The Margins Review · Culture-Centered Approach

One of the key elements of the CCA is the concept of structure (Dutta, 2008). Structures refer to forms of social organization that create as well as constrain access to a wide range of resources. These resources not only include basic necessities such as food, clothing, shelter, healthcare, education etc., but also the communication infrastructures necessary to participate in the dominant public spheres. Based on empirical evidence documented in health communication scholarship for instance, the CCA notes the correspondence between the absence of communication infrastructures and the lack of health infrastructures. These correlations narrate an underlying economic dimension where being poor gets constituted in the realm of being unable to secure access to a plethora of resources necessary for life. Having noted this economic base of structures then, CCA raises questions about the role that communication scholars could play in challenging and transforming structures. In other words, no...

One of my earlier blogs talks about US intervention in Aghanistan and the earlier support for Taliban offered by the US. This blog continues that conversation thread further. One of my students is studying the portrayals of "freeing Afghan women" that circulated in the US media during the US intervention in Afghanistan, further exploring the ways in which women in/from the Middle East construct, participate in and resist these images. In recounting a story of one of her interviews, she shared with me how a feminist scholar from the Middle East discarded postcolonial theory, stating that "Afghanistan really is backward. They don't even have a railway system." This statement stayed with me the entire evening, and here I am posting this message after much thought. When I begin with the notion, what really is backward, I also have to ask myself who gets to define the discursive frame of advanced/backward. The dominant logic of Western empires have historically scrip...

As we wrap up our discussions of the culture-centered approach, I am drawn to the question of the role of dominant social institutions (academia, funding agencies, global agencies, NGOs) as tools for neoliberal trade. The other day, I found myself in the midst of this meeting where the people assembled were talking about how there is a lot of funding now for doing things related to poverty and inequality. What struck me was the dishonesty of the conversation. Poverty now has become a hot topic area that could draw a lot of funding. So the same people who were running after these other things when the wind was blowing in another direction are now running after poverty because this is fundable. What I find problematic here is not that academics/agencies etc. have now become interested in issues of poverty (in fact, this could be a great thing), but rather what is disconcerting to me is the mercenary logic underlying the renewed emphasis on poverty. And what lies this mercenary logic is ...

No I am not going to shut up And pretend That I agree with Whatever it is That you Shove down my throat. No I am not going to shut up And sing praise to your cross and white coat and Whatever it is That you Want me to memorize. No I am not going to shut up And sing Praises for Whatever it is That you Throw at me as aid.

Today is our last class of the semester. Last readings of the semester. What stands out? What would be the meta analysis of what I have learned here? What would be the key ideas that have come up on Culture and Health? Based on all of our reading from the semester, and the discussions, I feel these are the things that stand out to me: I know nothing. So much more to learn and know and apply. Articulating questions, concerns, and opinions can be tough when the materials are so interesting. Is everything hegemonic in nature? Is everything Eurocentric in its core? What are the legitimacy of efforts that are good at heart but are wrong on the approach? How can I really make a difference that is beyond discursive space and entry points? Let the journey begin. Purdue should make everyone take a class like this one.

they told me to participate & took my thumbprint while I clutched at the soggy food packet & scuttled to my field my baby wailing its a lot hotter now the fields are wilting like my aged mother Her partner.... My father speaks of glorious days of yore.. and I wonder shouldn't our dreams be glorious too? My baby's father.. strong and wise but he too gets scared with these men and women from town shiny white skins  fancy clothes, talks, ways why do they come here? our good doctor is scared too.. even the school master they come more now, regularly I store some food for them give them local things after all government has posted them for my baby I do not mind the hardships only they're increasing how much can I do? and then these visitors almost everyday.. interested in us our lives are so interesting they're good people they talk of dreams of glorious futures unlike my father.. It was better when I was a child my needs were few I knew little & did not have to ...

Just to let you "green eyed monsters" know that I will be posting my BLOG soon...wait....

