Category: Anthropology

Categories
Anthropology

Interview 1: Part Two

I apologize for the wait to get this part out of the interview. As school starts up, things get hectic, but I am planning on trying to post regularly. This is the end of the interview with Dr. Ketan Shah, and he closed with some riveting takes on the world of medicine. Enjoy!

So, following up on this point, how do you believe Western treatment could improve by adopting Indian practice?

A lot, 100%, there is no question.

How in the sense, principally how?

Principally is a little difficult, because all these are like, you know, established things, which are so very difficult to change, and I would not rate myself as the best person to give you this answer, but seriously, I am the best person to give you this answer because I have seen both the counterparts.

I have worked with both counterparts.

I always feel that they (the west) are broader, their mindsets and everything is completely different.

So if somebody would ask how can we adapt to them-India adapt to them-is still a marginally possible chance for me because the areas that they excel in are non-human, so as to say.

So if I have 100 crores, I can make the same hospital as in the U.S. I can bring in the same instruments.

So infrastructure is possible for India, but the same, like, you know, the gray zones of, say, the U.S. medical system, if you compare it with any of the Asian countries, is much bigger. I visit Seoul, South Korea as a professor. So even in Seoul, there is a huge quantum. Asian countries are essentially crowded. You get that exposure. Everything is in magnitude. I could get 55 cases of fever in one day.

For med students, that (the exposure) is a compulsion. Because you have to attend. 

And if you don’t attend, you don’t go for the exam. From 9 o’clock to 1 o’clock, you are doing one thing every day. The amount of cases med students here see is in no way possible in the US. So, taking something there is not possible.

Secondly, they say that their strengths are their strengths. There is a weakness in that. Infrastructure is a strength. Technology is strength. Inventory is strength. So they are upgraded or they are at strength in so many zones. They will not degrade to what they believe is a lower practice. Their gray zones are not going to go because that system is so very complex now.

They also have a system set in place. Whosoever it is, they have to go through a system. You cannot see a consultant straight away. You will have to go through your GP. So it is a system. You just cannot go to a radiology workplace and say that I need a CT scan or I need an x-ray. It is just not possible.

Here you can get an X-Ray or a CT scan even without my prescription. If you want to do a CT scan, fine.

So that is not something which is possible in the US.

As I said, I would still see that this question can be a little reformed in what we can or what we should take from them. What we should take from the US is something which is a very serious point.

Do you think India could learn from the West from an infrastructure and technology standpoint?

Exactly. System and documentation I would say. We are a country which is very poor in documentation. The amount of work that we do doesn’t go in the textbook. If you just scribble the number of textbooks that are written by Indian doctors or scientists, it’s not even 10%. Whereas, they are only doing 10% of the work we are doing. When it comes to putting down on paper, when it comes to documentation, we are so very poor. As I said, I have done around 10,000 cases, but I have not done documents.

Manpower obviously, even though it is an overcrowded and overly populated country. We are always short of manpower. Those helping hands and things like that.

So maybe that is something which we need to learn from them.

You said the system there consists of a hierarchy in hospitals. There is a general practitioner, and then a specialist, versus going straight to a specialist here. Do you think it would benefit specialists to make such a system here? Do you think they should make a system with just specialists?

They should make such a system. In times of crisis, it is much easier to find treatment here, whereas there you have to go through so many more steps.

But, many times, the patient is coming to me, but in reality it is a waste of my time and energy and resources and whatsoever. If a general practitioner has a strong pull, then they can be of a very good help to filter out cases. Like here, if I have to go to attend some camps or see some peripheral patients, I see so many patients who would not definitely require our services. They would have been jolly well treated by the general practitioner.

And here it’s like, you know, because we are easily accessible, it’s like, you know, even if somebody would have a cough or sneeze, they see the super specialist number 1000.

But we are changing a little here. We have assistants, subordinates, to help us. So that is very systematically coming up in India as well, wherein it’s not exactly the general practitioner, but then we have our subordinates. If I didn’t have them, I couldn’t have given this interview right now. I would be up to my eyes in patients. But my subordinates can weed out the cases for me. So that is gradually coming up in India, but it is not as systematic or as rigid as you have it in the US.

