Call to Action: Influence of Medical Anthropology for COVID-19 Response

To:                  Wider Medical Anthropology Community

From:              Anthropological Responses to Health Emergencies SIG

Authors:          Mark Nichter, Kristin Hedges, Elizabeth Cartwright

Date:               April 12, 2020

  • Medical anthropology has much to contribute to an understanding of the COVID-19 pandemic as it changes over time in different contexts. As medical anthropologists, our focus is broadly on how Covid-19 is experienced by the public, stakeholders facing different social and economic circumstances, and Covid-19 related policies introduced by those in power, for better or worse.
  • More specifically, we see our research as contributing in three ways. First, our research endeavors to inform those delivering health services as well as policy makers by enhancing their understanding of the social relations of COVID-19 and how social relations influence disease transmission, health care seeking, and support of those who are vulnerable or have fallen ill.  Our research provides information on adherence to the preventive and promotive COVID-19 guidelines recommended by experts, and the ad hoc harm -reduction and self-care activities undertaken by community members. We also track changing perceptions of the physical, social and economic risk of COVID-19.  And we document   information and disinformation circulating in mainstream and social media  as a means to identify what information is compelling as well as  points of confusion, mistrust and uncertainty fostering non –adherence to guidelines and epidemic fear . 
  • Second, as medical anthropologists we can contribute to an assessment of COVID-19 policies and the political and economic factors that have influenced them.  Attentive to health disparity and those who are structurally vulnerable, we investigate who is favored and who is overlooked if not sacrificed by COVID-19 related policies. Our purview takes into account the survival and livelihood of all segments of populations at home and abroad.  
  • Third, we also see our role as contributing to the generation of innovative ideas for better pandemic response now and in the future, in communities and health care settings.
  • Toward these three ends, we are generating working lists of high priority research issues in need of investigation by medical anthropologists. The first list highlights themes and issues in line with the objectives of action oriented engaged anthropology.  A second working list will highlight themes and issues related to COVID-19 that demand critical medical anthropology consideration. The list will be posted at: http://arhe.medanthro.net/
  • As a special interest group, we would also like to collect briefs from different settings on the issues listed under thematic topics below enabling intra and intercountry comparisons. If you would like to submit a brief please to our blog page: http://arhe.medanthro.net/ please email your submission to Kristin Hedges (ARHE co-chair at hedgeskr@gvsu.edu

THE FOLLOWING IS A LIST OF CORE ISSUES THAT DEMAND ENGAGED ANTHROPOLOGICAL RESEARCH

  • 1. Lay perceptions and understanding of   COVID-19 
  • 2. Disease transmission, adherence to public health guidelines and ad hoc harm reduction 
  • 3. Health and treatment seeking (including health care worker experiences) 
  • 4. Care of the ill
  • 5. Social stigma
  • 6. Mental health and social solidarity
  • 7. Precarious populations
  • 8. Health service issues  
  • 9. Death rituals and burials

1. Lay perceptions and understanding of COVID-19, and sources of information accessed  

  • How is COVID-19 understood in different locales? 
  • Where are people getting information, what sources of information are trusted, who are different segments of the population listening to? 
  • Describe images and metaphors related to Covid-19.  
  • What sound bites and facts do people remember from core health messaging?
  • What COVID-19 related information is driving behavior change: consider the impact of information related to the international, state, city, local levels?
  • Points of confusion 
    • How do people evaluate inconsistent messages and conflicting information from different sources?
  • Biocommunicability –Who is invested in promoting different representations of COVID-19, their circulation: politicians, public health experts, industry, other stakeholders?
  • Comparisons to other diseases and past experience 
  • How do local understandings of COVID -19 influence health care seeking, illness experience, and the identity of those falling ill?
  • Dis/Mis-information
  • Sources –media, sale of bogus products, political groups
  • Partisan fighting and othering, ‘democratic hoax’
  • Epidemic fear and rumors –what do they index, larger conspiracy theories
  • Efforts to address and debunk –by whom and how 

