Medical Citizenships - Essay Example

MEDICAL Introduction The anthropological term, medical citizenship, refers to the extent of access to medical care, both physical and mental and including pharmaceuticals, enjoyed by different populations in the world and the quality of care received. This essay outlines examples to illustrate the different standards available due to different medical citizenships. Citizenship and Physical and Mental Health Care Cancer in Botswana is much different than cancer in New York City in terms of its’ oncology, that is its’ recognition as a distinct entity (Livingston 2012). For example pre or early stage breast cancers are unknown in Botswana because required screening technologies and programs of mass screening are unavailable there. Cancers are usually realized when they become obvious in an advanced stage requiring mastectomy. Also in the US women are more likely to learn how to deal with breast cancer through friends with the disease, support groups, and fund raising appeals. In Botswana because of the absence of oncology there is no collective experience of the disease or knowledge of the biomedical therapeutic process required for cure. Recently there have been some attempts to disseminate public knowledge through posters and other means, but they do not resonate in Botswana as they are copied from ones in the West and recommend unavailable screening and are without cultural adaptation. On the other hand, diseases such as HIV, hypertension, diabetes and tuberculosis are well known, so Botswana patients have to learn to distinguish these diseases from cancer. Although Botswana has universal care it is geared to grappling with infectious diseases and mother-child health. Cancer is largely unknown by medical workers except in a cancer ward in a public hospital. Furthermore, even in the hospital diagnosis and treatment are hampered by staff shortages and turnover, lack of modern functioning equipment, and appropriate drugs. There is also a high risk of co-infection with diseases such as HIV. Even when some women are told they have cancer, they may self deny until it advances and they are forced to deal with it. Also even many doctors in clinics and private hospitals deny the oncology because of ignorance of the disease and/or they don’t know how to deal with it. When arriving at the cancer treating hospital some patients are distrustful because they already had sought relief from Christian an Tswana prophetic leaders without success. Many do not understand biomedical explanations so it is better to talk in terms of analogies or say things like” you will hate my treatment, but it will help you”. In Botswana the human body is understood in different ways with organs in different places and connected in different ways. Therefore imported medical texts are useless unless adaptations are made to take this into account. Doctors need to be able to analyze patient symptom descriptions to determine which are relevant to the cancer being treated. Where there are no equivalent terms such as for the English immune system clever analogies such as “little soldiers” have to be invented to get the point across. The treating doctor would impart cancer knowledge piecemeal over several clinical visits to make it more easily understood by the patient. Humor is often used to help alleviate the pain of cancer and the rigorous treatment required. Thus it can be seen that medical citizenship for cancer patients in Botswana is very different than it is in the US. Medical citizenship of a very different kind is illustrated by Ukraine resulting from the Chernobyl disaster. A nuclear plant exploded in Chernobyl, Ukraine (then part of the Soviet Union) in April, 1986. This resulted in immediate injury in the form of radiation burns and death to plant workers, damaged immunities and high rates of cancer among resettled populations and substantial soil and water contamination (Petryna 2004). There was no official announcement of the disaster for about 3 weeks. In that time about 13,000 children in contaminated areas took doses of radiation to the thyroid more than twice the highest allowable dose for nuclear workers for a year. A massive onset of thyroid cancer in adults and children began appearing 4 years later. The numbers could have been significantly reduced had the Soviet Union supplied iodine pills within a week .Soviet authorities consistently underestimated the extent of the injuries which were exacerbated by dubious repair and containment efforts. When Ukraine became independent in 1991 it took steps to decommission the power plant and shore up it’s protective shelter at least partly in order to qualify for Western aid. Workers who had been victimized by the disaster were designated as “sufferers” by Ukraine and given very small pensions. In spite of continued radiation hazards workers continued to compete for jobs in the Zone of Exclusion, 30m kilometers surrounding the former nuclear plant, because of relatively high salaries. The disaster is estimated to have harmed at least 3.5 million people in Ukraine and the long terms effects are unknown but most likely underestimated by conflicting projections influenced by political considerations. Although people classified as “disabled” could command greater benefits in terms of pensions, cash subsidies, family allowances, free medical care and education than those classified as merely “sufferers” this is still inadequate compensation due at least in part to conflicting health projections allowing bureaucrats to select the one with the least entitlement. Furthermore the onus is on the claimant to prove their radiation dose and therefore their compensation entitlement. Nevertheless Ukrainian compensation was better neighboring Belarus, which suffered more damage, and Russia causing some critics to argue that the Ukrainian claimants just didn’t want to work. However the Chernobyl disaster was an impetus for international medical research as Gorbachev invited American and other scientists, which likely would not have occurred but for the disaster. There was Soviet government interference in benefit entitlements by classifying some symptoms as panic disorders to minimize qualification for disability benefits. They also had high thresholds for acceptable safe levels later reduced by Ukraine to comparable American standards Under Ukraine administration there was a sharp increase in benefit qualification to include psychological disorders attributed to the disaster. Of course such broadened benefit entitlement open to all in Ukraine affected by the Chernobyl disaster whether citizens or not has led to some corruption in the competition for benefits There is a motive to allege ailments of children not even born at the time of the Chernobyl disaster as being caused by it through the mother’s radiation exposure in an effort to establish benefit entitlement under medical citizenship. In Canada legal citizenship brings medical citizenship in entitlement to high quality universally accessible care financed by taxation. Although this