I would like to thank you for sharing your thoughts with me, and I thoroughly enjoyed talking with you today. I hope to speak with you again, down the line, as medicine progresses and changes, to hear your thoughts on the future. 

Categories
Anthropology

Interview 1: Part One

A few weeks ago, I met with a prestigious orthopedic surgeon who practices in Rajkot, India. He has studied all over the world, including the UK, the USA, and South Korea. He is a teacher and a continuous academic, constantly striving to improve his knowledge about his field. I was very happy and honored to conduct this interview with Dr. Ketan Shah of Prabhukrupa Hospital.

I really wanted to examine his thoughts on the differences between Western and Eastern medicine, but before we dove into that, I was able to learn more about Dr. Shah’s life. I hope you enjoy reading this interview as much as I enjoyed talking with him!

Where did you go to school?

I did my undergrad from Karamsad, which is in Gujarat, and then I did my masters in orthopedics, so that is called MS, so masters in orthopedic surgery from the same medical school. Then I did my superspecialization, which is the diploma of national boards, so I became a diplomat in the field of orthopedics, which I did it from Pune.

I took my fellowship from different places across the globe for my knee replacement, so that I precisely did from 2000 to somewhere around 2003 – 2005, wherein primarily I got myself trained in Germany, where I was for a very long time. That was a long term fellowship, I stayed there for about a year or so.

I did some short-term fellowships across Singapore and then again back in 2006 I went to Australia, wherein I did my fellowship and training for revision knee replacements. (Revision knee replacements are when a previous knee replacement fails, so a doctor goes in to try to fix the botched replacement).

Why did you become a doctor?

I always wanted to be a doctor, I don’t know why, but I think that’s what my parents say, that the first thing that I started saying was that I want to become a doctor. I don’t know, but there should be some influence as far as the family was concerned, because you know both my parents are doctors and my grandfather was a doctor, grandfather on both sides, my paternal grandfather and my maternal grandfather, both of them were doctors. Maybe that would have had some influence over me, but I’m not very sure.

Right from day one, I wanted to be a doctor gradually as I started growing up and started visiting my parents’ hospital and the discussions that used to happen back home. You get a chance to save somebody’s life and more than that, you start getting a chance to make some difference to somebody’s family. Things like that made me all the more inclined towards taking that (step). After I did my undergrad, I did my first residence in General Surgery. One of my teachers showed me the brighter side of orthopedics and I precisely came to orthopedics because one of the points was that they come crippled and they go back home walking. So that was so very satisfying overall, that you make a huge difference in somebody’s life.

(For example), we used to have a lot of poly-trauma patients, road traffic accidents and stuff like that.

They would have many fractures and things like that. You know, if they are not well fixed, their entire life would get ruined. Somebody who is 20 years old, and if they have some fracture and then it is left out with a deformity, they are crippled for the rest of their life.

So orthopedics was a satisfying kind of a field wherein you feel that completeness of giving a good quality life. Then when the time came to select some subspecialty, I selected joint replacements. Again, precisely because joint pain, so as to say arthritis, is typically a crippling kind of a disease and it is going to affect a geriatric population. So, you know, here we start seeing a lot of people suffering from arthritis being neglected because they can’t walk, they are not self-sufficient, they are not self-reliant. So gradually over a period of time, they have to be dependent on somebody and that is so very traumatic. Putting yourself into four walls, you know. So that was again one of the points why I started doing joint replacements. The aim was to make them independent, give them a good quality of life, so, if not anything, they are self-sufficient. (They aren’t) dependent for the silliest of the things on somebody else.

So that was probably why practically I chose medical school.

Thank you! You have already answered this question somewhat, but … What is your branch of medicine and what does it entail?

My parent branch is orthopedics and my subspecialization is called arthroplasty, which is the medical terminology for joint replacements. So, I deal with joint problems, which essentially would require joint replacements.

You said you enjoyed orthopedics because patients come crippled and go back walking. Is there anything you want to add?

