CHILD MORTALITY IN INDIA

Venessa Misewe

Introduction

            Child mortality is one of the leading global health issues in the world. It is caused by various factors; malnutrition, common childhood diseases (pneumonia, tetanus, diphtheria, measles and malaria) and poor prenatal care during pregnancy. Looking at the World Health Organization Statistics clearly shows the significance difference in the rate of child mortality between developed and developing nations. Developed nations like America and Germany have a low child mortality rate compared to developing nations like India and Mali, which have a very high child mortality rate (WHO 2012 p.19). Even though the World Health Organization has recognized child mortality as a global health problem, and has really made a great deal of effort in trying to reduce child mortality in many developing nations through providing vaccines against common deadly childhood diseases, educating mothers on the importance of good nutrition for their children, and providing prenatal care to pregnant women and educating them on the importance of prenatal care, a lot of work still needs to be done to reduce child mortality in developing countries.

            In the article entitled, “Causes of neonatal and child mortality in India: a nationally representative mortality survey,” Bassani the main author, talks about neonatal and child mortality in India and delves deep to discuss the main causes of child mortality in the country. He starts off his article by highlighting a shocking fact that states that India is the nation with the highest child mortality rate in the world with about 2.2 million of its children under five years dying each year, which accounts for twenty percent of the 8.8 million child deaths in the world. Bassani is in India and is determined to find out why India has the highest child mortality rate in the world, and through a survey he conducts by mainly asking local Indian people, and doctors about child deaths and health care in India, he is able to find out that the main cause of child mortality in the country is due to common childhood diseases l(pneumonia, diarrhea and malaria), malnutrition and mainly medical tourism which has greatly affected the public health system in India and has resulted in poor health care for the local India people.

Body

            While Bassani conducts his survey in India, going from door to door interviewing families in different parts of India and mainly asking them questions about the number of children they have lost under five years, and the primary cause of their children’s death, he notices that most neonatal and child mortality in India is due to common preventable childhood diseases like pneumonia and diarrhea which are very life threatening in India, and account for ninety percent of all neonatal deaths, and fifty percent of childhood deaths. Furthermore as he conducts interviews with doctors, he notices that many of the infant and child deaths in India are not reported because they mainly occur at home, in rural areas without the medical attention of a health care worker (p.116). He additionally discovers that the key reason why most child deaths are not reported is because of the high corruption rate in the country’s medical system. You basically have to give bribes to local health professionals in order to get treated, vaccinated in public hospitals or even report a death in your family, and that’s why most Indian people don’t feel the need to report a child’s death because it is expensive, and they have far more important things to worry about than spending their time focusing on the death of a child (p.116). At first, when Bassani realized that most child deaths were not reported, he ethnocentrically thought that Indian mothers did not care about their children and that’s why they did not report their deaths or try to seek medical help to save their children’s lives, but after further investigating the issue and using cultural relativism to understand why Indian mothers did this, he was able to sympathize with Indian mothers and understand that poverty and the high corruption in Indian’s health system is the main  reason why they did this. Having grown up in London, in a more developed culture with low child mortality, Bassani was very fortunate as a child to have access to good health care that rarely had corruption in its system. This reminded me of the week 6 article we read in class by Borovoy Hine entitled, “Managing the unmanageable elderly Russian Jews émigrés and the biomedical culture of diabetes care,” in which American doctors ethnocentrically judged Russian Jews as stubborn and non-compliant when dealing with their Diabetes health because they mostly did not follow their prescribed treatment plans (p.18). However further research indicated that Russian Jews seemed non-compliant when dealing with their Diabetes care plan because in Russia, they were used to having their doctors involved in their treatment, on the other hand in America, Diabetes treatment is more of a personal experience with very little doctor involvement. Russian Jews in America were mainly non-compliant in Diabetes management because they felt that American doctors were not as involved in helping them manage their Diabetes, and that is why they were non-compliant. When American doctors finally understood why Russian Jews were acting the way they were, they were able to use cultural relativism, and help Russian Jews better manage their Diabetes which consequently brought peace and understanding among both parties. 

In India, the general population which is mostly living below the poverty line mostly relies on public hospitals for their health care. Health care is free in India, but in public hospitals, people have to wait in long lines, for hours in order to be treated by very few doctors. The average doctor to patient ratio is 1 to 30, which means that in a public hospital a doctor has to work on so many patients in a very short time, which also affects the level and quality of health care the patients get. Bassani also found out that most people are expected to offer bribes to local nurses and hospital staff in order to be moved to the front of the line and access care in public hospitals, and when patients do get to be treated, the level of treatment is very quick and poor which subsequently makes patients hesitate to rely on public hospitals during emergency situations. Likewise when it comes to offering vaccines to most toddlers and infants in public hospitals most mothers have to give bribes in order to get their children vaccinated, or ends up waiting for long hours in line for free vaccination which normally takes months (p.117). Vaccines in India are supposed to be free and accessible to all people, but public health workers are taking advantage of the vulnerability of the Indian people, and making them pay in order to access what they are rightfully entitled to (p.3). This made Bassani able to understand that eradicating and preventing common childhood diseases like diarrhea and pneumonia will be a long struggle in India because corruption in India’s health system has made it hard to help save lives of children through the existence of poor management in health care which results in high neonatal and child mortality rates in the long run. Most Indian mothers have no choice but to watch their infant and toddlers die in front of their eyes from preventable diseases because of their health system’s corruption and poor governance, and it’s sad because there is nothing they can do about it.

