Tag: healthcare

  • Understanding Susto: The Impacts of Fright Illness

    Understanding Susto: The Impacts of Fright Illness

    Hello all, and welcome back to another post. I have not been active for a while due to a busy schedule at school, but I will try to get back to posting once or twice per month soon. Today, I am writing the first part of what I can hopefully make into a series about folk illnesses and their implications. In the context of healthcare AI models (if you haven’t read my old article, you can here), there is a potential for structural violence to develop based on folk illnesses. Aside from structural violence, folk illnesses that are treated in traditional folk manners can introduce further complications in the patient’s health. One such illness is the Latin American folk illness Susto. This will be a fairly short article, as it is the first of many that will discuss folk illnesses and medical descriptors across cultures.

    Susto

    Susto, often referred to as “fright illness”, is the name for a collection of symptoms including anorexia, fever, depression, and insomnia. Frightening events are typically attributed to causing the ailment, with emotional trauma, accidents, sudden scares, and witnessing tragic events being among the believed causes. In Latino cultures, it is believed that such traumatic events causes the soul to leave the body. The sickness is highly prevalent among people from South and Central America as well as some Latinos living in the United States. Treatment for Susto is performed by a Curandero (healer) through rituals like limpias (cleansings), prayers, and herbal medicines.

    Image Credit: Humanities Colaborative

    Many cases have appeared where individuals have claimed to be affected by susto. One of the most well-known studies describes a teenage boy named Junior who was admitted to a hospital for presumed Guillain-Barre syndrome. Though doctors were ready to treat him for such, the boy’s mother said that the symptoms were caused by a scare. Though doctors pressed a bit more about what could have caused the susto effects, the only information offered by the pair was that the incident had taken place with Junior’s father. No consideration of other illnesses by the family was described in the article.

    There is much to be considered with respect to the potential implications of folk illnesses like susto in programs and institutions; this will be further detailed in a later post. Many articles on the topic of susto discuss it in the context of cultural literacy; the failiure of many American doctors to understand the unfamiliar ailment serves as a call for increased cultural literacy in the medical sphere. The AMA article goes on to talk about communication styles in physician-patient communications as well as suggested education programs. Though I will write about the communication styles in a later article, I found the suggested literacy program to be interesting.

    The AMA describes a proposed model for cultural competency first created by Lee Pachter called “awareness assessment negotiation (AAN)”. Intended to be deployed when the health values of a patient or family do not fit the established western model, the AAN involves knowing about the normative cultural values of a group, assessing whether or not the patient or family conforms to those cultural values, and finding ways to meet the patient in the middle with regards to their beliefs. For example, in the aforementioned case, the physicians could have worked more to listen to Junior’s mom as well as acknowledge the warmer and more family-based communication style characteristic of Latino culture. While the system would be useful in solving cultural clashes in an ideal world, realistically speaking, it is impractical and near impossible to educate healthcare professionals about the intricacies of every culture’s communication styles and values. Still, the importance of cultural literacy that these cases convey is an importance that must be acted upon.

    Though this post was brief, I enjoyed writing about a new topic, and I hope to learn more about healthcare and medical anthropology as I continue to write. Stay tuned for the next article!

  • Research Review: Semantics of Illness in AI Healthcare

    Research Review: Semantics of Illness in AI Healthcare

    Hello everyone, this is my first post in a while as school got off to a busy start, but I will be posting more frequently in the future, so stay tuned for more anthropology articles.

    I recently participated in a guided research program where I wrote my first research paper. Choosing a topic was slightly hard, but I eventually settled on medical anthropology. I had the most difficult task to deal with next: finding a research question. After looking into many different areas in which medical anthropology could be applied, my mentor and I looked into the development of artificial intelligence (AI) healthcare models and applications of anthropology to them.

    The concept of healthcare AI models is a relatively new one, as the technology needed to produce something effective enough to be worth developing has only just recently become available. Though experimental research could only be performed on existing prototype models (the soonest beta releases are years away), I wanted to look into issues that could arise in a fully functional healthcare model, specifically in regards to cultural differences. These theoretical issues would occur (most likely) primarily by way of cross-cultural differences in semantics or communication style.

    In terms of methodology, I interviewed six participants: a man and a woman each from Walnut Creek, USA; Istanbul, Turkiye; and Develi, Turkiye. The interviews were conducted as series of questions over international encrypted messaging app WhatsApp.

    Image credit: National Cancer Institute

    Semantic Differences

    Fortunately, there exists some research that looks into cultural differences in semantics of illness. Acclaimed Harvard professor Byron J Good’s The Heart of What’s the Matter: Semantics of Illness in Iran examines the Persian folk illness “heart distress” and its perceived causes in Iranian culture. The paper draws on observed semantic networks to trace how people describe their illness, and the result was that Iranians understand their illnesses very differently than Americans understand theirs. While outdated (it was published in 1977), Good’s study provided a strong theoretical basis for me to do more research. In a theoretical healthcare AI model, misdiagnoses could stem from semantic differences, resulting in an unintentionally biased model. This potential harm, should it become an issue, would be classified as structural violence, a form of social harm that prevents groups of people from having their essential needs met (Read more in the paper linked below).

    The first two interview questions were oriented towards semantic differences. The first asked participants to describe symptoms of a common cold to a doctor, and the second asked them to describe symptoms to an AI model. In theory, these two questions would reveal differences across cultures in both how patients interacted with physicians and how they interacted with AI. Provided symptoms were compared in a table (included below), and the style of descriptions (symptom vs biomedical, list vs na

    Cultural Comfort Differences

    The other two questions were less important to the study; these dealt with contextual differences in communication across cultures. The participants were asked to honestly give any sensitive or embarrassing symptoms that they would not feel comfortable sharing with an in-person physician. They were then asked if they would be more comfortable sharing these symptoms with an AI doctor. The purpose of these questions was to evaluate two things. First, if patients felt more comfortable sharing symptoms with a doctor and, consequently, omitted certain symptoms from a report to an AI model, misdiagnosis could occur from a skewed description. Second, if patients felt more comfortable sharing details with an AI model, they would be more likely to share full details and receive an accurate diagnosis as a result.

    Results

    It was hypothesized based on existing theory and assumptions that there would be a good deal of cultural differences in semantics of illness and comfortability interacting with an AI model. The results, however, showed minimal differences across the three cultures (see tables in the paper). There were little to no differences within the country of Turkey, and Turks tended to describe their symptoms and comfortability with in relatively similar ways. The only major difference within Turkey was that rural Turks tended to describe their illness in a symptomatic hybrid difference, while urban Turks tended to describe their illnesses in a list fashion. American and Turkish responses displayed similar levels of variation, as the only major difference between the countries was the symptoms of the common flu that they provided (more detail in the paper).

    There are many potential explanations for the high level of similarity between cultures, but experimental research is needed to verify any one of these explanations. A possible and likely reason that the results of my study were so different from Dr. Good’s is that globalization has made the world a much smaller place since 1977. With the technological revolution putting internet access into the hands of almost all people, information can be spread much more easily, and as a result, cultural mannerisms and ways of interacting bleed into each other more than they used to.

    This study was non-experimental and hypothesis-generating, so no conclusions can be drawn from the results. It does, however, raise interesting questions about how important cultural differences really are to the development of healthcare AI models.

    I would like to thank the team at Lumiere education for providing excellent services and making the experience of writing a paper much easier than it would have been if I had attempted to do it myself. I highly recommend them to anyone who needs guidance in writing and publishing their first paper.