No, as I said, maybe that sense of gratification that you can make a small difference in somebody’s life.

Many times, saving somebody’s life is so very satisfying, but at the same time, every coin has two sides. So at times we see things going the other way around as well. And you know, those situations coming to somebody else’s life is beyond anybody’s scope of control. Making an effort to bring them out from it is something which we can do, and that is, like I said, truly satisfying.

So that’s one of the things which I’d always liked is that it is still a greatly noble kind of a (position).

People give us that dharaja, dharaja is status, status of somebody like, you know, godly kind, which I don’t really feel that and truly believe that we don’t deserve it. Doing all these joint replacements for all these long years, and recently, we studied our own data, we are now coming close to somewhere around 10,000 odd surgeries. So there’s a big number. So gradually, you know, you start to think that you take away nature’s joints, we take it off and then we fit in a part there. And at the end of the day, it has to match God’s joints. You know, we don’t have God, but we have to do it properly. So we can’t get the dharaja of God, but from the point of view of function, work and all that, we have to match to those standards of what has been eternally gifted to us. So there are a lot of challenges as well.

How would you consider your practices different from Western practices, if at all?

Yes, definitely there is a lot of difference and I would rate practice in this part of the world, especially if not anything else, practice as of now in India, any day better than any place across the globe. I visit the US very frequently. I am on their editorial board at HSS, Hospital for Special Surgery. But I would feel, any day, we are absolute on the scales of excellence, we are probably 10 on 10.

I don’t say that somebody is 7 on 10. But why I would say we are 10 on 10 is the exposure.

The amount of cases that we are subjected to in this big country, this big population, is probably triple.

(I will paraphrase the next part to aid in understanding and speed).

When I was in the US last month, I talked to a doctor about a new type of surgery they were trying in the US. He had only done it 2-3 times, and he had a long list of materials needed, and the surgery took a long time. I looked at the list and told him that I could do 10 surgeries with the items on the list. I’d done the surgery many times before, in less time, with less resources.

(The anecdote ends here.)

In India, patients come to us when they are on their last legs of life. When I was studying, the number of patients that we would see in a day was around 150 patients. For them, that was a month of work. I would see a difference as far as the clinical judgment is concerned, the surgical skills are concerned. I would surely undoubtedly say that we are far superior. As far as the technology is concerned, as far as the infrastructure is concerned, as far as the inventory is concerned, undoubtedly they are superior. That part of the world is far ahead in the amount of operation kits, the hospital infrastructure, the inventory so as to say, the instruments and equipment and all that stuff.

Would you say that in surgical skill, India is superior because there is so much exposure?

Absolutely, I would say. Because we are exposed from day one to the amount of cases, the variety of cases, and I would always feel that the limitations of resources made us powerful. Before you are entering your OR, before you are entering your operation theater, you know that you have limited resources. It is not going to be like, in the middle of the surgery if I ask for this kind of instrument, I am not going to get it.

So, before I start the case, I know that I have to finish this case with this many implants, inventory, so on and so forth.

I travel a lot in the territory to do cases. Now, the only time that I would come to know how the patient is doing is when I have already reached, say for example, Gondal or for example, Wankaner, wherein the patient would be taken to the operation theater.

So, you are going back there and that’s the first time that you are going to see that patient and back in your heart, you will feel, oh my God, what is this? He needs so much done, and I don’t have the instruments I need. So, from there, I need to deliver a world class result. With limited resources, you know that you have to play with only these three things and that’s it. So, maybe that over a period of time sharpens your skills.

A final point is people down here are forgiving. So, that is again one of the points why we clinically started getting a lot better. I have been traveling to the US for the last 10 years and I have been to almost all the big names and big centers across the US. Those people, I don’t know, are always afraid of getting sued. You know the people here are very forgiving, they forgive us. That made us good at the end of the day. Maybe we can take it both ways, but then obviously it is a blessing that people are forgiving here.