In addition to childhood vaccination in India, Bassani found out that Indian’s cultural preference of boys to girls affected the quality of health care that a child got. Indian people were three times likely to vaccinate boys than girls because in India girls are considered less important than boys. Boys are seen as future sources of wealth and power to their families, and that’s why mothers in India struggle to make sure their infant sons are vaccinated and well fed compared to their daughters (p.3). Even though both sexes experience child mortality, the rate at which boys die is lower than girls. Women in India also practice selective abortion to make sure that they have more boys than girls (p.117). Even though many boys are vaccinated compared to girls the overall child mortality rate due to common preventable diseases in both sexes is still very high. Bassani says that in India four children die every thirty seconds from preventable diseases like pneumonia (p.118).

Bassani was still determined to know what caused corruption in the health system in India. He was able to find out from his survey participants that the growth of medical tourism in India was the main cause of corruption and poor health care in India’s public health institutions. This was happening because the rapid growth of medical tourism in India made more doctors hungry for more money which in turn made them focus more on private vs. public health care in India which made them make six times the profit they would make working in public hospitals. The focus on private health care by many doctors in India (especially to cater to medical tourists around the world), put a strain on public health care in India, by reducing the number of physicians available to patients (p.119). Bassani states that as medical tourism continues booming in India, more physicians are becoming selfish and neglecting their oath to care for other, and are more driven to use their skills to benefit themselves (p.119). The problem is that more and more Indian people relying on public health care in India, especially children and infants are suffering and dying because of shortage of physicians, corruption and poor health care in India’s public health system (p.119). This reminded me of the medical tourism in India video we watched in week eight of lecture that showed how medical tourism in India benefited the rest of the world (the tourists seeking cheap medical procedures) but hurt the public health system in India through reducing the number of physicians available to work in public hospitals.  Likewise this reminded me of neoliberalism, a term we discussed on November 5^th during quiz section which basically shows the effect of free market and its long term result in privatization of health care. This just shows that medical tourism in India leads to health inequality in India by privatizing health care (making good health care only available for the wealthy, and thus neglecting the poor).

Malnutrition, which is one of the main causes of child mortality rate in India, is actually experienced by low income populations living under the poverty line who account for 70% of India’s population (p.118). Malnutrion has nothing to do with corruption or health care in the country, but the simple fact that most mothers are poor and struggle to provide adequate nutrition for themselves and their children. While interviewing local Indian people, Bassani found out that providing good nutritious food for their families is a problem for most mothers in India because they simply don’t have the money to do so. They in turn have to feed their infants and children very little wheat porridge twice a day which is very little food for a growing child. Malnutrition is a very big issue in India and the government has really tried to help out, but the number of children dying from malnutrition keeps rising rapidly each year (p.118). However the government has done little to resolve the corruption and health inequality affecting Indian people. The government has basically sat back and watched its people suffer, and its children die from diseases that can be prevented by better health care in public hospitals. The Indian government has allowed medical tourism and neoliberalism to kill its own people by denying them the most basic thing they need; healthcare. What’s happening in India just reminded me of the term bio politics which we talked about in week 8 of lecture, which basically shows the power that the government has on people’s lives. A government’s involvement and good governance in a country’ health care system through distribution of vaccines and quality treatment to its people can positively affect people’s lives. On the other hand, a governments ignorance and lack of good governance in a country’s health care, causes health inequality and poor healthcare which negatively affects people’s lives.

Conclusion

Reading this article and applying medical anthropology concepts to child mortality in India such as bio politics (effect that the Indian governments non-involvement in the nation’s healthcare has ultimately led to poor health care and rise in child mortality caused by preventable diseases), neoliberalism (has given rise to medical tourism in India and privatized health care and consequently caused shortage of physicians in public hospitals in India which directly affects child mortality in the long run), and governance in healthcare (corruption in India’s public health system) helped me shed light on child mortality in India by looking into rise in medical tourism in India as one of the main factors that affect it. I actually never thought that medical tourism had a negative impact on India’s health care by ultimately reducing physicians in the public hospitals and fueling corruption, cheapening the quality of health care and directly affecting the prevention and treatment of common childhood diseases that lead to child mortality. My understanding of the above medical anthropology concepts I have talked about has just helped me understand child mortality in India and see that Indian children are dying in high numbers because their government and health system is failing them by placing medical tourism above the interests of their own people. Bassani just showed me the power that the government has in our lives and ultimately the health and future of our children.

