Autopathographies: how "Sick Lit." shapes knowledge of the illness experience

I had the honour of being a member of the first class of MSc students in Medical Anthropology in Oxford in 2001. During the MSc I became interested in the intersections of medical anthropology and public health, particularly in considering how medical anthropology theory can be operationalized to improve public health program evaluation. I went on to complete a PhD in Anthropology and a Master's of Public Health in International Health from Boston University, where my research focused on the long-term impacts of oral rehydration therapy campaigns in highland Guatemala. I then spent a year working with Arthur Kleinman at Harvard University and, drawing on the foundational knowledge I gained from the MSc, became further interested in illness narratives. I conducted postdoctoral research on illness narratives through the Oxford Autopathographies Project, described here. I continue to investigate primary health care delivery in Guatemala and co-direct the NAPA-OT Field School in medical anthropology. I am currently Assistant Professor of Anthropology and Public Health at Agnes Scott College in Atlanta, Georgia

Stigma: A Social, Cultural, and Moral Process

Anthropolog

From guidelines to local realities: evaluation of oral rehydration therapy and zinc supplementation in Guatemala

Objectives: Diarrhea remains a leading cause of morbidity and mortality for children in low- and middle-income countries throughout the Americas. WHO guidelines have been developed to incorporate zinc supplementation (ZS) with traditional oral rehydration therapy (ORT) to shorten duration and reduce poor health outcomes. Guatemala adopted these guidelines in 2011, but they have not yet been fully implemented at the community level. The objectives of this study were to co-design an ORT/ZS training program with community health promoters appropriate to the local context and to understand how training with the promoters changes attitudes and behaviors of community members. Methods: In an observational study, community health promoters were trained in rural Guatemala according to WHO guidelines and collaboratively developed training curriculum to implement in their community. Community-based surveys, interviews, and focus group discussions were used to assess acceptability, accessibility, and availability of oral rehydration therapy and zinc supplementation

The Power of Orality in Multicultural American Literature

Multicultural literature exposes readers to histories which the current canon of American literature has obscured, giving voice to minority heritages and legacies characterized by oppression. In tribal tradition, storytelling both relays information and establishes native histories, which may be considered legends by non-natives, as fact. Before paper, oral stories’ power to record history and sustain culture made them essential to tribal societies’ preservation. Leslie Marmon Silko’s Lullaby and untitled poem “Long time ago” convey the stylistic chants of oral tradition, preserving the distinct characteristics of native storytelling. Components of native literature such as the capacity of words to renew and reestablish history emphasizes the cyclical, rather than linear, nature of time. In Silko’s “Storyteller,” the protagonist only speaks aloud to simultaneously alter her reality and create her story, using laughter in place of words to assert control without changing the story. Writers create realities expressing their cultural truth and representing their aspirations for their communities. These works function reciprocally, expressing the writer’s truth while allowing the audience to color their readings. Langston Hughes’s “Theme for English B” inquires whether the reception of a black writer’s work will be affected by race, and Toni Morrison’s “Recitatif” answers this question by purposefully leaving the page uncolored, inviting readers to incorporate their biases. These works challenge the idea that America has entered a post racial era and assert that racial disparity exists as it did during the Harlem Renaissance and the 1950s by exploring the readers’ need to identify race to understand truth

Health Needs Assessment of People with Disabilities in Massachusetts, 2013

The Disability, Health and Employment Policy Unit at UMass Medical School conducted an assessment of the health needs of people with disabilities on behalf of the Health and Disability Program (HDP), Office of Health Equity, Massachusetts Department of Public Health. The assessment was conducted to meet the Centers for Disease Control and Prevention (CDC) funding requirements of the Health and Disability Program and provided an in-depth examination of the health needs of people with disabilities in Massachusetts. This assessment provides comprehensive information on the unmet public health needs and priorities of the disability community in Massachusetts to enable HDP to prioritize its programmatic goals and objectives and better understand and meet the needs of Massachusetts residents with disabilities. A multi-prong approach was used to collect data for this needs assessment. The sources of data include: (1) an existing health survey of adults in Massachusetts, (2) an online community survey of the health needs of people with disabilities in Massachusetts, and (3) interviews with key informants from the Massachusetts disability community

