"To a fish, the water is invisible."

A year or two ago I took a class with Dr. Rita Geier that examined four different cultures and how they treated different life events. At the beginning of the class, we were tasked with defining ourselves as cultural beings. Interestingly, when it came time to share how we described ourselves we saw two outcomes:

1) People enlisted words such as funny, studious, etc. to describe themselves. But they were doing just that—describing themselves and their personality, not their culture.

2) A minimal, incomplete description consisting of one or two words. I fell into this group. I knew funny didn’t describe a culture…but what did?

Later in the class, a professor from Switzerland helped us to understand and describe our culture. It was interesting that an “outsider”, if you will, was much more able to identify our cultural characteristics thaN we were.

In Mary-Wynne Ashford’s essay “Toward a Culture of Peace” she discusses why it is hard to change culture. She implies that we are so immersed in our own culture that it is difficult to separate the culture and its values from other aspects of our lives. She illustrates this with an African proverb:

“To a fish, the water is invisible”

This immediately reminded me of my experience in Dr. Geier’s class. Our own culture was invisible to us. The Swiss professor helped us to grow a fuller understanding of our own culture. And truly, I recognized aspects of my cultural life that I had never pinpointed before.

When I and other colleagues go abroad we often wonder what our place in studying another culture is. This proverb, in combination with my experience in Dr. Geier’s class, clarifies our role a bit. Others, like we in our own culture, are fish in their own cultural waters. We because of our foreignness have the potential to notice aspects of other cultures that are just too obvious for the people to bother noticing, in general. An outside perspective can be beneficial once in a while.

A short war and health nugget that might hit closer to home

One of the adverse affects of war on health that I think about often is the diversion of resources—be it monetary or otherwise—to the war effort. Resources that could be spent on providing public services are used instead to build and/or purchase weapons and support military efforts. In the context of my general studies the narrative goes a little like this:

A corrupt government in the developing country of X is siphoning resources to use to its own ends, and the rebel militia group is stealing and looting from civilians. The government does not allot appropriate percentages of the national wealth to public services such as clean water, sanitation systems, public health services, or safe transportation. This leads to unhealthy living conditions and lack of access to health services.

To be succinct.

But I’d like to draw your attention to a disconcerting parallel you might have noticed in the news as of late—Health reform in the U.S. The current U.S. war effort is one of the main reasons our deficit is the leviathan it is today. I was first confronted with how pervasive the issue of the deficit was three years ago when I was in D.C. lobbying for Congress’s support of peace efforts in northern Uganda. Everyone’s go to reason for their inability to acquiesce our petitions—the deficit. Now, we are seeing Congress struggle with pushing through health reform efforts that work with the deficit. We’re a capitalist society. We know to start a new business you need capital. America has fondly taken healthcare to be a business, so it follows that to overhaul our current health system and start this “new business” we need significant capital.

Massive deficit due to war = minimal capital for health systems.

Although one might argue that the situation in the U.S. is completely different that in developing nation X, there are parallels. In the States, our money and resources have been diverted to the war effort, minimizing the resources remaining to be concentrated on public services such as healthcare. The same phenomenon I see in developing nation X.

Has a war taken place that has not had this effect on health, in any nation rich or poor?

Does Change.org membership reflect activists' priorities?

While browsing topics on Change.org, I noticed my pet, Global Health, had a comparatively low membership. After taking in all the memberships, I found Global Health actually boasts the second lowest membership of all 16 categories.

The lowest? Poverty in America

The highest? Animal Rights


Not that animals aren't important, but when it comes down to it, I'm going to have to say people are a bit more important.

Are there more oppressed animals in the U.S. than people? Or do today's activists just care more about animals than people? Or are animal rights easier to achieve than human rights?

There has been a surge of celebrity faced animal rights campaigns as of late. Why? Perhaps because it's a problem at which you actually can throw money and make it go away. Animals are easier to find homes for than are people. Animals cost less to feed. Animals need minimal healthcare. Animals are easier to love. No one accuses an animal for being homeless because it's lazy-- it's just cute.

I find this ranking rather alarming and find myself hoping this is not an accurate representation of today's activists. Hoping that someone in animal rights just had an incredibly effective campaign. Poverty is not just a phenomenon quarantined to developing areas. People in the United States die from poverty. Yet, according to the membership representation, this is the least important issue to Change.org's visitors with barely 20,000 members, while Animal Rights is going strong with over 67,000 members.

