Mohan Dutta: Culture-Centered Approach

In examining how issues of security and economy are linked with health, Dutta brings to light how global policies can come to impact local actions, particularly in light of determining the availability and distribution of resources. By continually framing health intervention as an opportunity for scientific and technological advancement, coupled with the interests of commercial organizations, health is deeply connected with economic questions at the global level, bringing forth the role of structures in influencing health. Wasteful bureaucratic overhead, high prices, high levels of uninsured, malpractice...it goes without stating that the American healthcare system is in crisis. As a communication scholar, I was intrigued by Dutta’s posing of the question, “How are particular communication strategies used by key political actors to background, discursively, the problems of healthcare?” I began to consider this in light of a side-interest of my own related to the communicative practices...

Growing up as a child, I remember the stories my father taught me...stories of the First International, American Federation of Labor (AFL), and of May Day. These were stories of the American working classes, their struggles, and their organizing to secure eight hour workdays for workers. The stories of 1877, the mass action of the American working classes, the Chicago strikes, and the Haymarket Affair were stories of inspiration. The stories of Joe Hill and worker organizing were stories that were uniquely American in the seeds of hope, solidarity, and global organizing they sowed. The stories of labor however were hidden from much of the mainstream discourses when I came to the US in the 1990s. The images of malls, shopping, advertising, abundance were images that made these stories of workers seem redudant and irrelevant. In fact, I found it difficult to relate any of the stories I had grown up listening to with the images of the US in the 1990s, surrounded by songs of nationalist ...

Today, the first half of the day, Agaptus and I spent at the mobile food pantry in Monticello. Most of our work was broken down into two tasks: unloading boxes and setting up food on the tables, and serving as personal shoppers for the clients of the pantry. These tasks in some ways were the other side of the "specific tasks" we have been doing at the organization, such as sorting food, packing them into boxes etc. The experience of serving as a shopper was overwhelming in many ways. That individual shoppers needed to be guided through the process also meant that we had to tell them how many packages of meat, how many packages of ketchup, how many packages of canned corn/beans etc. they could pick up depending upon their family size. The family size was already figured out at the check-in desk by the volunteer who did the registering. This part of telling how many items to pick up felt difficult to do, particularly as one could tell the discomfort and the pain in the moment...

The second chapter in the book has an excellent explanation of CCA and its principles. The section on values and context reminded me, some of my personal research experiences which I thought could fit into it very well. When I was working among the "Chenchu" people in Andhra Pradesh on my Masters dissertation project I noticed that the huts in the hamlets had small rooms next to them which were either empty or filled with old things. I asked the people around, about the utility of these rooms and they said that they were "latrines" built by the state health and hygiene department. I was surprised to know that latrines were provided by the government officials in such a remote "tribal" area. I probed further as to why they are not using them and they said that they are not used to defecating in these closed room for a various reasons. First was that they treat the hamlet land as sacred and hence would not be doing such a polluting act. They believe in defec...

I find these two key words “Engagement and Dialogue” in chapter two of the Culture Centered Approach to Health (Dutta, 2008) particularly striking, because the words reminded me about a conversation I had with five of my colleagues in my Cross-cultural communication class over listening to the “other” person. In our conversation about the co construction of cultures, we agreed that through listening to the “other” we could get a better understanding of their values that inform their actions and inactions. From our conversation, it became glaring that listening to the “other” is profound because it enhances communication considerably. To arrive at this position, we looked at several contexts. For this brief illustration,I use the example of offering food to a visitor, and how our cultural norms shape our reaction in such an encounter. In some cultures, it is a norm to offer food to a visitor. In such cultures, it is offensive for a visitor not to eat your food before talking to the ...

There are three things I want to share regarding this week’s reading and fieldwork. I apologize for the length, but since I can't be in class, I figured I just speak my mind here.. . ONE: “… a dominant paradigm is located within a meaning community – the community of scholars and practitioners who have come to define what it means to theorize and practice within the discipline” (Dutta, p. 46). What struck me with this statement, and with those that followed it, was the whole idea of meaning, tools, and the universal criteria used by the dominant paradigm in health communication. In many ways, they represent a conditioned approach, one that is well practiced. It is the norm; it is the most logical; it makes sense; it works; and it is dependable. What made me begin to mull this over and think about this so carefully was because, as I sat at home reading this, my five-year-old daughter sat next to me, playing a matching game on the computer. As she uncovered the hidden animals, a v...