If something goes wrong, or some complications happen, people would come and say to us that you gave it your best and it is our fate. Which never happens in the US. It’s like you know anything that they want to do, any extra step that they feel that it is necessary, they will not do it. Going anything beyond their destined route is just not possible. Here, we have a lot of luxury to change our decisions, make calls mid-operation, and we don’t have to inform anybody. There, if you have to change your plan in between the surgery, you have to take so many approvals.

Categories
Anthropology

The Basics of Medical Anthropology

When writing about the general four subfields of anthropology, I came across medical anthropology. This is a very interesting subset of, surprisingly, cultural anthropology. When I first read about it, I immediately thought that a field of anthropology involving medicine would go under biological anthropology, but as I learned more, it started to make more sense. According to the American Anthropological Association, medical anthropology is a field that aims to “better understand those factors which influence health and well being (broadly defined), the experience and distribution of illness, the prevention and treatment of sickness, healing processes, the social relations of therapy management, and the cultural importance and utilization of pluralistic medical systems”. Reading this gave me a bit of a headache, and it really didn’t help in my understanding. So I did some more research, and I am going to break it down for you.

Definition

Medical anthropology does not look at the scientific causes of diseases. Instead, medicine is viewed from a cultural light. These anthropologists are trying to figure out how disease is distributed and what factors influence that distribution by drawing upon the 4 subfields of anthropology. From a cultural perspective, they can view how different cultures respond to disease, and why some cultures have a higher risk of certain diseases. They can also view societal reactions to disease. A very recent example would be COVID 19. The USA struggled to get its citizens to comply with mask mandates and vaccines, while Asian countries, accustomed to wearing masks when feeling ill, responded better to those guidelines. Eastern and Western culture emphasizes very different things. Western culture promotes individuality, and Eastern cultures focus on family and community. This led to a lot of arguments about individual rights being violated in the US, whereas more people were compliant in the East, looking at face masks not as a destructor of individuality but as a tool to protect the community. Looking at these cultural trends is a way that medical anthropologists can predict disease response and outcome. Another topic that medical anthropologists focus on is how treatments of different diseases differ between societies, races, and cultures. This is a topic that I will be focusing heavily on in later blogs, specifically how Eastern vs Western cultures differ in their treatment styles, and how they go about treating diseases, mainly arthritis. So, to sum it all up, medical anthropology looks at how culture and society affect disease, whether it be treatment, distribution, knowledge, or risk.

In the Field

Medical anthropologists use ethnography to do research about different diseases. This means that they will travel to the part of the world they are conducting research on and stay there for a period of time to do research. They conduct interviews, see the healthcare system there themselves, and live with the community there to understand life from their perspective. This immersive technique helps medical anthropologists learn the culture and view how disease fits into that culture. An interesting part of medical anthropology that is not widely used in other fields of anthropology is that when the fieldwork is done, medical anthropologists actually use that information to implement that solution into those communities. It is a field that actively changes lives and improves the world.

An Example Case

I am subscribed to the Medical Anthropology Quarterly journal, which publishes new cases and book reviews. I want to share with you a short summary of one of those cases. The article is called Handle with Care: Rethinking the Rights versus Culture Dichotomy in Cancer Disclosure in India. It is written by Cecilia Coale Van Hollen, a medical anthropologist who lived in India, doing ethnographic research about how a cancer diagnosis is disclosed to patients in Southern India.. 

 

She discovered that many doctors don’t tell their patients about a cancer diagnosis, instead letting their family disclose the news whenever they feel it would be apt. This goes against the rights established in the West enabling an adult to make decisions for themselves about their health and treatment. She interviewed various women about their experiences wherein a cancer diagnosis had been withheld from them. Some of the women said that they didn’t mind at all, and it showed that their family cared about them and didn’t want them to stress over a diagnosis. The rest were upset, not because they wanted to make decisions about their health, but because they felt it showed a lack of care for them as humans. Hollen’s research showed a lack of empathy for these patients from the doctors treating them. By not telling these women their diagnoses, they left them in the dark, wondering what was going on. Hollen researched more about this divide by interviewing several women and sitting in on meetings in the hospital to see what the conditions were like. She observed that the women staying in the hospital would compare notes and symptoms to figure out their illness and help other people through their treatment because there was no professional guidance available to them. It was a great example of a community forming through a shared bond, but one that formed from the wrong reasons. 