I'm glad people are making noise about important issues. All the issues represented by Change.org are important-- but some are arguably more important.

This isn't about animal rights, versus human rights. It rings to bigger issues: the conditioning of our society, who the leaders in advocacy are today, and what people do in the face of a difficult issue. Do they run to that which is "easy"?

Human rights are tough. They will not be easy. But that makes it that much more important.

A holistic approach to health improvement in Africa

I’ve recently embarked on an exploration of the relationship between African belief systems and their practice and perspectives of health in Africa, inspired by the book Health Knowledge and Belief Systems in Africa by Toyin Falola and Matthew M. Heaton. To not mince words—there are a LOT of health problems plaguing Africa. Lots of problems in lots of different societies. There exists such diversity in the countless societies spanning the African continent—all this diversity includes different thoughts on health care and leads to the development of different health systems. Even if there isn’t a health system entirely evident to all, every society has some form of health system. Whether it is the government run British National Health Service or going to a medicine man in rural Togo, people have a way to deal with ailments. When trying to improve health conditions in a certain society, it is important to understand the pre-existing health system and all the beliefs and practices entwined in that system.

Why is understanding traditional health systems so important?

Health is an incredibly dynamic idea. As I learned during my research on health and human rights this summer, it is incredibly hard to define, and I believe that is due to this dynamic nature. So many aspects of daily life are related to, affect, or affected by an individual’s health, how do you narrow down which of those aspects are health? What parts of our lives can be wrapped up in a nice definition of health? The WHO includes physical, mental, and social well-being in their definition of health. I think the WHO definition is much too broad for practical purposes, but it’s a nice ideal.

When trying to improve health conditions in one society—a goal I think is best met by working from within the society through local, sustainable efforts—it’s helpful to have an understanding of the populations’ current health knowledge and beliefs. Falola and Heaton begin with a distinction crucial to this discussion: “Distinguishing between knowledge and belief can be a difficult task.” First, they make the point that knowledge and belief are different. This may seem common since reading it on a blog, but when you actually start talking to people in a community, it becomes harder to distinguish between the two and even harder to determine what they see as knowledge and what as belief—and when the two are too interconnected to say. Some knowledge an outsider tries to bring, perhaps through educational public health efforts, may contest with the society’s beliefs. A global health worker can’t go into a community blind. They have to do their homework, learn about the health system in place. This means, if Google can’t help you out on this one, then when you begin work in a community stop and talk to people before you start any changes—see how best to work within the community. Africa has seen enough imperialism in her days.

The understanding of the diversity in health knowledge and beliefs existent across Africa can lead to better provision of healthcare. Beliefs affect one’s perception of healthcare and medicine and how they can help him. Beliefs affect whether one will seek medical attention for a certain ailment. Beliefs affect whether or not women will use condoms to protect themselves from disease and practice family planning. Knowledge affects the same situations. Knowledge affects whether one will be able to use condoms to protect themselves and have control over their reproductive lives. There is surely power in both realms and both demand respect.

The major I have designed in College Scholars has always had the goal of educating me about the way people live life around the world and what I need to know to best serve my patients as a doctor. From anthropology to religious studies to political science, I have been able to combine the approaches of the various disciplines to grow a greater understanding of the way people live their lives, and how this way of life affects their health. That is what this book aims to explain and explore—how all the facets fof life come together holistically to shape one’s health.

The US and the compromise of global healthcare: Who knew US forgein policy practice and Idi Amin had something in common?

In 2005 I stood before a room of 35 people and declared I hated politics. Now I can’t get enough of it. I credit Paul Farmer firstly and a political science course on the causes of war secondly. Through these forums, I began to realize how powerful the United States is on the world stage.

Paul Farmer enticed me to explore the history of US-Haiti relations. It’s not a pretty one. I learned how the US manipulates weak states to serve their own interests. I learned how the media manipulates the US actions to bolster patriotism. I learned how the poor affected by these manipulations suffer. I learned that if you truly wish to know the truth, you have to dig for it—there’s a solid chance it won’t be hanging out on the surface for the public to glimpse as they put their shoes on in the morning.

While speaking with my uncle, who served a tour in Iraq, he told me stories about playing soccer with the kids, about jokingly trying to sell one of the women logisticians, about the cultural differences, and about how the entire time he was there and the year previous, civilians didn’t have reliable electricity. Why? It had been initially cut during the invasion in 2003 when Iraqi infrastructure was destroyed and two years later in 2005, they still had unreliable power. This has numerous impacts on health, from the sanitation of unrefrigerated foods to the lack of electricity and thus running water in clinics and hospitals.

