Mohan Dutta: Culture-Centered Approach

This is a posting that celebrates the news about one of my former advisees winning a Young Scholar Award...it is a moment of pride and a moment of joy! It is one of those wonderous moments when one sits back in awe and looks at the trajectories of meaningful work that has been created by a student, a mentee, and a friend. It is also a moment of reflection about what makes some teaching and mentoring relationships so very special, so very personal, and so very influential. Some of these very special relationships grow into friendships of a lifetime, relationships of solidarity, and partnerships in a lifelong journey of learning, living, and loving. When I think back to this one friend of mine, I remember that sense I had from the first time that I received an email from him expressing interest in my work. It was a conviction that this was someone with a purpose, a purpose that intrinsically connected to the politics of social change. In the years that we grew together, I learnt as

Understanding the magnetization of sex workers, there is two stigma attached to them that put them to the edge of the society: first one is can be seen in the UNAIDS definition, sex workers are“ female, male, and transgender adults and young people who receive money or goods in exchange for sexual services.”; second, sex workers are the populations that have the higher prevalence of STD, they are assumed as the disease carrier and spreader. Mohan J. Dutta(2009):Sex workers and HIV/AIDs tried to describe two organization Kolkata area of India, SHIP and New light’s HIV/AID project. It is very surprise to me that the stakeholders of these two organizations are mainly prostitutes. There is one word said by Lakshmi: “ You have to live here to really know what’s going on, You can’t just come in , ask questions and tell us what to do”. I totally understand that as a outsider researcher or government member, it is hard for them to build the communication with the sex workers, maybe that’

Young’s piece on Culture, illness got me thinking about three concepts he touched on.These include desocialization, biomedical reduction, and the dismissal of the other’s view as unscientific in our articulation of illness and disease. The three key words have one thing in common, the acclaimed supremacy of biomedical paradigm in our interpretation of illness, or better still the design of health interventions along the stipulations of biomedical paradigm. I use the term paradigm to mean the strongly held world views and beliefs that undergird scholarship or our beliefs that guide our interpretation of reality. Desocialization is the displacement of historical, political, and economic determinants of sickness, while biomedical reduction entails using medical and empirical standard as a normative referent for evaluating what constitutes illness or disease (Young,1982). As I reflect upon the arguments, two profound questions that resonate in my mind are: Is it right to incorrectly quest

Grounded theory is the premiere choice in culture-centered approach research. I write this as a statement because this is how I understand it, but I desperately want to end it with a question mark. If it is true, then I desire a confirmation as to why this may be the case. My assumption is because the existing theories that incorporate culture (such as theory of reasoned action and the health belief model, which are both referenced in Mohan’s article) were created under the auspices of institutions holding power and access. Therefore, to build a theoretical framework using these existing theories would be like instantly giving the upper hand to the hegemonic powers that be, rather than those who are the primary concern for the research: the marginalized communities. But, such pondering leads me to the next statement/question… How do you effectively use a grounded theory approach and still maintain a strong sense of credibility and buy-in from institutional peers? It is one thing to

The marriage of Comparative Effectiveness Research (CER) with the Culture-Centered Approach (CCA) seems to be one that was destined to happen...the synergies between these approaches to the uses of clinical information are incredible. This brings me to the core point about CCA, the one about Structure, and one that puts it in opposition to postmodern approaches to critical theory that often get reduced to the feel-good elements of identity politics in multiculturalism. In foregrounding the localized voices of the margins, the approach continually seeks to engage with entry points for making truth claims in relationship to social structures. That hunger is a truth in the most salient rendition of it is something that is continually brought to the forefront in multiple CCA studies. If CCA is positioned in the quest for truth that is grounded in material evidence, the value of CER to CCA precisely lies in the quest for clinical evidence base for medical decision-making that is grounded

I am in the process of reviewing a proposal for a large scale project that frames itself in terms of addressing healthcare disparities. After giving us sermons about how disparities are bad, and so on and so forth, the proposal goes on to talk about some silly and outdated concept of "external locus of control" and makes the claim that addressing external locus of control would change behaviors. The behavior in question, my favorite, eating fruits and vegetables. So the evaluation measures of the project that is asking for a large sum of money to address health disparities is played out in getting the target community to eat more fruits and vegetables. Silly, silly, silly...and more importantly, one might suggest, wastage of tax payer dollars. Nowhere in the proposal does the researcher show awareness of the prices that the poor have to pay for securing fruits and vegetables, or of the fact that fruits and vegetables are typically out of the reach of the common person. Most i