After volunteering at the mobile food pantry earlier today, I’ve come to realize that spending time in a classroom discussing health experiences for the marginalized does little in comparison to actually witnessing the effects of marginalization on vulnerable populations firsthand. For the first time in this project, I saw how the meanings of those experiencing health disadvantages were overshadowed and neglected by the structural interests of those in privileged positions. Consequentially, I also recognized how traditional approaches to health communication could blatantly neglect these perspectives, leaving the problem of food insecurity far from resolved. As Dutta suggests, “The silencing of voices of community members is achieved through the circulation of discourse that continues to construct the community as passive and voiceless, and advances policies and programs without the participation of the community...which constructs the community as incapable of participation.” My co-vo...

Of late, I have been increasingly amazed at the number of folks publishing in our journals making blanket statements about "doing" science and then using that pulpit to outright put down what they consider to be lay public opinion. In these instances, the language of science is being used to silence opinions that are contradictory to the status quo that our so-called communication scientists serve. The scientific terminology becomes a mechanism to silence and erase, a way to fundamentally ask people to "believe" without questioning because that happens to be the recommendations of these "high priests and priestesses" who have dominated knowledge for centuries. Much like the Church, they want us to take them at face value, and don't really care to offer backing and warrants in their arguments. Many of the arguments go like this, "anyone questioning a behavior (say immunization) must be unscientific because the behavior (say immunization) is scienti...

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...

“ Cultural Studies of Biomedicine: An Agenda For Research.” From Good etc (1995) brought out a term “ clinical narratives” specifically refers to clinical context between patients and physicians which is very interesting concept for me. In my opinion, the physicians of course hold the power of accessing the newly treatment method and they are the person will determine the language of diagnosis, disease progression, treatment and outcome, and professional obligations to patients. Besides this seems almost ideal professional power, it is very challenging for me to think of that they work under the frame of international information and also try to fit their language within the local culture and still under the influence of the “political economy of hope”. Influenced by all these, doctors from different area no matter the economic development level occupy different “clinical narratives”. When talking about the statistics in clinical narratives, the author gave an example of how a oncology...

Comparative Effectiveness Research is guided by the goal of creating information capacities regarding the best comparative evidence base on treatment effectiveness, side effects, and benefits of different treatment options. The CER process is one that attempts to de-center the shroud of secrecy and scientific legitimacy that the medical industry (pharmaceuticals, physicians etc.) rely on. What is most important about the CER process is the implicit acknowledgement that is built into it: that the culture of medicine operates often under a great deal of uncertainty, misinformation, and lack of solid information. The CER process therefore seeks to a) foster a scientific evidence base for comparing different treatments, and b) de-center the blindfolded legitimacy patients put in physicians by seeking to put information in the hands of patients. It is precisely in this backdrop that I have witnessed resistance from physicians about CER in one-on-one interactions with them. That the tran...

I have chosen this reading for comment as I could instantly relate this approach to the medical encounter scenrio in India and how tough it would be for the medical personnel to adopt this in their daily exeriences. In a country like India with the kind of diversity in culture and populations of the people, where there is minimal efficient medical infrastructure available ( cant get more optimistic than this), I do not hope that this approach would be relevant. More specifically if we ponder over the rural health and medical settings it becomes almost impossible for the physcians and other medical practitioners to employ such a method considering the meager faclities that are available in the government administered health centres. Even with the available facilities there would be very few practitioners who would at least lend an ear for such an approach (the kind of impressions people have towards the medical personal). I donot aim to generalise these statements for all the people an...

Good (1995) piece on ‘Cultural Studies of Biomedicine’ strikes me as unique, because he raises three key questions about the West’s transfer of technology to developing countries. The three issues include ethics, political economy, and competency. The three words summarize the author’s questions about the basis upon which the transfer of technology is executed between the two regions. According to the author, often times, the political economic interest embedded in the transfer takes precedence over the ethical dimensions of the act. For instance, does the recipient of the medical equipment have the competency to effectively use the new equipment? Or is the gift imposed on the recipient because of the political interest of the West? I find these three key words striking because of the experiences of developing countries with regard to hospital equipment supply. I am particularly drawn to this because of a scene that recently played out in Nigeria over the choice of equipment to be ins...