidden to eat or drink during the hours between sunrise and sundown.

The routine is one that involves the highest degrees of self-discipline and control. Through such rituals, there becomes a higher degree and awareness of spirituality. With the removal of a conscious acknowledgement of bodily needs, there is space for reflection and prayer. However, the object of effect is the human body. Awareness of the soul can be attained only through the regulation of the human body. Thus, there is almost a paradoxical relationship between the body and the soul during fasting.

more…

Memories

5 Jun, 10 | by Ayesha Ahmad

Memories

This piece is a reflection on an article from the New York Times this week. The story is told about a large family from Colombia, and their many relatives who have developed early onset Alzheimer’s disease. The case has been baffling doctors and scientists, both in Colombia and the United States.

more…

The Landscape of Lesotho

10 Apr, 10 | by Ayesha Ahmad

Lesotho is one of the highest countries and is entirely landlocked by South Africa. 40% of Lesotho’s population survives on less than $1.25 a day. In centuries gone by, the people of Lesotho were driven high up into the mountains by the Xhosa and Zulu people and have repeated a solitary and isolated life, mainly farming, ever since. However, Lesotho is also experiencing one of the highest rates of HIV/AIDs infection rates in the world. This is their modern day crisis. What does survival mean in this situation? How can we conform to a meaning of being human when our human situations differ so dramatically?

more…

Whose autonomy is it anyway? Drawing back the curtain

3 Feb, 10 | by Deborah Kirklin

A few weeks ago our first year students were thinking about patient confidentiality and it was my task to facilitate the process. The group I was with were from diverse cultural backgrounds and from several different countries, including the UK. Whilst they all readily grasped the idea of respecting  confidentiality as a way of respecting autonomy, some came from cultures where doing so was less important than it is for the average UK patient. Last weekend, visiting an elderly relative in hospital in Germany, I was reminded of that conversation.

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