Evaluating the effect of upper-body morbidity on quality of life following primary breast cancer treatment: a systematic review and meta-analysis

Purpose: Improvements in breast cancer management continue to increase survival and life expectancy after treatment. Yet the adverse effects of treatment may persist long term, threatening physical, psychological, and social wellbeing, leading to impaired quality of life (QOL). Upper-body morbidity (UBM) such as pain, lymphoedema, restricted shoulder range of motion (ROM), and impaired function are widely reported after breast cancer treatment, but evidence demonstrating its impact on QOL is inconsistent. Therefore, the aim of the study was to conduct a systematic review and meta-analysis evaluating the effect of UBM on QOL following primary breast cancer treatment. Methods: The study was prospectively registered on PROSPERO (CRD42020203445). CINAHL, Embase, Emcare, PsycInfo, PubMed/Medline, and SPORTDiscus databases were searched for studies reporting QOL in individuals with and without UBM following primary breast cancer treatment. Primary analysis determined the standardised mean difference (SMD) in physical, psychological, and social wellbeing scores between UBM + /UBM - groups. Secondary analyses identified differences in QOL scores between groups, according to questionnaire. Results: Fifty-eight studies were included, with 39 conducive to meta-analysis. Types of UBM included pain, lymphoedema, restricted shoulder ROM, impaired upper-body function, and upper-body symptoms. UBM + groups reported poorer physical (SMD = - 0.99; 95%CI = - 1.26, - 0.71; p < 0.00001), psychological (SMD = - 0.43; 95%CI = - 0.60, - 0.27; p < 0.00001), and social wellbeing (SMD = - 0.62; 95%CI = - 0.83, - 0.40; p < 0.00001) than UBM - groups. Secondary analyses according to questionnaire showed that UBM + groups rated their QOL poorer or at equal to, UBM - groups across all domains. Conclusions: Findings demonstrate the significant, negative impact of UBM on QOL, pervading physical, psychological, and social domains

A retrospective report (2003–2013) of the complications associated with the use of a one-man (head and tail) rope recovery system in horses following general anaesthesia

Abstract Background The mortality rate of horses undergoing general anaesthesia is high when compared to humans or small animal patients. One of the most critical periods during equine anaesthesia is recovery, as the horse attempts to regain a standing position. This study was performed in a private equine practice in Belgium that uses a purpose-designed one-man (head and tail) rope recovery system to assist the horse during the standing process. The main purpose of the retrospective study was to report and analyse complications and the mortality rate in horses during recovery from anaesthesia using the described recovery system. Information retrieved from the medical records included patient signalment, anaesthetic protocol, duration of anaesthesia, ASA grade, type of surgery, recovery time and complications during recovery. Sedation was administered to all horses prior to recovery with the rope system. Complications were divided into major complications in which the horse was euthanized and minor complications where the horse survived. Major complications were further subdivided into those where the rope system did not contribute to the recovery complication (Group 1) and those where it was not possible to determine if the rope system was of any benefit (Group 2). Results Five thousand eight hundred fifty two horses recovered from general anaesthesia with rope assistance. Complications were identified in 30 (0.51%). Major complications occurred in 12 horses (0.20%) of which three (0.05%) were assigned to Group 1 and nine (0.15%) to Group 2. Three horses in Group 2 suffered musculoskeletal injuries (0.05%). Eighteen horses (0.31%) suffered minor complications, of which five (0.08%) were categorised as failures of the recovery system. Conclusions This study reports the major and minor complication and mortality rate during recovery from anaesthesia using a specific type of rope recovery system. Mortality associated with the rope recovery system was low. During recovery from anaesthesia this rope system may reduce the risk of lethal complications, particularly major orthopaedic injuries

Elephant tourism: An analysis and recommendations for public health, safety, and animal welfare