This week's reading theme was Culture and Prevention. The overarching theme was how different factors (culture being one) play a role in preventive measures and perhaps cures to illnesses in today's world. Susser & Stein (2000) talks about how culture plays a role in the sexuality and sexual relations in the women of Southern Africa, specifically in situations of preventing HIV/AIDS. The authors conducted a study in different location of Southern Africa and tried to find out factors effecting women's sexual practices and birth control methods that are accepted by both men and women of that region. The authors mentioned many times how all their subjects were excited about using female condoms and almost in unison they said this is what they need. They say that "with regard to women at least, each community needs to be studied in terms of the local situation, and the preventive measures advised and facilitated for residents must take account of the differences betwee...

Parts of the readings for this week dealt with the development of effective health messages. Kreuter and colleagues talked about the effectiveness of health communication and ways to improve its quality. They introduce a model of health communication planning that considers the source, the message, the channel factors, the receiver, and the destination of a message in respect to communication and how these components might be affected by culture. The article highlights that source credibility depends on expertise and trustworthiness. As much as I agree with that, I do think we need to differentiate here, because expertise can be different things to different people. For me, growing up in a biomedical world, expertise is defined differently than for someone who grew up around traditional healers. It was also interesting to read how messages are perceived differently depending who narrates them, showing cleary that receivers of messages try to identify themselves with the narrator, hence...

After reading an article and remembering a discussion from a previous course, I thought I should post this video.

My take home message from this week's readings was that in many instances focussing on "adapting behaviors" would do much good than focussing on "prevention". Of course, ideally, we should work on prevention behaviors but there are situations in which culture, structure and agency make it difficult to display the preventive behaviors. In such circumstances, an adaptive behavior makes sense.  Lifeskills training, training to negotiate, skill building on taking the optimum decisions within the context are ways in which we promote "adaptive behaviors". Of course I am trying to connect culturally situated approaches with the "behavioral" approaches. Focussing on adaptive behaviors also has a good match with the "prediction" objective; as they are more efficient and achievable.  Consider the oft discussed case of vegetable and fruit consumption as a cancer prevention behavior being advised to the inner city population. Here, we would not...

  This week's readings and the BLOG were a bit challenging for me in the sense, I had not thought of sexuality in this sense and understanding sexuality and relating it to the readings took me some time. Of course, culture and sexuality are related and intertwined. Culture is a meaning making enterprise and so is sexuality, the way we identify ourselves in relation to sex, gender. As a human being, your sexuality is a part of your physical, emotional, intellectual, and social self. It very much influences how we think of ourselves, how we relate to others and our meaning making process in the society. As all of us are different, there is no normative "sexuality but it is a product of the interaction of our gender, sexual orientation, religious beliefs, identity creation, values and persepectives (again leading towards epistemologies and the cosmology we access in the meaning making enterprise). This manifests in our expectations of how we think a man or woman should behave and...

When we come to you Our rags are torn off us And you listen all over our naked body. As to the cause of our illness One glance at our rags would  Tell you more. It is the same cause that wears out Our bodies and our clothes. The pain in our shoulder comes You say, from the damp; and this is also the reason For the stain on the wall of our flat. So tell us: Where does the damp come from?

This week's readings quite explicitly focused on the theme of resistance. At some point in my life I knew of only one meaning of resistance - armed or violent opposition. And now critical studies have given me more knowledge was understanding of what else can be constructed as resistance. We see resistance in Mallory & Stern's (2008) article Awakening as a Change Process Among Women at Risk for HIV Who Engage in Survival Sex . The authors highlight that one out of every five AIDS patients is a woman, and HIV/AIDS is the leading cause of death among African American women. More importantly, such AIDS prevalence seems to be more common among women who are marginalized by poverty drug abuse, and sex trade. The authors implicitly argues how addressing the root causes of such behavior among this population acts as resistance towards further victimization of these women. We then read about the resistive acts of the low income African American young females in Martyn & Hatchin...