My prior understanding of child mortality in India was that it was due to chronic malnutrition, but I had no idea that medical tourism would have any effect in accelerating child mortality in India. To just be clear, Bassani did not say that child mortality was not an issue before medical tourism began in India, but all he is saying is that his survey results showed that increase in medical tourism consequently increased child mortality in the country. In summary, my final practical perspective is that child mortality in India needs to be approached by the World Health Organization differently because providing India with vaccines against common childhood diseases and offering education on good nutrition to Indian mother is not really helping the problem. The main problem is the corruption in the public health system that is causing many children who can’t afford to access vaccination against preventable diseases and quality health care to die rapidly. I strongly feel that the World Health Organization has done its best to help India deal with child mortality, and the only way child mortality will decrease in India is if the government solves the health inequality issue caused by medical tourism and fueled by neoliberalism in India which has led to the privatization of health care in the country. Indian people and ultimately children are suffering because of the selfish doings of few people (doctors tending to medical tourists by focusing on private health care and neglecting public hospitals and resulting in health inequality and poor health care for Indian people). I think the government should place some kind of restrictions on neoliberalism in India which will lessen the privatization of health care in the country and provide better care to the majority of Indian citizens in public hospitals, and ultimately save lives of Indian children by reducing child mortality rates in the nation.

Bibliography

• ·         Bassani, D. G., Kumar, R., Awasthi, S., Morris, S. K., Paul, V. K., Shet, A., Ram, U., Million Death Study Collaborators. (January 01, 2010). “Causes of neonatal and child mortality in India: a nationally representative mortality survey.” Medical Anthropology Quartely.18.2 (2005):116-20.Print.
• ·         Borovoy A, Hine J.

            2008: Managing the Unmanageable Elderly Russian Jewish Émigrés And The

            The Biomedical Culture of Diabetes Care. Mar; 22(1): 1-26.

• ·         World Health Organization. World Health Statistics 2012.

• ·         Cerón, Alejandro. 13 Nov. 2012. Class Lecture.

• ·         Cerón, Alejandro. 30 Nov. 2012. Class Lecture.

DANCING SKELETONS – ETHNOGRAPHY REVIEW

Dancing Skeletons: Life and Death in West Africa by Katherine Dettwyler is an ethnography that mainly focuses on how infant feeding and weaning practices, and chronic childhood malnutrition leads to an increased chance of children being more able to succumb to life threatening childhood diseases like malaria, tetanus, diarrhea, diphtheria, kwashiorkor, marasmus and measles in Mali. Furthermore, the author also talks about how Malian people perceive death and illness, and the social structure and women’s control over their own reproduction in Mali.

First and foremost, I really liked this ethnography. At first I was a little skeptical about reading this ethnography because I had a preconceived notion that Katherine Dettwyler (a foreigner with an etic perspective), would not write a good ethnography since she would be very biased and ethnocentric, and thus judge the Mali people that she was studying, and look down on them. To my surprise, Dettwyler actually was very open minded, and even though her epistemology as an American on childhood nutrition made her biased and ethnocentric in the beginning of her research, she was able to shed her biased opinions and through cultural relativism, Dettwyler was able to understand Malian culture and answer her main research question. As a reader with an emic view on childhood malnutrition and threatening childhood diseases in Africa, this ethnography confirmed what I already knew about the topic. This ethnography made me happy to see that anthropology, and biomedicine as a whole is finally maturing by trying to see things from other cultures point of view instead of looking down on them, an making them feel that their traditional ways are wrong by forcefully making them assimilate to western healing practices. Likewise Dettwyler inspired me to also give biomedicine a chance in my life, and have a happy medium between my traditional healing practices and biomedicine.

Dettwyler’s main point in the ethnography is that poor infant feeding and weaning practices in Mali, leads to chronic childhood malnutrition which in turn results in increased risk of children dying from life threatening childhood diseases like malaria and tetanus because malnutrition is the main cause of a poor immune system. Her research question is on infant feeding and weaning practices in Mali and how it leads to malnutrition in children and their ability to conquer childhood diseases. After conducting her research Dettwyler concludes that the main cause of childhood malnutrition in Mali is ignorance (mothers lack of knowledge on the appropriate foods to feed children during child growth), and inappropriate cultural beliefs and practices towards infant feeding and weaning practices (p.159). It’s funny because at the start of her research, Dettwyler assumed that the main cause of childhood malnutrition in Mali is overpopulation which led to lack of food for the people of Mali, most importantly the children. However, as her research progressed, she noticed that people in Mali have plenty of food. The main reason their children are malnourished is because the women, don’t know which type of foods to feed children, and this is shown by how they feed young children millet rice day in and day out (p.11), which is evidently does not provide young growing children the nutritional requirements they need in order to stay healthy and develop a strong immune system. Even though Dettwyler ethnocentrically judged women in Mali for not caring about their children’s nutrition, she later on noted that this is just part of their culture; these women were fed millet rice as kids and they are just using their predecessor’s knowledge about nutrition that has been passed on to them (p.45).