 

I really enjoyed reading this article, and I recommend anyone interested in medical anthropology to subscribe to this journal. The link to the article is below:

https://anthrosource.onlinelibrary.wiley.com/doi/10.1111/maq.12406

Next Steps

As I mentioned earlier, I will begin to interview physicians from the East to learn more about differences in treatment of diseases like arthritis between cultures. After learning about medical anthropology, the combination of culture with a hint of science has intrigued me. I am excited to go down this rabbit hole and learn more!

Categories
Anthropology

Intro to Anthropology

As I venture into the world of anthropology for the first time, I want to start with a basic understanding of what it entails and the different components that make up anthropology. I am mostly interested in biological and cultural anthropology, but learning more about the field as a whole will create a clearer picture of the field for me. Therefore, my first blog post is dedicated to an overview of what anthropology is, different types of anthropology, and the jobs that can be gotten with a major in each subfield.

Overview

The question I started researching first was basic: What is anthropology? I looked at scholarly articles and different websites, but I realized that, while learning through reading articles may help some people, what I needed was visuals and easily understandable language. So I turned to the best thing I could think of: Youtube. A basic search of anthropology pulled up numerous videos about majoring in anthropology in college and the vast variety of different fields of anthropology, plus an interesting song by Charlie Parker. These search results only led to more questions, so I started simple and watched videos that gave me short overviews of anthropology (with a brief break to listen to Charlie Parker). Then, I read through a few college’s descriptions of anthropology as a major to get an idea of it in a school setting.

Anthropology can be broken down into two Greek roots: anthrop (or anthropos), which means “human”, and ology, which means “the study of”. So, in its purest form, anthropology is the study of humans: their similarities and differences. There are four main subfields of anthropology: biological, cultural, linguistic, and archaeology. Combining these four can help anthropologists see how humans have changed over time, whether it be evolutionarily, culturally, historically, or linguistically. Using this knowledge, anthropologists can try to predict future trends or better understand the journey humanity has made so far.

An important word to keep in mind when learning about anthropology is holism. Anthropologists use a holistic approach to their studies by considering every factor that could affect the phenomena being studied. An example pulled from the book Explorations: An Open Invitation to Biological Anthropology, first edition states “A cultural anthropologist studying marriage in a small village in India would not only consider local gender norms but also family networks, laws regarding marriage, religious rules, and economic factors. All of these aspects can influence marital practices in a given context”. When reading about these different subfields with examples of studies that can be done within them, keep in mind this holistic approach that will be present. It makes these studies that much more impressive when you realize the magnitude of research that goes into them.

Biological Anthropology

Biological anthropology mostly looks at the evolution of humans and the biological variations that have formed. However, there is a vast range of research that can be performed under the umbrella of biological anthropology, so classifying it with a simple definition is tough. To study evolution, anthropologists either focus on primates or human remains. Studying variation involves observing humans now, whether it be adaptations, genetics in different populations, or overall health from several lifestyle factors. This short list in no way encompasses everything a biological anthropologist can do; it is just a few introductory points. 

Biological anthropologists find their work taking them into the field quite often. Those studying primates (primatologists) go into the wild to closely observe their behaviors. This could involve a study in which an anthropologist is trying to compare the social relationships of a primate to human society. They can also work in a zoology department. Those who combine archaeology and biology (human paleontologists) go around the world, studying fossils to determine the behavior of humans in the past, or they could work at museums of natural history. Studying human biology today could involve researching the evolution of different races, or the circumstances behind different allergies that some populations are more prone to. Biological anthropologists can even go into law enforcement as forensics experts. The varied jobs that a biological anthropology degree can get you is part of the reason why it is such a popular subfield of anthropology.