"Borderlands are folded over and crossed again, and recrossed. The membranes of the border are of varying porosities, closures and openings, subversions and states of exception, checkpoints and circumventions, surveillances and (in)securities, orders and disorders, fears and displacements, with the Real gazing back from holes in the defences." (Fischer, 2008). This could be a snapshot from a war zone or from an emergency room of the Home hospital. Borderlands are also the places where resistance is enacted.  Dutta (2008) posits that resistance is intrinsically communicative as it communicates certain meaning about social structure. It could be an organizational structure too as Granzow and Theberge (2009) find in their investigation of workers experienced meaningful participation in the participatory project and some of the main barriers to worker participation. Dutta-Bergman (2004a, 2004b), defines resistance as a process of enacting agency in opposition to the structures th...

The first article from the package I read this week was Mallory's article on women at risk for HIV because of survival sex. I was excited to read about this topic as it somewhat feeds into my research area. Maybe my expectations were too high, but I was very disappointed when I was done reading. Mallory's research topic was great and I think the questions asked made a lot of sense, but I was hoping she would present more of the responses from the women they interview instead of trying to press her findings in a more than questionable theory. Also, did anybody else get upset with her figures? Luckily the next article I read was the one by Martyn on 'tough girls' rewriting negative scripts, now that is what I call qualitative research and I was thinking to myself: that's how it needs to be done! I liked the article's thick descriptions and how it presented the topic from various viewpoints. It allowed the reader to be part of their experiences although I doubt any...

I thought this is interesting as we are in health care to some extent. This video is less than 2 minutes long.

In a previous posting, I talked to some extent about a teacher I had in school who died of breast cancer. She never sought biomedical treatment for her disease. She was afraid. She never tried local/ alternative health care in terms of homeopathy or Ayurveda. She went for the religious healing that did not help her save her life. People subscribe to different ideologies and practices for their health outcomes. Their reasons are as varied as the ways they choose. But still, to a large extent the biomedical model has come to dominate the most of the world. As this week's readings elaborate more on this, we find out about the Flexner Report. The Flexner Report (also called Carnegie Foundation Bulletin Number Four) is a book-length study of medical education in the United States and Canada, written by the professional educator Abraham Flexner and published in 1910 under the aegis of the Carnegie Foundation. Many aspects of the present-day American medical profession stem from the Flexn...

http://video.nytimes.com/video/2009/03/28/health/1194838918148/translating-health-care.html?hp

A couple of interesting questions arose while reading this week. Let's start with Arakelova's article on healing practices in Armenia. Being somewhat close to this ongoing fight for years by being a German citizens and by experiencing cultural clashes between Yezidis and Kurds on a weekly basis, this article was especially interesting to me. At some point, when the article talked about ethno-religious groups, I started to think about the question we had discussed many times before: What defines identity? What does it take/need to be a culture of its own? Can a culture extinguish because the passing on orally of traditions fails? Another topic that evolved in this reading, but also in Kim's article on Korean elderly was assimilation or acculturation. Arakelova talks about "necessitated assimilation". I wondered, after moving to a new country, is assimilation a voluntary, mandatory, or automatic and completely subconscious process? Is it easier for some but nor for ...

The first question I want to raise is that "does pluralism means agency"?   Meyer's makes a substantive point with his poignant account of Beverly. Quoting him, "the ground upon which chronic illness is made meaningful becomes profoundly unstable when the conditions of experience fail to conform to standard disease categories and their symptomatology." We have come across this thread in previous readings too when we have seen biomedicine being applied and experience reduced to "measurable", "diagnosable" categories.  The other question is what else to do and how to reconcile? In today's world, when movements constantly take people across borders and translational locations, where people exercise their agency (do they?) to get into stultifying systems...what are the options to negotiate health? How do they then exercise agency? Beverly exerts agency when she decides not to apply for social security benefits as then she might be judged inca...