Evidently, Dettwyler’s has an etic role on the ethnography. She is an outsider (a researcher with prior exposure to the Malian culture) looking in and observing the culture. Her etic perspective as a researcher might affect the research through ethnocentrism and biases based on her epistemologies (her cultural thoughts about what is wrong or right). Her role as an outsider of the Malian culture has pros and cons; she could either be more open minded to understanding the culture of the Mali people as compared to an anthropologist with an insider perspective doing the same research who might be tempted to defend some cultural practices due to ethnocentrism, or Dettwyler could either be ethnocentric because of her biomedical background, and judge the Malian beliefs and traditions based on her epistemology. Detwyler’s role as an outsider looking into the Malian culture was clearly stated as the very beginning of the ethnography, when she openly admits that she has no prior knowledge of Mali, or it culture (p.4).

Summary

            Dettwyler is an American physical anthropologist in Mali conducting her fieldwork research in the town of Magnambougou for her Ph.D. for two years. She left her husband and four year old son in America, and came to Mali with her nine year old daughter Miranda for company, and also to make her learn about another less fortunate culture, so that she can be able to appreciate what she has in America. Her research involved documenting traditional infant feeding practices and their effects on children’s growth; she measured the height and weight of infants, toddlers, teenagers, and adults in Mali, in order to determine the effects of malnutrition and how it affected children in their adult years. She had to interact with her informants, ask them about their infant feeding practices, and learn about their cultural view on weaning and infant feeding practices, malnutrition, and death of children as a result of life threatening diseases in their communities like tetanus, malaria, kwashiorkor and diarrhea. She listened, observed and provided necessary ethical advice on how to improve malnutrition, infant feeding, weaning, and how to prevent childhood diseases like kwashiorkor, marasmus, diarrhea, tetanus and malaria. She while conducting her research she mostly relied on interviewing her informants, and collecting data about their height, weight and illnesses. She took stool and urine samples of her participants to test for intestinal parasites, and offered treatment for the participants who tested positive for intestinal parasites like tapeworm and schistosoma. Dettwyler also organized a nutritional program that educated Malian women on the importance of good nutrition especially in the first five years of a child’s life. Particularly, she was able to show how social structure and women’s control over their own reproductive health in Mali, ignorance and inappropriate cultural beliefs and practices resulted in childhood malnutrition in Mali and mortality of children under five years old due to poor immunity and increased risk of infection of threatening childhood illnesses (malaria, kwashiorkor, measles and tetanus).

Discussion

            I would really like to talk about the reasons that Dettwlyer attributes to the cause of childhood malnutrition in Mali. First of all, she argues that Mali’s cultural concept that children should not be feed good food because they don’t know its value and that old people deserve good food because they have worked hard for it and need it more compared to children because they are going to die soon is one of the main reason that shapes the kind of food children in Mali are given. Most children in Mali, especially toddlers, are feed only millet rice and peanut source every day, which certainly does not meet even half of the nutritional requirements they need to be strong and healthy(p.13). When Dettwyler tried to educate mothers in Mali on the importance of giving children a balanced diet in the first years of their lives because this was the building block for their immune system, most Malian mothers at first failed to comply and change the way they feed their children because they felt that Dettwyler was trying to change their culture (p.29). Dettwyler felt very frustrated when some mothers stuck to their bad feeding practices even though she had advised them and told them about the importance of good nutrition for children (p.37). This reminded me of the discussion we had during quiz section on October 16^th about the consumption of fry bread in the Native American community and the consumption of pigtails in the African American community. The Native American community started consuming “fry bread,” when they were taken from their fertile lands and pushed to reserves by Americans and were only given pounds of corn flour as their main source of food, by the American government. Native Americans had to be creative and find means to survive in the reserves, so they decided to mix the corn flour with water, form dough, and roll it out in the form of a tortilla and fry it. The fry bread helped Native Americans survive in the reserves, and this food tradition was passed down to later generation. Unfortunately, recent studies of obesity and high cholesterol in the Native American community reveal that consumption of fry bread is one of the main causes of obesity among the Native American people because it is very high in fat and cholesterol.