Cultural Anthropology

Cultural anthropology focuses on cultural variations in humans, and how it shapes their lives and the world. These anthropologists must let go of their own biases and judgments to immerse themselves in different cultures so they can get a complete picture of that culture. This is a practice known as cultural relativism. In doing so, they must temporarily shut out their own culture to effectively view a culture from a fresh perspective. Cultural anthropologists study everything, from art and music to religion and politics. To understand a culture completely, they use the concept of holism. Many cultural anthropologists may go live in the place they are studying to better understand the culture present there. A famous example of an experiment in cultural anthropology was performed by Margaret Mead in 1928. She went to Samoa to live there for a few months, researching their teens. This was because there was a “rebellious teenager” phase that the US was going through and she wanted to see if it held up elsewhere. Her findings said differently, showing that the Samoan teens were calm and well-behaved. After she came back, she published it in a book, criticizing American parents for being restrictive and conservative parents. 

Cultural anthropologists work mostly in the field as they research. They must be a part of the culture they are studying temporarily, so they travel around the world through their research. This is called ethnographic research. However, research isn’t the only option. They could become historians because of their schooling as a general anthropologist, or even become an interpreter. Though they are not linguistic anthropologists, studying different cultures and doing research around the globe opens up opportunities to learn different languages and skills. This branch of anthropology is one of the most general, and many subfields branch off of it, such as medical, legal, and business anthropology.

Archaeology

Archaeology is probably one of the most well known of the subfields of anthropology. It is very connected to human paleontology, however archeologists mostly work with materials, while paleontologists work with fossils. Archaeology is the study of human history and prehistory. Just as a side note, prehistory is before writing was invented, and history is between the invention of writing and present day. Archaeologists can do anything from analyzing old artifacts from ancient civilizations or excavating ancient cities. 

I used to think that archaeologists had the coolest job ever: finding dinosaur fossils. (I’ve since realized paleontology is actually the field where dinosaurs can be found.) However, as disappointed as I was to learn that, archaeologists actually do have an interesting line of work. Of course, the part of the job that everyone knows about is the excavation, but there is so much to be done after something is discovered. They must research that artifact and use it to learn more about our ancestors. They are also responsible for the preservation of historical sites, such as Petra. There is a misconception that archaeologists travel all the time, but actually, most aren’t on the field. They work in museums, schools, and for the government, so while it may not be all traveling, there are plenty of job opportunities.

Linguistic Anthropology

Linguistic anthropology is the study of language and how it affects different cultures and human socialization. I had never heard of this branch of anthropology, so this was both the most fun and the hardest to learn about. Language is used to communicate ideas, bring about change, and illustrate beliefs. Linguistic anthropologists study how differences in language shape thought and communication. For example, there is a word in Spanish and Portuguese, sobremesa, that means relaxing and chatting at the table after a meal has finished. It’s really untranslatable to English, and linguistic anthropologists could look at it to see cultural differences between English speakers and Spanish/Portuguese speakers. It is thought that those cultures are less rushed to go about their day after a meal, so it is a more relaxed affair. These anthropologists also study how languages came about and the changes that have occurred in it over time. Slang constantly keeps changing throughout generations, and anthropologists study those types of changes to see differences in these generations. They could also look at how languages could bring to light inequalities in certain cultures.

Linguistic Anthropologists can have field jobs, though many do end up working as professors. Because of their language skills and studies in social interaction, they can end up also working on social media teams or in public relations. They can even get asked to create a new language. In fact, many fantasy movies and shows have asked linguists and linguistic anthropologists to create languages for them, such as Star Trek and Superman. While it may not be a very well known field, it is a major part of anthropology that looks at something everyone can relate to: language.

The End!

After talking about these four branches, I realized there is one “branch” I did not mention. It is called applied anthropology, and it is not truly a branch, but instead more of an umbrella term. It is just the practical application of every field of anthropology; any research done to solve a real-world problem would be classified under this umbrella. 

Thank you for reading this post, and I hope you come back to read more!

My Research

These are some websites I read and videos I watched to write this blog.

https://www.youtube.com/watchv=3iB7lvdjhzE

https://bioanth.org/career/career-biological-anthropology/

Introduction to Biological Anthropology