This week's reading discussed the possibilities of alternative ways of healing and health. The debate between traditional methods of cure/ preventing illnesses and the dominant biomedicine was the center of the discussions. With examples from different parts of the world, the authors promoted their viewpoints. Mansfield et. al (2002) focused their research on the religious practices and spiritual beliefs of people regarding health care in people from rural eastern North Carolina, USA. Their research says that "health professionals should consider the faith of patients, not only in God per se, but also in how patients believe that God may act through a health professional in the healing process" (p. 407). Without getting into any criticisms of the study, I would like to share something from this research that reminded me of a personal story about how during critical times of illness people may lean more towards the unexplained and spiritual that what is explicitly availab...

This weeks readings dealt with alternative ways of healing and knowing, wonderful readings that taught me about rituals of healing in other cultures, but also about the struggles that people from these cultures have to deal with on a regular basis due to the forces of Western medicine. Mansfield wrote about spiritual practice and beliefs related to healing. It sounded like a very promising article to begin with, but for some reason did the concept of measuring religiosity and believes in respect to healing NOT sit well with me. I don't understand why people are always trying to put everything within the frames of measurements - I do see that this will help them compare and in Mansfield's case, help to create a model (thinking about it, how stupid is that to begin with???) - but why is there this constant need to compare so one can look better than the other? You can tell from my strong reaction, I think Mansfield's article was maybe worth a big laugh, nothing more, nothing ...

What is a culturally appropriate intervention? What is a "culturally appropriate" AIDS intervention? What is a "culturally appropriate" safe motherhood intervention? How do we deal with the critique of "medicalization of sexuality" vs the "sexualization of consumption"? How do find the right path, the balance between a development - commercial - government - multilateral - private sector collaboration? Is the territory of health and sex still uncharted?  Are all local values and meanings "cultural" and should we consider all services, methods, models to be "appropriate"? What "can" be done and what "should" be done? Assessments of "can" and "should" are bound up with views of the "culture" in question, assessments of its boundaries, its integrity, its authenticity, its very location "in" some places, some practices and some knowledges but not in others. If this is tru...

"Believe it or not, rice can diagnose your ailment" Source : OTV Bureau published on : 3/18/2009 11:32:24 AM Rayagada: You must have heard of tribal people resorting to medicinal plants to cure themselves of different diseases. Witchcraft is another remedy for these illiterate inhabitants. Now, rice can also do wonders on patients.    Believe it or not, Dandasi Senapati, a tribal ‘doctor’, as he is widely called, of Sirikana village near the district headquarters town of Rayagada gave a queer definition of medical science by adopting the unique healing method - rice treatment - in the tribal dominated region. Be it superstition or firm faith, Senapati’s rice treatment has many takers in the locality.    Senapati’s healing style is quite funny. Patients are asked to bring a handful of husk-free rice and Rs 20 as doctor’s fee with them. And then Senapati prescribes medicine, mostly medicinal herbs and shrubs for any physical ailment.    What is more interesting is the diagnosis...

I grew up in a family of five that included my parents. I would say that it is an average family size in Bangladesh. Growing up, I was close to my parents, especially to my mother, although the idea of calling my mother my best friend (or even friend for that matter) never occurred to me. I was quite terrified of my father, as he would frequently ask me to memorize chapters from my text books all the time. For example, before going out to work in the morning, he would ask me to memorize chapters one through three in my physics, chemistry, and biology books. "When I come back form work in the afternoon, I will test you on your memorizations" he would say. So every second of the passing clock made me more worried as that would bring me closer to seeing my father again. But still, I felt close to both my parents - I loved them and respected them and I knew they will be there for me when I needed them. And still, they were not my friends in the way we use the word 'friend...