            Similarly in the African American community, many of them could not afford the healthier and more expensive parts of meat during slavery, so they had to consume pigtails, which are very cheap, high in fat and cholesterol and have no good protein benefit. Even though slavery was over, these tradition of eating pigtails was passed down to later generations, and resent research has also shown that pigtails have very little health benefit. But how are Native Americans, African Americans and Mali people supposed to just give up an important part of their culture just because biomedicine says it is wrong? These food practices in these three cultures have all been imbedded in the culture during colonial times, and have been passed down to later generations as part of their culture. Mali people fed children millet rice and soup for years because during colonial days (Mali was colonized by the French), adults had to work in the farms and factories of their French colony so the Malians so it fit to feed adults good and healthy food because they had to work all day, and feed children less nutritional food because all they did was sit around, and did not really use a lot of energy (p.94). This shows that colonialism still has a big impact on the customs and traditions of many people in today’s world. If colonization did not take place, the Native American people would probably not be eating the fry bread, the African American society would definitely not be consuming pigtails, and lastly the Mali people would be providing better nutrition for their children. The colonial notion that children don’t need good food because they don’t require a lot of energy, has also affected infant weaning practices in Mali; infants are only breastfed for the first year of their life and weaned to solid food (usually millet rice only), which is very little food and thus leads to malnutrition because a baby requires both food and milk to be satisfied and healthy (p.15).

            Correspondingly, the unwillingness of Malian mothers to feed their children more nutritious food also reminded me of Borovoy’s article, “Managing the Unmanageable Elderly Russian Jewish Émigrés And The Biomedical Culture of Diabetes Care,” which talks about how biomedical diabetic doctors in America are frustrated by elderly Russian Jewish immigrants with diabetic conditions because they are stubborn, and lack the will power of self-control one of the key aspects in successfully regulating diabetes(p.16-22). American doctors feel that Russian immigrants with diabetes are stubborn and don’t want to change their bad eating habits (consumption of their favorite foods which are very high in sugar, cholesterol, fat and starch), even though they are constantly being told by their doctors that it is bad for them. In actual sense, Russian immigrants fail to comply and follow the advice of their doctors because they have certain foods that they hold sacred and indulge in during their Jewish holidays, and in doing this, it makes them feel more connected to their culture because they are miles away from home. Moreover, these immigrants fail to comply and take doctors’ advice on diabetes prevention because they feel that American doctors are not genuine and personable, and they tend to be fake (being polite, and putting on fake smiles), which makes these immigrants miss their doctors in Russia who were more personal, and hands on with them (p.17). While American doctors view Russian immigrants as stubborn and require more attention, the truth is that the Russian immigrants are this way because they are used to doctors being in charge of their health, and the thought of them being in charge of their health (diabetes central idea) does not make sense to them because it is not what happens in their culture because they are used to doctors doing everything for they; they mainly work on the principle of damage control rather than prevention (p.16). This article shows that until American doctors understand the culture of the Russian Jewish immigrants, they will always be ethnocentric and see them as being ignorant while in actual sense, these immigrants are just used to a certain way or form of treatment. This just shows that Dettwyler needs to work with the Malian mother’s in order to achieve her goal of good nutrition for children in Mali, and likewise American diabetic doctors need to be sensitive to the culture of Russian immigrant Jews because stereotyping them as stubborn and non-compliant, and looking down on their culture, does not help solve the problem.

            Another argument in Dettwyler’s ethnography that stood out to me was her argument about how people in Mozambique view certain childhood diseases as a normal part of life, and she attributed this to the culture’s calm acceptance of death as a part of life. She felt that mother’s and the rest of the Malian community were numb to issue of mortality in children from deadly diseases because in their culture, they were already considered diseases like malaria as normal (p.147).  This claim reminded me of Scrimshaw’s article about Culture, behavior and health and how malaria is said to be seen as normal in Africa because “everyone has it or has had it” (p. 46). In Mali, malaria in children is considered normal because children always get it, and multiple infections of malaria in children, make them immune to the disease as adults (p.48). By the same token, when Dettwyler interview mother’s about their reproductive history (how many kids they had, and how many had died, and the causes of their deaths), she was flabbergasted by how mother’s seemed to show no emotion when talking about their deceased children (p.158). As a mother, she could not understand why these women acted this way, and for a moment she thought that maybe they did not love their children or care about them. After further investigation and research, she learned that some mothers seemed to exhibit no emotion when talking about their deceased children because they were unwillingly married off and made to have kids with husbands they did not love, so the death of the kids they had did not pain them as much (p.159). Women in Mali have no control over their reproductive choices because most men demand ten to more children, and the women have no choice but to go by their husbands desires, since they rely on their husbands for provision of income. It is culturally held that having a lot of children in Malian culture is essential because it helps in the provision of labor that is needed in the field and at home (p.158). Malian women feel trapped in their own culture because their main role is to rare children, and take care of the household. Most Malian women are not literate because the society favors boys over girls in terms of education. Parents in Mali struggle to send boys to school, while girls stay home and help out with chores and are often married off by the age of fourteen (p.154).

            Undoubtedly, social representations in Mali favor the old to the young (this is shown in the case of good nutrition for adults, and poor nutrition for children), and men to women (this is shown by the gender inequality as far as sending boys to school, while girls stay home and help with chores and eventually married off). Although the above practices are certainly unfair, they cannot be looked down upon because they are actually part of the Mali culture, and is what defines them as a group of people.

