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Year: 4th, Semester: 7th
Dr. S. M. Arif Mahmud
Department of Anthropology
University of Dhaka
Health Seeking Behavior of Arthritis Patients
This research is a medical anthropological study on arthritis disease. The biomedical explanation of arthritis is universal; it is a musculoskeletal disease that causes the progressive inflammation and degeneration of articular surfaces and the underlying bone.
Osteoarthritis is one of the most common pathologies affecting human skeleton. In this research I will show the social and cultural context of this disease other than human’s biological condition. Individual’s body is manipulated, guided and constrained by cultural norms. In this study I will make a bridge between the biomedical explanation of this disease and medical anthropological knowledge as well. Here, I will show how people define and contextualize this disease through their socio-cultural and political-economic perspectives.
I will interpret how people relate cultural, political and economical factors to the diagnosis of this disease and the health seeking process of this disease. How they are experiencing this disease based on their age, sex, class and social position and how they make decision regarding the health seeking of this disease and finally how people share their experience of sufferings.
Arthritis is the inflammation of joints, it occurs when the cartilage (surface on the ends of bones) which absorbs mechanical forces on joints and responses to subsequent inflammatory simulations breaks down. Cartilage is hardly a regenerative tissue resulting in the incurable disease called arthritis. There are over 200 forms of arthritis the most common forms are osteoarthritis and rheumatoid arthritis.
In Bangladesh the prevalence of arthritis per 1000 population was 4.7 in 2000 which increased to 14.0 in 2012. Morbidity among elderly population (64+ years) was highest 77 per 1000. Prevalence of arthritis was higher in females (91.0) than that of males (63.7) per 1000 population. Morbidity prevalence of arthritis is higher in rural area (14.8) than urban area (11.2).
As arthritis is not a curable disease regular physical exercise and treatment is required to reduce its symptoms. However individuals with this disease have little benefit from prescribed medications (Holman and Lorig, 2004). In Bangladesh, knee Osteoarthritis is one of the familiar disabling diseases affecting both elderly male and female (Rashid et al., 1997). It is show that 32-64 years age group were most affected and female were mostly affected by osteoarthritis. Among them the rate of housewives affected were 39% so they are more vulnerable to osteoarthritis. Patients with disabling osteoarthritis of the knee are rapidly increasing day by day. One statistics give a general indication to the prevalence of osteoarthritis; about 10,392,681 people are affected by osteoarthritis in 2004 (Statistics by Country Osteoarthritis, 2005).
I have stated that the aim of my study is to find out the health seeking behavior of arthritis patients and the cultural factors which influence health seeking and choosing treatment from plural medical system regarding arthritis. Below, I will explain the theoretical framework related to my work.
Explanatory model was developed in the works of Arthur kleinman who was a physician. There are different components in the description of a person’s illness a disease.
1. Etiological description
4. Therapy sessions
The detailed explanation an individual gives about a illness or disease is is explanatory model. For example: a shaman, a doctor or a sufferer will have three different explanation of the same disease or illness. All this explanation has difference among them this is known as the explanatory model It is the differences in explanation of people on a same disease or illness.
Klinman developed this concept as a tool that would “privilege the voices of patients and families” involved in clinical encounter ( Kleinman 1995, P. 8) Kleinman hoped to create a system that would illuminate the gaps between the ways of provider’s and patient’s health problems by drawing attention to the fact that medical practices, concepts and meaning are just culturally derived as those of patients (Kleinman 1995 ).
Critical Medical Anthropology
Critical approach in medical anthropology claims that social stratification impacts health issues. The profit making orientation of capitalist society caused biomedicine to evolve into a capital intensive endeavor heavily oriented to high-technology, the massive use of drugs and the concentration of services in medical complexes.
Critical approach gave importance to recognize the role played by class and related social struggle as a breeding ground for medical pluralism. Critical approach includes postmodernism, marxism and deconstructionism as the basis for its argument. Critical approach argued that reality is socially constructed and this version of reality can be used to conceal complex social, political and economic relationships.
According to singer (1989) critical medical anthropology has seven main areas of focus. These includes:
1. examining the role of global economic system and social processes in shaping health and illness;
2. assessing health policy, state involvement and resource distribution in developing countries;
3. critically examining the idea of medical pluralism;
4. developing a critique of biomedicine;
5. assessing conflict in health and health-care countries;
6. recasting micro level health behavior in light of broader structural process;
7. investigating health in socialist countries.
critical medical anthropologys theoretical roots ultimately emerge from Marx’s broader critique of capitalism ( Marx 1888/2006 ) to Engel’s early research on health of the working class ( Engel’s 1845/1998 ) and from dependency theory’s analysis of peripheral nations in the world capitalist system ( Wallenstein, 1974)
Statement of the Problem
Sickness is a social, biological and cultural phenomenon (brown 1998). Anthropology is primarily about the human and their culture and its practices. It tries to find out the inner meaning of these cultural facts. Anthropology is not an experimental science in search of law but it is engaged in search of meaning (Geertz, 1973). From this point of view I find interest to seek out the socio-cultural interpretation of arthritis, its health seeking behavior and etiological explanation. The current rate of arthritis is increasing rapidly and treatment system is based on doctor’s dominance where arthritis is seen as biological phenomenon but there are other factors influencing behind it such as social, political, economic and cultural which are being ignored. Modern biomedicine focuses on the curing rather than the prevention of disease or illness and spends much time in money, hospitals, clinics, ambulance, drugs then it does on public healing facilities, preventive education and eliminating the stress etc ( Hahn, 1983 )
1. To assess patients knowledge about arthritis
2. To identify the cultural interpretation of arthritis
3. To understand people’s experience of sufferings
1. How much do the sufferers know about their disease?
2. How do the sufferers interpret their illness?
3. How the sufferers experience their illness?
Rationale of the Research
This study emphasizes on the influence in cultural factors that help person choose healing system for their health are practices and treatment and also help with initial diagnosis of illness. It explores the relationship between existing healthcare systems and social structure of the community.