After going through this forest of pages, I am at a loss as to where to anchor my BLOG post and how do I articulate so that I am able to talk about many of the things I have read.  In the readings about Indian Ayurveda, dominant and erased cosmologies, local politics with global connections, Chinese geomancy, KFD as a disease of development, commodification of medicines, health services, identities.....what comes across is the complexities, the dimensions and their constant movement. Achieving a healthy status is a complex exercise. In our normal day to day lives, we unconsciously/ consciously perform a set of actions located within our culture, structure and agency and lay claim to our "health". The understanding of the complexity is important to us as health practitioners when we strive to improve the health of others through our campaigns, theories, arguments and other contritions.  Dutta (2008) in his "pathways to curing and healing" chapter lays down such case ...

Two things have been coming to my mind so far after having read all of the articles for this week: For one, all the stories that talked about health tradition and believes in other cultures reminded me of something we do in Germany when someone suffers from diarrhea. We are told to eat brezels and drink coca cola. I have not once in my life wondered if these two medical advices had a deeper biological meaning, with that said, you can tell I am already trying to relate to Westernized medicine because that's what I was brought up with. I came to thinking, the salt on the brezels might help the loss of water in the body, maybe the sugar in the coke is supposed to bring you easy energy? Or are those two medical advices supposed to even be closely related to anything physical, but are rather a tradition that has survived for many many years because people believed in their powers? Therefore, relating to the readings which I found very interesting, I learned many new things when it comes...

The story that I enjoyed reading the most and that probably stimulated my thinking the most was Hawkins' story about Dr. Lewis and Mr. Pearsall. I pondered for a while over the statement or rather justification that Dr. Lewis used to make himself feel better after he first told Mr. Pearsall about his treatment option: "He didn't lie to Mr. Pearsall about those side effects, because Mr. Pearsall didn't ask." It make me think about how may people I know that go by the motto "don't ask, don't tell" and the fact that they can live and deal with their consciousness of NOT telling. There has to be a cognitive process that fights your inner feeling of what is right (can we call that morals or maybe instinct) and justifies your actions. Are those morals/instincts learned or do they reside in all of us naturally? Do your emotions influence your decision-making and your justifications when you have to make choices in life? According to Hawkins in case of D...

The different narratives of a situation by the different people involved in it reminded me of a movie very close to my heart, Rashomon . As Connelly (2002) succintly puts it, the decision to retell a story will depend on the personal reasons/ motivations of the reteller. In today's world of health communication we have so many competing narratives. The search for the "real" or "right" narrative is not important but what's important is not to ignore these stories. Narratives provide us invaluable insights into a human beings life, suffering, existence, surrounding, health. In many ways it provides us a ground to move ahead, take decisions.  In emergency response, in the first 48 hours, usually teams do not find much records or information as most records are affected and the normal information channels are in a disarray and non functional. So, the way the response team moves ahead is by collecting narratives: "so please tell us how did the flood waters c...

Quintus Horatius Flaccus, (Venosa, December 8, 65 BC - Rome, November 27, 8 BC), known in the English-speaking world as Horace, was the leading Roman lyric poet during the time of Augustus. Horace said that literature should at once teach and delight. Narratives, as part of literature should do the same. Narratives "capture [an] incredible tangle of necessity and freedom in human life, and plot enacts it in the selection and ordering of events and in the quasi-casula implications of its telling" (Chambers and Montgomery, 2002, p.77). They argue the necessity of choice in our moral lives, but that our predispositions and options are always conditioned by our past and history. Russian formalists distinguish 'story' from 'plot', defining the first as actual set of events and the latter as the teller's viewpoints. Chambers and Montgomery further argue that there can never a story without a plot, and plots vary from situation to situation and thus also influenc...

This week’s readings once again created a very emotional response…I am usually a very optimistic person but the readings are trying to make me turn 180 degrees. Dutta illustrates in chapter 7 how there are many more marginalized groups, not only the ones we have so far talked about. The fact that your mere gender, age, or race can be reason for marginalization is very sad. The reason for my rather pessimistic outlook after reading has to due with the fact, that to me it seems like, most of the dominant structures are not seeking any change. Why would they? For them the world is a little happy place with food on their plate, a roof over their head at night, access to medical services, etc. Is there even a chance to change these structures if the people who run them and create them are the ones that don’t want change and at the same time fear change because they could/would mean they had to give up parts of their little happy world in order to help others? The connectedness of agency, st...