            Like anything in life, this ethnography certainly has its strengths and weaknesses. The strength of this ethnography is that the author made a very big effort in interacting with the Mali people. Dettwyler, tried to learn Bambara, the native language of the Malian people, which made her seem friendly and approachable, and made her informants more willing to participate in her research because they felt that she was genuine and wanted to know, understand and be part of their culture. She quickly learned how to say greeting in Bambara which is a very big part of the Malian culture (greeting is seen as a very essential aspect of respect in the culture), she put her ethnocentric views aside, and accepted the people’s food and way of life, which made the people very pleased with her. I also feel that her research methods were very successful and also her main strength in her research; she interviewed people by making use of a Malian translator who was fluent in both Bambara and English, and she did not offer incentives like money or gifts to her participants which made her work more ethical. In contrast, the ethnography’s main weakness was that the author did not provide any data to support her claims. She actually measured children’s height and weight, but did not publish any numerical data to support her claims, which made it very hard for me to estimate the level of malnutrition in the children (numerical data tend to shock people and raise awareness on issues). To make up for not including numerical data on her research, the author successfully made use of very elaborate pictures, which really explained what she was talking about.

            The different perspectives that are seen in the ethnography are the emic and etic perspectives. Dettwyler plays the role of the outsider which helps shape biomedicine understanding of chronic childhood malnutrition in Mali. On the other hand, the children, women and the entire Malian culture play the insider role and helps biomedicine understand Malian problem of childhood malnutrition by explaining their culture and beliefs to the ethnographer. The Malian people help the ethnographer answer her research question of chronic childhood malnutrition in Mali by making her understand their culture and seeing things from their point of view. This ethnography shows how the Malian culture operates through social representation, and helps readers have a feel of the culture and judge it through cultural relativism and not ethnocentrism; this work presents the Malian community in a positive light, and strives to understand them for who they are. The possible impact of this ethnography is that readers and people around the world will be able to understand childhood malnutrition by learning about a culture’s belief system, and seeing how nutrition is imbedded in the roots of a culture and its struggle during colonialism. In addition to this, this ethnography brings light to a very important global health issue; child malnutrition, and its impact in conquering life threatening childhood diseases.

            Childhood malnutrition is a very important global health issue, and this is clearly shown in the WHO 2102 World Health Statistics report which states, “Childhood malnutrition is the underlying cause of an estimated 35% of all deaths among children under five years of age” (p.12).

Conclusion

            In summary, I feel like this ethnography is a very strong and insightful piece of work. The author has written this ethnography like a diary, where she has fully pointed out her epistemology and biases, and talked about how doing this research has helped her redefine her perspective on childhood malnutrition in Mali. I feel like the author went above and beyond to fight and get rid of her preconceived notion, which greatly helped her successfully mingle and understand her research subjects. However, I really wish she would have given numerical data and a little colonial history of Mali in order to make her ethnography stronger. Dettwyler left out a big chunk of the colonial history of Mali, which would have really helped readers better understand her research and overall ethnography. All in all, I feel inspired by this ethnography, and I feel like I have a better understanding of the Malian culture.

Bibliography

Dettwyler A. Katherine

            1994 Dancing Skeletons: Life and Death in West Africa. Long Grove, Illinois.

            Waveland Press, Inc.

Borovoy A, Hine J.

            2008: Managing the Unmanageable Elderly Russian Jewish Émigrés And The

            The Biomedical Culture of Diabetes Care. Mar; 22(1): 1-26.

Scrimshaw, S. C.

            2006: Culture, behavior and health. International Public Health. Diseases, Programs, Systems and Policies.

Venessa Misewe

WIFE INHERITANCE IN THE LUO COMMUNITY IN KENYA, EAST AFRICA

The Luo community is the third largest tribal group in Kenya with a population of about 3.3 million. Kenya is a small country in East Africa, along the coast of the Indian Ocean, with a total of forty two tribes, and a population of about forty million people. The Luo tribe is one of the main tribes in Kenya known to have very strong customs that have been tightly preserved and passed on for generations. One of the main cultural practices in the Luo culture is wife inheritance, which is a main part of the culture, and one of the key practices that the Luo people are known for. Wife Inheritance is a practice where a Luo woman is forced to be inherited by a married cousin or any kinsman of her deceased husband upon his death. This practice was originally intended for good and was meant to take care of widows in the Luo community by caring for their economic needs(the person who inherited the widow was responsible for providing for the widow and her children), physical needs(the man who inherited the widow had the right to engage in sexual acts with the widow) and lastly the man who inherited the widow was responsible for protecting the widow’s wealth that she acquired from her deceased husband, and he in turn was the one who decided how the widow’s wealth would be used. 

