Wednesday, 17 November 2010
MEDICAL ANTHROPOLOGY AND WESTERN MEDICINE
Western Medicine is practiced without empathy and understanding of the person, in a totally un-holistic way in all the five countries mentioned.
The Cardiologist in Miami was friendly, the Cardiologist in France was efficient, the Neurologist in Bangalore did a brief exam and the ENT doctor in KL was humourous but dismissed my queries as being not important. No body could help me with information about how to remain healthy, but all of them had a tendency to convey the information that one can expect wear and tear, as one gets older. All of them had cursory advice like: Take care of the nutrition.
Thus the experience with Western Medicine has been a robotic one. It is as if I was a car needing some replacement for worn out parts and the mechanic could take care of it: a CT of the lower back, Stress test, Echocardiogram, MRI of the sinuses.
Objectification of symptoms, mechanization of thought, dismissal of the patient’s explanatory models, and in general a disregard for the knowledge of the patient.
My respect for western medicine is at its lowest level at the moment after the encounter with the Cuban Doctor. Secretly I had hoped that the Cubans with a formation within the society which is far more egalitarian and socialist would have a point of view slightly different from the money driven medical practice of Miami, or the Meat Market Shopping of Manipal Medical Center in Bangalore or controlled National Health Service of France. No, it was not to be. He was overbearing, middle aged and obese, with no bedside manners, and his examination of my limbs took him less than one minute. There was no comforting words but only some paternalistic advice (I did tell him that I knew a fair bit about nutrition and that the advice to take care of my nutrition was a little superficial).
The consultation fees differed by the country regardless of the service or the results.
USA 235 usd France 75 Euros Bangalore 300 INR Cuba 25 cuc and the doctor in KL did not charge me as I was a friend of his faithful patient and the normal charge would have been about 30 usd.
Dissatisfaction at any price!
My connection with Cuba has been in the fields of Psychology and Anthropology and I have been impressed with the quality of their thinking and caring. Cira Garcia is a fee for service system set up in Cuba to serve foreigners and many Caribbean islanders come here since the services are cheap compared to the other alternative, which is Miami. I wish the clinic financial success as there is a need for tertiary advice but my advice to you is:
Doctors are not helpful when your problem is not acute or simple that they need to think about it. They are good at acute situations and vague when it comes to prevention with no interest at all in Health but with all the interest in the world in Disease. Cuban doctors have the same mentality as the western doctors trained in the Cartesian model of division of body and mind.
My friend is a professor of Psychology, can with her comprehension about human feelings; take care of a lot of medical problems even though she is not a medical doctor. When my blood pressure was fluctuating, the cardiologist in Miami suggested that I take medications, while the cardiologist in France did not see the need for medication. The neurologist in Bangalore after seeing that my CT of lower back and Nerve Conduction studies were normal, said in a plain voice, I am not quite sure what to advice you. The humourous ENT physician suggested that my decreased hearing might indicate my decreased desire to hear! The psychologist in Cuba was the first one to alert me, her first question to me was: what has happened in your life in the past year? And then suggested a way to go around the stress of the times and take care of my body thus.
2009 had been an eventful year for me; I had traveled 13 times from Paris to Miami to oversee the medical treatment and the surgical removal of the cancer in the lung of my sister. I was her counselor and translator of the medical world. For those of you who have watched a dear one undergoing chemotherapy with the likes of Taxol or Neulasta (to increase the white cells), and the excruciating pain as well as the general sense of being totally unwell, can understand the stress of being a care provider. In addition, I had to think in terms of prevention of any complications. Since her medications could give her hemorrhagic cystitis, we had to set up alarm to make sure that she emptied her bladder once every three to four hours at night and was well hydrated.
So the psychologist’s advice to me was not to take any medications, but to cut the frequency of my visits to my sister now that she was free of the disease.
I am a Medical Anthropologist and take the doctor-patient relationship seriously and see it much more than just a mechanical transaction the kind a car mechanic has with your car. Every person lives in the context of their lives and no two lives are the same, so this idea that a general consensus exists about the treatment or an algorithm of treatment exists is sheer nonsense. I had written earlier how one has to navigate very carefully through clinical studies done since up to 90 per cent of them are without value outside their contexts.
I am concluding my anthropological study of the observation of doctors practicing western medicine in five different countries: two in the Americas, one in Europe and two in Asia, with the following warnings.
Doctors and Western Medicine, to reiterate what Ivan Illich has said thirty or forty years ago, is dangerous to your health.
Western Medicine is excellent when you are having an acute problem such as multiple fractures after an accident or a myocardial infarction. It is not helpful and actually may harm you if you have a chronic problem such as Hypertension or Diabetes.
Western medicine is incapable of prevention of diseases since the thinking behind the treatment if detrimental to the process of prevention. None of the doctors I talked to were in a position to give advice to prevent diseases whereas they were able to suggest various mechanical resolutions such as CT, Gastroscopy, Sinus Surgery, all invasion of the body. None of the doctors I interviewed were capable of giving any sort of psychological or socially related counseling or advice.
But this is the world we live in, whether it is Cambodia or Cuba. At least in most societies you are not paying for your medical care so you can be a little bit more expansive in your choices. It is in the societies where the medical care is fee for service that the dominance of the western medicine usually quashes the appearance of alternative or complementary medicine. Even the nomenclature Alternative Medicine assumes the supremacy of Western Medicine. I am sure they don't consider Chinese Medicine in China, Alternative?
But great diversity exists in the healing systems all over the world. After the brisk encounter with the mechanistic world of Western Medicine in Cuba, I drove to the house of the longest practicing Yoga teacher in Cuba! Western Medicine is just one part of the spectrum of what is available and I believe that in the care of patients, western medicine including their lackeys Doctors, Nutritionists, Exercise Persons, Pharmaceuticals consist no more than 25 per cent of the efforts necessary to heal the suffering person.
American Indians have taught me that, to achieve a balanced life, there has to be equal attention to many parts in ones life. Using the model I have come to following conclusion:
For a person who is suffering from a chronic condition or illness:
25 % western medicine, including the clinic and Physiotherapy etc, all the western accouterments
25% has to be family oriented counseling
25% spiritually oriented counseling
25% is the changes in the lives of the patients in understanding the social responsibility of their lives.
Western Medical trained people can take care of you; they are the complimentary medicine to the 75% of the caring. Healing comes from counselors and persons who can educate you about the context in your lives and that is the major part. Western medicine interested in curing plays a minor part.