Wilkins (1999) says that "development communication refers to the strategic application of communication technologies and processes to promote social change" (p. 197) and that all future trends in this field needs to focus on the issues of power - both in theory and in practice. Wilkins says that power as a variable should be central to policy developments, and that it is imperative to understand how the power framework effects social change. Using Simmel (1986) and Foucault (1986), Wilkins says that "power is unevenly held but established through interaction within existing networks" (p. 198) and institutional discourse helps promote agency in people and cannot be apolitical. Governments and other agencies try to promote social changes using political, economic and ideological power and institutions. However, such policies/programs look at interventions in a sort of us versus them way. It is more of a foreigner perspective on things local. This links well with the ...

After reading Farmer's account, I stayed silent for a long time; it pushed me into deep introspection. It reminded me of the displacement colony in Koraput. There are some unique tribal families living there in the colony. They were once very prosperous with acres of land and beautiful home in the ravine land irrigated by the Kolab river. Then came "Pembangunan". Orissa constructed the Upper Kolab hydroelectric project to electrify the capital towns and business hubs thousands of miles away and these families' houses, lands and villages  were submerged by the Kolab dam reservoir. The villages are still visible when the water goes down, an eerie, beautiful sight. The families moved to a nearby place. They again dug up foundations and built their houses. "Pembangunan" came again in form of a huge factory which manufactured aircraft parts; the proud leaders declared that we have been blessed with the important project by the Indian government. It produced jobs,...

Marginalization and related articulations comes across strongly in this week's readings. Dutta (2008) writes marginalization as" being at the periphery of a dominant system and that marginalization is embodied in the position of being under, of being silenced, of being without a voice and of being without resources". Marginalization can be caused by poverty, ignorance, location, access, positionality in the societal and economic system (pecking order!!) and in God's own country, insurance!!  From a critical cultural perspective, marginalization occurs from basic structural deprivations, created and sustained by structural inequities and unequal distribution at resources, further created and sustained by unhealthy practices which are in turn created and sustained by those in positions of power (Dutta, 2008). True, and I feel this is ingrained in our lives. The principle and declaration of human rights (1948) say "all human beings are equal...etc...". There ca...

Once again we see and read about the necessity of putting the participant voice in decision making, especially on issues related to health outcomes. The narratives of the Santali lives and views on health was immensely powerful in describing the above need. Academicians and policy makers tend to make marginalized populations as the subjects of health interventions designed by them, primarily from Eurocentric and post-positivist ways which do not seem to answer the question of essence properly. And yet, most research found on health issues and policy developments are designed by people who do not participate in the living experiences of the group being worked on. Here lies the key - policy makers are working on the people and not with the people whose voices are absent from the main stream. It is foreseeable that an all White group of policy developers may not be able to realize how the tribal population of Nepal (for example) negotiate their beliefs of healthy living. Many studies have...

I enjoyed (enjoy is probably the wrong word in this context, because once again these readings made me look at the world with disgust) the readings for week 5, I felt they were a great summary of what we have been talking so far. The book chapter on culture and marginalization got me into thinking about what constitutes a marginalized group. Dutta defines marginalization as "at the periphery of a dominant system." What about a population that is not at the periphery, but yet the health issues that this population is concerned with is not addressed? I even want to take it as far as: the dominant system knowingly doesn't inform this population of certain health threats they face. Are we talking of a marginalized group here as well? The articles on the Santalis and the FM patients once again served as a great example of how the voices of the marginalized are unheard and not cared for in the main stream. When coming across Nietzsche's quote (see headline) while reading I ...