However in the late 1980’s the Luo practice of wife inheritance was being threatened by the onset of HIV. When HIV first started in Kenya, many people began dying in large numbers, and the infection rate especially in the Luo culture tripled because when a HIV infected man died, his wife(who was also HIV positive), was automatically inherited by her husband’s brother. The wife was required to have sexual relations with her husband’s brother and this in turn passed on the infection to the husband’s brother. Let’s keep in mind that the man who inherited the widow was still married and still sexually active with his wife. In no time, HIV infection increased and many men continued dying and many HIV positive widows were inherited, and in turn greatly aided in spreading HIV infection. This practice went on for years until the late 1990’s when AIDS was declared a national epidemic in Kenya with about 500 people dying of the disease every day in 1998. The British people who were assisting in trying to stop HIV infection in the 1990’s came to the Luo community and learned about the “Wife Inheritance” practice in the culture, and attacked the Luo people by saying that the practice was wrong and needed to be abolished because it was increasing the spread of HIV. The British in turn tried to educate the Luo women about condom use, and additionally tried to urge them to say no to wife inheritance. When the women tried to implement the use of condoms the men in the Luo culture were very angered by this because they viewed condoms as a way in which white people who had previously colonized them were trying to exert power on them again, and consequently, Luo men felt attacked and hey lashed out in an attempt to say no to condoms and preserve their wife inheritance custom. Women who insisted on the use of condoms or refused to be inherited were disowned and kicked out of the community together with their children.

Before the HIV pandemic hit Kenya, the Luo culture did everything to make sure widow’s conformed to the wife inheritance custom. To make the widows succumb to the 'wife inheritance' practice, the Luo culture imposes some rules to ensure that all the widows conform. Unless a widow goes through the inheritance cleansing ritual, she is (1) not allowed to attend social functions in the village and among relatives. She is viewed as a bringer of death and a bad omen. Even carrying someone's child is a taboo. (2) She is not allowed to engage in any economic activities such as farming. Even erecting a new house for her by anyone else apart from her male inheritor is a taboo. (3) She is threatened with wasting diseases leading to death. Failure to go through the ritual of wife inheritance is said to lead to a complete wipe-out of the widow's children and future offspring.   

http://www.preventgbvafrica.org/sites/default/files/images/resources/wife_inheritance_large.jpg?1313242355

Widows in the Luo culture had no choice but to conform to the wife inheritance practice. Although this practice was intended for good, the picture above shows that many men in the Luo culture misused this practice and used it as a way of taking advantage of the widow’s vulnerability by stealing her wealth. Not only did the men do this, but in turn, they raped many of the widows who refused to engage in sexual acts with them, and thus aided in the spread of HIV during the 1980’s. Many widows in the Luo culture did not like the practice, but had no choice but to conform to it. It was degrading and oppressed not only the widows but also their children because the men did not do much to provide for the widows children. The image above shows how widows in the Luo community suffered for years all in the name of culture which in turn lead to their death sentence during the onset of HIV. The mask symbolizes the evilness on the wife inheritance practice, and all the negative effects in brings along with it; rape, property theft and HIV/AIDS. It just shows how something that was originally intended for a good cause can lead to all these negative side effects. Culture can sometimes be our worst enemy, and it is better for us to hold on to what is good in our culture, and try our best to get rid of what is not good in our culture.

Although Wife Inheritance has been openly criticized in today in Kenya, many Luo people are still stubbornly trying to continue implementing the culture. The video below shows how widows in the Luo community are still struggling to free themselves of wife inheritance practices, and in order to do this, they have to go outside the community and seek help from government officials and tribal elders who are more open to change the custom. In most Kenyan communities women are traditionally not allowed to inherit their deceased husband’s land, but a new constitution was released in 2010 that gave women the right to inherit their deceased husband’s land. Although the constitution gave women the right to inherit land, many communities are still having trouble accepting and following this new rule, and this is what the video below shows.

DISINHERITED WIDOWS VIDEO PLACE HERE

                                  http://www.youtube.com/watch?v=3daHAXZlC2I

This topic of wife inheritance in Kenya reminded me of this week’s article, “Endangering safe motherhood in Mozambique: prenatal care as pregnancy risk,” by Rachael Chapman that talked about how women in Mozambique delayed seeking prenatal care until their second and third trimester because they had a cultural belief that if they went for prenatal care early in their pregnancies because they were scared that “they and their unborn infants will be targets of witchcraft or sorcery by jealous neighbors and kin.” Even though Mozambique women had good intentions for delaying their early prenatal care treatments, they did not know that they were actually harming themselves and their unborn infants by not seeking prenatal care in their first trimester. The cultural practice of delaying prenatal care by the Mozambique women actually resulted high infant mortality rate, lost pregnancies and high maternal mortality rate in women in Mozambique. To the Mozambique women, delaying prenatal care was seen as a good thing, even though they were not seeing the consequences that their cultural practice was doing to them and their unborn infants. 

