Cross Cultural Communications in a Clinical
Environment
A COMMON GROUND BETWEEN ANTHROPOLOGY AND BIOLOGICAL HEALTH SCIENCE
WHAT IS MEDICAL ANTHROPOLOGY
Anthropology is the study of humans, their biology, their culture, their language,
and their past.
Medical anthropology is a biocultural discipline integrating medical science and
biology with social and behavioral sciences. - Cecil Helman
There are two varieties of medical anthropological studies;
1. The investigation of the role of sociocultural effects on the source and
prevalence of certain diseases.
2. The study of the effect of social and cultural differences on the outcome
of public-health programs in intercultural settings.
This study is a brief examination, using both variants, of the cross-cultural
clinical experience of a medical team composed of pre-health undergraduates
from the United States, health care providers from both North and Central
America, and translators from North American, European, and Central America.
VOLUNTEERS FOR INTERCULTURAL AND
DEFINITIVE ADVENTURE
Volunteers for Intercultural and Definitive Adventures, or VIDA, is a non-profit
humanitarian association based out of Costa Rica that helps to empower individuals
and provides free medical, dental, and veterinary assistance to needy communities to
improve quality of life.
Many people in Mexico, Guatemala, Honduras, Nicaragua, Panama, and Costa Rica receive no regular
health care or dental care. By partnering with communities in need and globally-minded volunteers,
Volunteers for Intercultural and Definitive Adventures;
•Provides basic health care and dental care through medical brigades and dental mission trips to those
who would otherwise not receive any medical or dental attention.
•Supports other international nonprofits in their commitment to the communities they work in as well as
provide support to remote and isolated communities.
•Aims to be a truly nonprofit organization that will have no other motives (religious or political) than to
bring people together to make this world a better place through service learning.
•Offers hands–on, eye-opening, and mind-enriching international volunteer experiences to students and
professionals of medical, dental, veterinary, and other fields from around the world.
VIDA was created to be a resource volunteers can depend on to support their cause of helping fellow human
beings
CULTURAL INFLUENCES ON ORAL
HEALTH
There are several ways in which culture can affect a persons health, for example,
Peter J. Brown and Marcia C. Inhorn propose two mechanisms which allow
culture to play a determining role in patterns of disease and death in
populations;
1.
Culture may shape behaviors such as diet, activity, sexual
practices, etcetera, that give individuals predispositions to
certain diseases.
2.
People actively change the nature of their environment
through culture in ways that often affect their health.
The majority of the observed cultural effects on health during this study
were results of the first mechanism. The observed cultural effects could further
be broken down into lack communication/education of bio-medical knowledge,
and cultural customs and beliefs.
Lack of Communication/Bio-Medical Education
Example 1. No baby teeth—No problem.
It is a common belief amongst many of the patients encountered, as well as their family members,
that baby teeth are of little or no importance. It is thought that because new teeth will come in and replace
the baby teeth, it is fine if they are decayed and/or removed before the new teeth are ready to come in.
However, baby teeth have significant purpose, not only in mastication, but in acting as “place holders” for
incoming permanent teeth. Tooth decay is typically the result of infection. An infection in the tooth can lead
to infections in the gums, which may allow bacteria to enter the blood stream, possibly causing other health
complications. Any type of oral infection should be treated, regardless of the status of the teeth.
Example 2. Misinformed Pre-Extraction Preparation
On the first clinic day in Nicaragua, I encountered the patient who perhaps had the greatest emotional
effect on me. He was there waiting at the clinic when the bus containing the volunteers and equipment
arrived. With his hand against his swollen cheek. His first upper molar was rotted completely, and his
surrounding gums had a sever infection. He came for an extraction. Unfamiliar with how clinical extractions
work, he thought that copious amounts of alcohol consumption was an adequate and necessary painkiller.
Unfortunately, according to the dentist in charge, the alcohol in his system would render the anesthetic
ineffective and not allow a blood clot to form over the socket if the extraction occred, therefore, we could
not extract his tooth. All we could do was give him a cleaning and ten days worth of antibiotics and
painkillers– not enough to make a permanent difference. While I was cleaning his teeth he kept patting my
arm and motioning for me to pull the tooth. The only words he spoke were “No hablo” (I can’t speak).
Confused, I ask “¿Porque tiene dolor?” (Because you’re in pain?). He nodded, I told him I was sorry.
Because we were not returning to that site, the extraction could not be done by VIDA once he had sobered.
Example 3. Coca-Cola in the Baby Bottle
Going along with the misconception that baby teeth are not important the acidic and caffeinated
beverage Coke is given to children at very young ages. Along with lack of brushing , this results in observed
situations where children around 5 years of age have already rotted every single remaining tooth in their
mouth. Baby teeth and permanent teeth alike rot at rapid rates due to the combined over consumption of
coke, and absence of adequate brushing.