Background: Elephants are exploited for public entertainment tourism throughout Asia and Africa. Areas of concern include public health and safety and animal welfare. Materials and Methods: We examined over 500 scientific publications with respect to our primary objectives, as well as non-peer-reviewed materials relating to other relevant subject matters (e.g., tourism promotional websites and YouTube films) for background purposes, although these additional materials were not included in this review. Results: We identified at least 12 confirmed or potential zoonotic and other transmissible infections relevant to the elephant tourism sector, and at least 13 areas of animal welfare concern. Conclusion: Infection and injury risks between humans and captive elephants cannot be safely controlled where close contact experiences are involved, arguably creating an unredeemable and indefensible public health and safety situation. Elephant welfare within some sectors of the close contact interactive tourism industry continues to involve significant mistreatment and abuse. To alleviate key One Health concerns outlined in this study, we recommend several types of regulation, monitoring, and control regarding interactions at the human-captive elephant interface. These include legal bans on the promotion and performance of close contact experiences, combined with strong enforcement protocols; new policies toward discouraging elephant tourism; 24/7 surveillance of captive elephants; and the adoption of independent scientific positive list systems for tourism promoters or providers regarding public observation of free-ranging elephants within national parks and protected areas

A syndemic born of war: Combining intersectionality and structural violence to explore the biosocial interactions of neglected tropical diseases, disability and mental distress in Liberia

The intersections between NTDs, disability, and mental ill-health are increasingly recognised globally. Chronic morbidity resultant from many NTDs, particularly those affecting the skin—including lymphatic filariasis (LF), leprosy, Buruli ulcer (BU) and onchocerciasis—is well known and largely documented from a medicalised perspective. However less is known about the complex biosocial interaction shaping interconnected morbidities. We apply syndemic theory to explain the biosocial relationship between NTDs and mental distress in the context of structural violence in Liberia. By advancing syndemic theory to include intersectional thought, it is apparent that structural violence becomes embodied in different ways through interacting multi-level (macro, meso and micro) processes. Through the use of in-depth qualitative methods, we explore the syndemic interaction of NTDs and mental distress from the vantage point of the most vulnerable and suggest that: 1) the post-conflict environment in Liberia predisposes people to the chronic effects of NTDs as well as other ‘generalised stressors’ as a consequence of ongoing structural violence; 2) people affected by NTDs are additionally exposed to stigma and discrimination that cause additional stressors and synergistically produce negative health outcomes in relation to NTDs and mental distress; and 3) the impact and experience of consequential syndemic suffering is shaped by intersecting axes of inequity such as gender and generation which are themselves created by unequal power distribution across multiple systems levels. Bringing together health systems discourse, which is focused on service integration and centred around disease control, with syndemic discourse that considers the biosocial context of disease interaction offers new approaches. We suggest that taking a syndemic-informed approach to care in the development of people-centred health systems is key to alleviating the burden of syndemic suffering associated with NTDs and mental distress currently experienced by vulnerable populations in resource-limited settings

Inhalation of diesel exhaust and allergen alters human bronchial epithelium DNA methylation

Background Allergic disease affects 30% to 40% of the world's population, and its development is determined by the interplay between environmental and inherited factors. Air pollution, primarily consisting of diesel exhaust emissions, has increased at a similar rate to allergic disease. Exposure to diesel exhaust may play a role in the development and progression of allergic disease, in particular allergic respiratory disease. One potential mechanism underlying the connection between air pollution and increased allergic disease incidence is DNA methylation, an epigenetic process with the capacity to integrate gene-environment interactions. Objective We sought to investigate the effect of allergen and diesel exhaust exposure on bronchial epithelial DNA methylation. Methods We performed a randomized crossover-controlled exposure study to allergen and diesel exhaust in humans, and measured single-site (CpG) resolution global DNA methylation in bronchial epithelial cells. Results Exposure to allergen alone, diesel exhaust alone, or allergen and diesel exhaust together (coexposure) led to significant changes in 7 CpG sites at 48 hours. However, when the same lung was exposed to allergen and diesel exhaust but separated by approximately 4 weeks, significant changes in more than 500 sites were observed. Furthermore, sites of differential methylation differed depending on which exposure was experienced first. Functional analysis of differentially methylated CpG sites found genes involved in transcription factor activity, protein metabolism, cell adhesion, and vascular development, among others. Conclusions These findings suggest that specific exposures can prime the lung for changes in DNA methylation induced by a subsequent insult