Reading Dutta’s chapter on marginalization reinforced my views about the disenfranchisement of those living in particular rural communities and forced me to probe my understanding of the nature of their health disparity further than what I had before. In discussing the mechanisms that lead to marginalization, I was left questioning, in what ways are rural individuals cast towards the margins? Is the marginalized based on access to health information resources? Equitable health care? Resources for engaging in positive health behaviors (such as farmer’s markets or exercise facilities)? Educational avenues for furthering one’s ability to be employed and out of poverty? Or, is the marginalization more closely related to the inability of the rural citizen to participate in the discursive space where policy decisions are made? Ultimately, all of these questions could be answer with the affirmative. Disentangling their individual impact, however, would be exponentially difficult. Broadly, man

After reading this week’s articles on pain, a central question that continues to resonate on my mind is: should the lived experience of patients or expert’s explanation serve as the basis for the design of therapy for pain. I consider the above question as intriguing, because our understanding or the values we attach to a problem serve as a basis for the design of a therapy for the ailment. I use us to refer to the public. My question about which view should take precedence over the other is based on the accounts in this week’s readings. Of particular interest to me is how the MPQ became a tool to legitimize the concept of pain, consequently impacting the terminologies and tools used for pain management. So I ask, could such articulation of terminologies be representative? Can it accurately reflect what the patients feel? I believe that the patient should be allowed to spontaneously generate words that accurately reflect or capture their experiences; otherwise we could be robbing the

If you got a chronic pain that lasts more than three months, what’s your reaction to it? Paper by Bates: “Control, Culture and Chronic pain.” tried to explain that the “ locus of control” beliefs influence people’s responses to the chronic pain experiences. Furthermore, the LOC style has this intimate relationship with the ethnic or cultural background. Form comparing the research data from New England and Puerto Rico patients, Bates etc concluded that after one years of emergency reaction of the chronic pain, then they would developed in two directions: positive adaptation and negative adaptation which depends on the individual internal LOC or External LOC style, that the definition as in the paper: “ An internal LOC style involves a reported cognitive perception or expectation that life events and circumstances are the result of one’s own actions. By comparison, an external LOC style includes the perception or expectation that life events and circumstances are beyond on

What is pain? I personally asked myself this question time and again as I read the articles (specifically the Raheim, Crawford and Mowat articles). Of course, it is subjective. On a day when I have an excruciating headache, how does that compare to an individual who suffers from migraines? If we were both to rank our intensity of pain on a scale from 1-10, would an 8 mean the same thing for both of us? Seems relative to me. Last summer I began intensely looking for answers, and hopefully subsequent relief, for chronic neck and back pain. A sports doctor, a pain management specialist, a deep-tissue massage therapist, a chiropractor/acupuncturist… Each of them asked me to fill out a packet (some a couple pages, other nearly 15). I became very familiar with the multi-view body illustration within the forms, on which I was asked to shade the areas of the body where I was feeling pain. I’m pretty sure each diagram (while a few key areas were always shaded) looked differently, depending on

In thinking about the notion of pain as private verses intersubjective (as put forward in scholarly dialogue between Crawford and Mowat), I recalled my last trip to the emergency room (about 2 ½ years ago) with what I would describe as serious pain that later resulted in an appendectomy. In my entrance interview, I was asked to rate my pain on a scale from 1 to 10, where 1 equaled fleeting and dull and 10 equaled the most pain I’ve ever experienced. I can’t remember what my response was, but in conceptualizing the experience of pain as private and personal, it seems as though it was the need for the biomedical system to place my pain in the context of a shared language for the experience (such that the appropriate treatment could be prescribed, in the form of medication or further physical evaluation) that ultimately left me feeling disheartened and poorly served. I’m left questioning, was I really able to describe my pain? Did the measure truly capture my experience? It seems as thoug