applies Canada wide health care is administered by the provinces (equivalent to US states). Therefore there is some provincial discretion concerning the exact benefits provided. For example in Ontario benefits tend to be limited to orthodox Western style treatments and Oriental treatments of proven efficacy such as acupuncture are not covered. However such treatments are covered for example in British Columbia. I suspect the Ontario exclusion is due both to budget restraints as well as unfamiliarity with their efficacy. Thus Canadian citizenship also provides a high degree of medical citizenship.. The US also has of course high quality medical care but not universal access as it is very expensive. President Obama has improved access by establishing insurance exchanges under the Affordable Care Act to reduce this cost and offer consumers different levels of coverage and mandated the removal of previous exclusions by insurers such as for preexisting conditions. He has also offered subsidies for those unable to pay the insurers premiums. Thus while care is still provided through private insurers rather than the government he has stabilized costs and improved accessibility. Also tax rates are kept lower than in Canada and the UK where the governments finance the care. Thus while US citizenship does not include medical citizenship to the degree of Canada and the UK Obama has stabilized the cost and improved access. Finally in this section “Dreaming of Psychiatric Citizenship” in relation to an inmate convicted of murder incarcerated in the Supermax section of a prison (Rhodes). The inmate approached the author admitting he was placed in solitary confinement due to violent behavior, but asking for her help as a case study. She diagnosed him as suffering PTSD among other things due to a parental abuse upbringing. She lamented that he did not fall into any of the psychiatric citizenship classifications recognized by the prison and therefore considered him simply as a very bad guy only worthy of isolation in solitary confinement. With her help he was transferred to another institution in a little less isolated setting and although the article followed him only for a short time, he displayed some improvement in both disposition and ability to coexist with other prisoners. The author concluded that there should be consideration given to broadening inmates’ psychiatric citizenship because the continued solitary confinement appeared only to exacerbate the inmates’ violent antisocial tendencies. Pharmaceuticals and Citizenship The “Anthropology of Pharmaceuticals” describes how culture has long attached special transformative power to material substances such as pharmaceuticals (van der Geeat et al 1996). The concreteness of medicines are deemed to have the capacity to change the condition of a living organism for better or in the case of sorcery for worse. Anthropologists did not begin to study systematically pharmaceuticals until the 1980s when issues developed concerning the heavy reliance and possible over consumption of pharmaceuticals developed in Western medicine through self medication the supervision of a formally trained health worker. Although inanimate objects, the authors discuss pharmaceuticals in terms of a biographical life cycle including 1)production and marketing 2) prescriptions 3) distribution and 4) use. With regard to production and marketing, recent studies show how the industry presents biased safety data to drug regulatory bodies like the Food and Drug Administration (FDA) to register new products and get them on the market. This is concerning because when it happens the interest of patients having adequate information is compromised. In my view the FDA and other regulatory bodies should do their own rigorous testing. Drug manufacturers are huge and powerful corporations and not only must regulators be free from corrupt bribes, but political contributions from them should be strictly limited to prevent political influence. Although there have been few anthropological studies on pharmaceutical production and marketing including sales reps, the industry argues that it is now sensitive to local variations in cultural concepts of health, illness and medicine. Unlike in some parts of the world, in North America only doctors are legally supposed to write prescriptions which give the patient the power to buy the product from a pharmacist. While it is impossible to control the patient’s misuse of the product, I suggest that efforts be made to try to control the distribution that could facilitate the misuse. For example a doctor and patient may collude to get prescriptions for excessive amounts of legitimate product(s) that have dubious value for treatment of the stated ailment, or patients may doctor shop to get prescriptions from several doctors. This may be done to make a “cocktail” to get euphoric highs which can be just as dangerous as illicit drugs like heroin and cocaine even though safe if used as intended. Even though innocently intended, doctors may over prescribe rather than consider the efficacy of alternative treatments such as acupuncture because of the high value our culture places on “pills” with the expectation that their consumption will bring quick effective results. If prescriptions are considered the right treatment, I suggest that herbal based be considered as an alternative to chemical based which may have more negative side effects. In my opinion to guard against the potential for inappropriate prescription sales, they should be done only by qualified pharmacists and recorded on a data base so that suspicious attempts to buy can be flagged and delayed until their propriety can be investigated by the governing medical association. Conclusion From the few examples given it is clear that accessibility and quality of medical citizenship varies widely from country to country. I would argue that this is morally wrong. Good health care should be a human right like food and shelter. While it could not be done overnight, I suggest that efforts be made to level the “playing field” of medical citizenship by having an organization such as the World Health Organization control the distribution of medical services. It could “tax” countries based on their ability to pay as measured by GDP for example, and control the distribution of services based on need keeping in mind regional cultural variations. References 1) Livingston, Julie “Creating and Embedding Cancer in Botswana’s Oncology Ward. Improvising Medicine An African Oncology Ward in an Emerging Cancer Epidemic” Duke University Press Durham & London 2012. 2) Petryna, Adriana “Biological Citizenship The Science and Politics of Chernobyl Exposed Populations” Osiries 19(224) 250-63 The University of Chicago Press. 3, Rhodes, Lorna A. “Dreaming of Psychiatric Citizenship A Case Study of Supermax Confinement” A Reader in Medical Anthropology. 4) van der Geest, Sjaak, Reynolds-Whyte, Susan and Hardu, Anita “The Anthropology of Pharmaceuticals A Biographical Approach” Amer. Rev. Anthropol. 1996. 25-153-78. Read More