To do my research I will be following these methods.
1.Open ended interview
2.semi structured interview
These methods are able to give emphasize on the people’s view and help explore people’s cultural understanding about a specific issue.
1.Elahee, Md. Ashek, (2012), Risk factors of developing knee osteoarthritis, Department of Physiotherapy CRP, Savar, Dhaka-1343 Bangladesh
In this study there were 35 cases and 35 number of control that means case: control was 1:1 and hospital based unmatched setting. Intended of this study to determine the risk factors of developing osteoarthritis with considering the variables like socio- demographic and socio-economic variables, using high heeled shoe, past history of painful knee swelling, barefoot walking, BMI, occupation, heavy activity more than four hour, stair climbing, sitting on the floor for home activity, prolonged standing, positive family history of knee or other joint diseases, regular weight bearing and sustained knee bending. The important way for prevention of knee osteoarthritis including the modification daily activity for reduces risk factors. The investigator suggested careful about the occupational posture during work which might be reduced the risk of knee osteoarthritis. Always maintain the correct working position during daily living activities and correct the faulty ergonomics design of the house which also reduces the risk of knee osteoarthritis, because investigator found that sitting on the floor for home activity one of the risk factor of the knee osteoarthritis in the study.
2. Singer, M. and Baer H ( 2007 ), Introducing Medical Anthropology: A discipline in action New York Rowman and Littlefield.
This book introduces basic concepts of medical anthropology and explores the historical development of medical anthropology, it explains illness and disease, it also introduces several of the dominant theoretical framework that guides much of the work done in medical anthropology.
3. Helman, C.G. (1994), Culture, Health and illness: An introduction for health professionals. London, butterworth, Heinemann.
This book explains different forms of healing and diagnosis. Eat explore some physiological and cultural factors that influences in Healthcare system these are given below:
1. Not all social cultural group response to pain in exact same way
2. Cultural and social background can influence health seeking behaviour
3. How people communicate their paint to help professionals and others is influenced by cultural factors
4. Brown, P. J. (1998), Understanding and Applying Medical Anthropology. London: Mayfield publishing company.
This book helps in the understanding of different approaches in medical anthropology. It discusses different types of field in medical Anthropology that help to understand different perspective of disease and illness in various cultural perspective among different communities as well as societies.
Geertz, Clifford (1975), The interpretation of cultures. Londan: Hutchison.
Holman, H., Lorig, K. (2004), Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public Health Reports (Washington, D.C. : 1974)
Sima, Salma Haque (2016), “Survey on Prevalence Risk Factors and Treatment Pattern of Osteoarthritis.” East West University.
Singer, M. and Baer H ( 2007 ), Introducing Medical Anthropology: A discipline in action New York Rowman and Littlefield.
Brown, P. J. (1998), Understanding and Applying Medical Anthropology. London: Mayfield publishing company.
Elahee, Md. Ashek, (2012), Risk factors of developing knee osteoarthritis, Department of Physiotherapy CRP, Savar, Dhaka-1343 Bangladesh
Statistics by Country Osteoarthritis, 2005
Case Study 1:
Aleya Banu (36) homemaker and mother of three claims that she has been suffering for about eight years. She has pain in her neck, back, spine and hips. Her pain is extreme during early morning and gradually dulls during the day and again rises as night increases. She has just bought a special pair of shoes that she believes will help with her hip ache. When asked she answered it was recommended by a friend (vabi). She does not continue the exercise instructed to her by her doctor she usually exercise for four to five days and then give up. When the pain increases to the point of unbearable, she visits a new doctor again.
While answering her thought on the etiology of her illness Aleya claimed that she was married at an early age in a joint family where she had to do plenty of hard labour which ultimately caused her illness. At her in laws she would bend over to clean the yard and nearby space of the house which would take up to two hours every day. This caused her too often get blisters on her hand and then she would also have to cook sitting down in a squatting position which was uncomfortable for her back, yet she would not complain due to her embarrassment and fear. She also cleaned pots and plates at the pond in that bent over position. At the end of the day her back would hurt extremely bad yet proper treatment were not accessible to her at most she said she would get hot oil massage (sarishar tel) from her sister in law (nanad).
She also had to work in the processing of paddy during the harvest season as she had no space to decline. Now with her illness she finds it difficult to do everyday chores like making roti cutting fish or chicken. Using the lavatory has also become difficult as she cannot squat down, she can barely sit on a high sitting toilet. She finds it hard to use transportation where it requires more higher movements to get in and out like rickshaw, bus or train and using private car all the time is too expensive for her.
Aleya Banu has visited multiple renowned doctors in the hospital and clinics of Dhaka. She has been taking various types of biomedical oral medicine. She has recently started physiotherapy since eight days. Despite doctors recommendation to take physiotherapy previously, she has been delaying this treatment because she said that she has a family to run, she is always busy and it is hard to find time in her busy schedule to visit physiotherapists routinely. The cost has also been an obstacle for her since physiotherapy is expensive.
Regarding her knowledge on arthritis she could not define arthritis or exactly what type of arthritis she has. She claimed she has joint e bat er betha.