The wife inheritance image with the mask, the disinherited widows video and the Rachel Chapman’s article about prenatal care in Mozambique all show how culture is embedded in us, and how even though some of our cultural practices can be meant for good, it can actually be causing harm to us. The wife inheritance culture in the Luo community of Kenya was actually meant to protect and provide for the widow and her children, but in turn ended up actually harming the widows through rape, property theft and HIV/AIDS infection. The video about the disinherited widows shows how the wife inheritance practice still affects many widows in the Luo community and how Luo men are still trying to keep the practice alive by oppressing widows. Rachel Chapman’s article shows how a mother’s good will to protect her unborn child actually ends up hurting her in the long run. 

I think that these three elements (the video, image and Rachel Chapman’s quote from her article) show us how culture is a very important part of who we are and how we view life. It’s very patriotic to love and want to preserve your culture, but at the same time, you should be willing to let go of cultural practices that are harmful to you. It may seem like an act of Ethnocentrism when an outside comes into your culture and tries to correct certain parts of your beliefs, but you must be willing to reevaluate your culture, swallow your pride and change the wrong things that need to be eradicated, and preserve the good things. In summary you should make your culture work for you.

Worked cited

http://www.preventgbvafrica.org/sites/default/files/images/resources/wife_inheritance_large.jpg?1313242355

https://www.morebooks.de/assets/product_images/9783848448/big/5031078/wife-inheritance-among-the-luo-of-kenya.jpg?locale=gb

Centre for Rights Education & Awareness (CREAW)

Family Planning Association of Kenya

http://www.fpak.org/

FEMNET - African Women's Development and Communication Network

http://www.femnet.or.ke/

s

Center for AIDS, Development, Research and Evaluation

http://www.cadre.org.za/

POWA - People Opposing Women Abuse

http://www.powa.co.za/

http://www.arc-kenya.org

http://www.youtube.com/watch?v=3daHAXZlC2I

http://anth215withava.blogspot.com/

THE WORLD HEALTH ORGANIZATION AND GLOBAL HEALTH

THE WORLD HEALTH ORGANIZATION AND GLOBAL HEALTH

            The most striking thing about the readings we’ve done in the last ten days is how everything is about Global Health. It really interesting to see how global health and the World Health Organization are mainly controlled by the developed countries e.g.: United States, Europe and the Soviet Union. These developed nations are the ones who make the rules and regulations that for the most part favor their own personal interests, and hurt the interests of the other less developed countries. A perfect example is shown in this week’s article “The WHO transition from International to Global Health” when United States and other developed countries in the WHO took full dominance of the organization in 1949 after the Soviet Union and other communist countries left the organization. America found a way to quickly dominate the WHO in 1949 and by the time the Soviet Union joined the UN and WHO in 1956, the US had already used the WHO to favor their country’s personal interest.

            I will not refuse to give credit to the WHO because they have really helped third world countries in the control and treatment of diseases like AIDS, Malaria, Small pox and Polio, but at the same time I personally feel like they could have done more. If you closely look at the WHO, yes it’s meant to serve and meet the problems of all nations in the world, but is certainly does the opposite. The WHO is just a way of developed countries to enforce power over developing and undeveloped nations. It’s like a form of slavery in a way. The developed nations (mostly white) form the guidelines, set the rules and force other nation to live by these rules and follow them. Developed countries are the ones who determine what is wrong or right in terms of health care and make the whole world believe that their ways are correct.

           

            The image above clearly shows that the whole world is judged by the standards of a small group of people. This group of people (developed countries) is the one that determine the world’s health care, and that the whole world is forced to do things their way or the high way. Which leads me to another thought; the World Bank. The World Bank was mainly created so that nations can borrow money from it during times of need. The World Bank which is mostly governed by developed countries, mainly loans most of its money to undeveloped and developing countries that were mainly colonized by the developed countries. Most of these third world countries borrow and will continue borrowing money form the World Bank because after their colonizers left, and they gained independence, they had a hard time starting over and learning to govern their countries and do things on their own. When colonizers like the British, Dutch, French and Portuguese colonized their colonies, all they did was use all their colonies resources (human labor, gold, oil and plantation) to benefit themselves, and as a result, they got richer, why their colonies for the most part did not benefit at all. After their colonies gained independence, their colonies were left with the hard task of figuring out how to use their lands resources, and that took a long time to figure out. Most colonies gained independence in the 1960, and up to date, they are still trying to figure out how to govern themselves.

            So for the most part third world countries will always owe the World Bank millions of money in loans, and the developed countries will always have power over global health because they are the main contributors to the World Health Organization, and as much as I hate to say this, developed countries will forever reign superior over the whole world. That’s just the plain truth.

            Global Health is just a word that was coined in order to make the world believe that the World Health Organization is all for one and one for all. But in actual sense, global health is not a universal movement because it has major actors who are: - the World Bank, WHO, private organizations and philanthropists (westerners), who will always be at the top food chain of global health.