Cultural Customs and Beliefs
Example 1. Local Superstition
There was a sudden change of pace in the dental clinic on the fifth day. There were virtually patients
for extractions, and hardly any for cleanings– a stark contrast to the non-stop flow of patients the previous
four days. A medical patient told the dentist this was because it was raining. It is apparently a local
superstition near San Blas, Nicaragua that it is bad luck to have a tooth pulled on a rainy day. It is possible
that because of this superstition, locals who were in need of dental care choose not to take advantage of the
two day window of free care VIDA offered.
RESEARCH IN THE FIELD:
CLINICAL WORK IN NICARAGUA & COSTA RICA
Observations were made during a 12 day period while
traveling with the organization VIDA. Most clinical
observations occurred in the dental clinic; few
occurred in the medical clinic.
Cultural observations were made throughout the 12
days, in every setting. Both clinical and cultural
observations were made in a public hospital in
Managua, the capital of Nicaragua.
Four of those 12 days were spent in Costa Rica, two of
which were spent in satellite clinics set up by VIDA.
The remaining eight were spent in Nicaragua, with four
clinic days.
Costa Rica is ranked first in Latin America for developments in curative and preventative diseases. In fact,
Costa Rica has both a lower infant mortality and a higher life expectancy than the United States. This could
be attributed to the fact that Costa Rica’s health care system is subsidized through the social security system,
providing low-cost medical care for naturalized residents.
Clinical observations for Costa Rica were made in northern Costa Rica in a town near the city of Puntarenas.
The majority of the patients seen were immigrants from Nicaragua, and therefore were not eligible in Costa
Rica’s health care system.
Nicaragua has widespread underemployment and has one of the highest degrees
of income inequality in the world. Though Nicaragua has progressed toward
macroeconomic stability, annual GDP growth has been far too low to meet the
country’s needs, forcing reliance on international assistance. A study carried out
during 2007 and 2008 by Ministerio de Salud found that 58% of Nicaraguans are
unable to access adequate healthcare and treatment due to poverty and social
exclusion from health services. This study also found that 20% of children under
five years of age suffer from chronic malnutrition and 6.3% from severe chronic
malnutrition.
Clinical observation were made in two separate clinics near the city of Jinotepe,
and one clinic near Granada.
Example 2. Cavity Care– Nicaraguan Style
Many patients coming in had metal foil wrapped around the teeth that were causing them pain. This
is how some Nicaraguan dental clinics would deal with cavities. Unlike the western method or drilling to
remove decay and bacteria, and filling both to fill the new hole, and to aide in aesthetics and mastication, the
Nicaraguan method consisted of scrapping the surface of the infected tooth, and wrapping it with foil. Too
many patients seen in the VIDA clinics had severe infections thriving under these foil wrapping.
Example 3. Pointed Tirbal Beauty
As part of pre-clinical training, volunteers were shown pictures of the teeth of some of the women
from the indigenous tribe, Ngobe Bugle, from Panama. These women practices a form of body
modification where their teeth were either filed to a point, or to two points, with a V in the middle. They
said it was not very painful, and consuming large quantities of hot soup helped with the process.
THE SYMBOLISM OF A TOOTH BRUSH
The first time I cried on this trip, I was leaving my host family in Costa Rica. The tears
were not entirely due to sadness, knowing I was going to miss them, in fact, they were mostly tears of joy.
This family that I had been living with for four days had no tooth brushes in their home. When they walked
me and my house mate to meet the bus, we surprised them with enough tooth brushes for every family
member we met. To most people living in North America, receiving a tooth brush is no big deal. To this
family, it was. I couldn’t hold back the tears nor the smile as I watched the youngest family member bounce
around with happiness over his new tooth brush, excited about the colors, saying he would use it “todos los
días y todas las noches” (every day, and every night).
This experience can be contrasted to the experience with my Nicaraguan host family,
which, unlike my Costa Rican family, were quite above the poverty line. The first morning I excused myself
from breakfast to brush my teeth, upon rising from the table, I was ask if I needed a tooth brush.
Each clinic day in Central America, surpluses of crayons, stickers, and tooth brushes
would be given out to children and adults visiting the clinic. Every child showed
extreme joy and excitement upon receiving these items.
In contrast, while volunteering with the UWF Pre-Dental society at a kids camp here
in the United States giving dental education, few children were excited about
receiving a toothbrush, crayons and stickers, most were indifferent, and one refused
to take a toothbrush.
BIBLIOGRAPHY
Johnson, Thomas M., and Carolyn Fishel Sargent. Medical Anthropology: a Handbook of Theory and Method. New York: Greenwood, 1990.
"Healthcare in Nicaragua." Un Enfoque Diferente - Nicaragua - a Different Focus. 2 Sept. 2009.
<http://www.tortillaconsal.com/health_nicaragua.html>.
Helman, Cecil. Culture, Health, and Illness. London: Hodder Arnold, 2007
printed
by
Paul, B. D. "Anthropological Perspectives on Medicine and Public Health." The ANNALS of the American Academy of Political
and Social
Science 346.1 (1963): 34-43
VIDA Volunteer and Travel - Home Page. Web. 04 Nov. 2010. <http://www.vidavolunteertravel.org/>.
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