The actions of the U.S. affect the standard of living for people all over the world. In Iraq, for example, economic sanctions prohibited the nations from importing the materials needed to repair their destroyed infrastructure. The same sanctions, I imagine, inhibit the advancement of medicine. It almost seems a stretch to discuss advancement of medicine when their healthcare infrastructure was struggling to provide services to people in its precarious state.

U.S. policy and U.S. ideals have had great, and sometimes negative, impacts on other nations around the world. I read of rebel groups destroying infrastructure in the DRC. I read of Idi Amin’s destruction of the formerly impressive Ugandan healthcare infrastructure. It at first may seem different when this destruction involves actors on the same level (i.e.- all actors of developing areas), but it’s necessary to take a step back and realize that the United States is participating in the same actions. As Amin brought mass human rights violations in Uganda in the 1970s, the US brings them upon less stable, less developed states now. The U.S.—which ideally should be an example in human rights if it is to be a world power with mass resources—is just as guilty of violating human rights. They’re just better at covering it up.

We denounce the cruelties of rebel groups roaming sub-Saharan Africa, but who is holding the United States accountable? It’s certainly not the UN.

Who Lives? Who Dies?

“It makes no great difference how a society distinguishes the marks of infamy that allow it to separate those who may live from those who can or must die; the human mind, endowed with limitless imagination, can redefine them in accordance with the latest notions of an ideal society. While in certain countries skin colour or the way a particular word is pronounced is enough to provoke a roadside execution, in contemporary Western societies such indicators have been displaced from the surface to the interior of the human body. Today, because of ‘biological deviance’ (hypocholesterolaemia) or ‘behavioural deviance’ (obesity), an individual may be refused treatment or medical insurance.”

-In the Shadow of 'Just Wars': Violence, Politics and Humanitarian Action

It’s interesting how the idea of what society should be changes the discriminatory factors attached to certain peoples. It changes like fashion—yesterday it was the minimal, two button blazer; today it’s the strong shouldered blazer heralding the shoulder pads of the early 90s. While discrimination by race in the US has reduced since the Jim Crow days, new forms of discrimination have bubbled under the surface of society, so ingrained that most don’t notice them on a daily basis. The genetic factors that deprive people of appropriate health insurance, the economically challenged neighborhood that denies residents access to fresh foods. These are forms of structural violence that go widely unnoticed in the United States—in Knoxville—except by those who live it.

Perhaps it’s because I spend too much time reading of people living far away that the implications of the above passage stopped me. As soon as the change from external to internal discrimination indicators was explicitly stated, it was blatantly obvious. I knew these problems existed; I’ve spent hours in conversation denouncing the injustices of the healthcare system and the health inequities due to socioeconomic status. But never had I directly linked them to the term structural violence* and put them on the same mind page as corrupt aid-hording governments I come across in my readings of the developing world.

Lately, my global health comrades at AMSA (American Medical Student Association) have been pushing the fact that global health includes the entire globe—yes, that includes the U.S. We are not above global health inequities, yet we like to talk as if we are in another class. We have “the best healthcare in the world”. (I’m still trying to figure out what statistics people are looking at when they declare this.) Yet Americans are plagued by government corruption (any lobbyists in the crowd?) that creates obstacles in obtaining healthcare. Complaints in some regions of sub-Saharan Africa are that there are no clinics, no doctors. We have the clinics and doctors, but that doesn’t mean they are accessible to the average uninsured person. A person without health insurance likely cannot afford medical treatment. They almost positively will not seek preventative care. If they have a known genetic disorder and try to purchase insurance? Forget it. No one will insure them if they have a preexisting condition.

In the States it’s no longer denial of opportunities because you’re black. But it might be because your grandfather had high cholesterol. The internalization of discriminatory factors has pushed injustices behind the curtains. You only notice them if you’re in the play. If you’re healthy and living in suburbia with 2.1 kids, you probably won’t notice the violence committed against your fellow citizens by the very government that is supposed to protect them. These internal markers are not as blatant as skin color, but the consequences of modern discrimination create inequities just the same.

*Structural violence is the violence that systems—political, economical, social, cultural, religious– commit against individuals.

The Universal Declaration of Human Rights Animated

This is great! Check it out!