2. Disease transmission, adherence to public health guidelines and ad hoc harm -reduction 

  • Physical distancing
  • Cultural factors making physical distancing difficult
    • Gender and generational  responsibilities, expectations, social conventions 
    • Care for elderly: home care and institution, cultural values and shifts in care and visitation routines during COVID-19
    • Shifts in grandparent – grandchildren interaction and emotional dimension of decisions related to visitation
  • Modification of rituals and ceremonies: church / Mosque/temple attendance, graduation, weddings, funerals [all life cycle rituals, which vary tremendously.]
    • Modified forms of rituals and ceremonies (ritual via Zoom, outside vs. inside) 
    • Barriers to modification of rituals and religious gatherings 
  • Local ‘compliance’ and adherence to order to shelter in place
  • Enforcement of government orders
  • Wearing of masks 
    • Where and when are different types of masks worn by the public: spaces and places, social  activities, personal interactions in terms of perceived  risk 
      • Masks worn to protect self while traveling, shopping and on the job 
      • Masks worn to protect at risk groups: elderly, those who have chronic illnesses or impaired immune systems, etc.
    • How does wearing masks change perceptions of safety and adherence to physical distance guidelines? 
    • Perception of protection afforded –how does mask wearing change physical distancing behavior?
    • Children’s response to seeing family members and the public wearing masks 
      • How are people disposing and cleaning /re-using masks`
    • Confusion in messages related to wearing masks – who is believed? 
    • Masks and social norms
      • social norms of mask wearing prior to COVID -19,  
      • meaning of mask wearing in public 
      • How have new norms been introduced and responded to  over the course of the pandemic? 
    • Production of homemade masks for self -use and health care workers – meaning of making, wearing and gifting masks 
  • Cleaning procedures and rituals 
  • Hand washing –adults and children – how and how often
  • Cleaning of homes, purchased goods etc. 
  • Use of recommended cleaning products, what used when they are not available
  • Access to water, 
    • What steps are taken to engage in harm reduction in water scarce environments and situations 
    • Anxiety related to water scarcity 
  • Testing
    • PCR and serological 
    • How are tests being used and explained to the population?
    • Who is being offered tests and under what circumstances?
      • what underlies decisions about when and who to test
    • How is “swab” and blood” testing understood? Do people know the difference between testing for the disease and for immunity? 
    • Who is administering tests and how: in person / mobile phones? 
    • How is testing being received in the community –for those with and without symptoms? 
    • How are test being manipulated? Forged? 
    • What does it mean to have proof of immunity? 
  • Contact tracing
    • Local understanding of reasons for contact tracing 
    • How was population prepared for contact tracing?
    • Past experience with contact tracing? 
    • Piggy backing on TB, STI, Polio etc. programs, 
    • Experience of digital and in person contact tracing- how received in community, fears associated with citizenship status etc.?
    • What does it mean to be identified as an asymptomatic carrier? As the person who infected a group of people? Shame, blame and guilt.

3. Health and treatment seeking (including health care worker experiences

  • Health care seeking decisions related to home care and going to hospital 
    • Sensorial – what symptoms are seen as signs of COVID-19 
    • When is COVID suspected given the wide range of symptoms 
    • When are clinics /doctors contacted, how –use of phone as well as visits
    • Perceptions of  illness severity and how this  influences health care seeking
    • Danger signs – what are  seen as signs one must immediately see a practitioner
    • Decisions to visit a clinic-what basis, who decides, disagreements in household 
    • Therapy management group –who consulted for advice within extended family and larger social networks etc. 
    • Use of the internet to inform decision making 
    • Self -medication 
    • Treatment and prophylaxis     
    • OTC, home remedies , CAM, pharmacy 
    • Dietary
      • foods consumed and in demand for health improvement / immune system strengthening
  • Health care workers (HCW) 
    • Concerns about working in surge conditions given hospital inability to supply necessary PPE resources
    • Duty to patients / profession vs duty of family –concerns about bringing this  disease home to family 
  • Testimonials –documenting the experiences of  HCW  and  their families
    • Both those who return home to families ach day  and those who choose/ are able to self –quarantine  
    • Documenting the experiences of HCW who are ill –at home, quarantined elsewhere,  and in hospital
    • Social and cultural dimensions 
      • Lessons learned that can inform HCW support efforts 
      • Teamwork, comradery, resilience, psychological impact when colleague gets sick or dies  
      • Rules of hospitals allowing HCW to speak to press or acquire own resources 

4. Care of the ill 

  • Care of individuals within the household who are/presumed to be Covid- 19,  
    • Who is responsible for caring for  sick individual(s) gender/generation
    • How are individuals isolated in household, what happens if living quarters are tight ?
      • How are households re-arranged to accommodate for the presence of an infected individual?
    • Forms of support to households with ill person by kin, friends and neighbors 
    • Expected support that is not forthcoming?
  • Care of those chronically  ill or needing immediate treatment due to other health conditions 
    • Suspending of  routine  health care due to unavailability of  ‘essential services’
    • Self-suspending  health care treatment due to fear of going to clinic as environment of risk
    • Care of individuals with disabilities
  • Social stigma and ‘othering’  associated with COVID-19
  • Who are considered “dangerous others” associated with COVID-19 spread?
    • Ethic groups 
    • Health care providers and their families 
    • Other occupations working in environments of risk
    • Age groups 
  • Use of “othering” for political agenda
  • Source of  stigma  related messages and rumors – associated with past  messages related to other diseases 
  • Forms stigma takes from shunning and eviction to violence 
  • Stigma of recovered individuals 
    • Long term effects of stigma 

6. Social solidarity and mental health 

  • Impact of COVID lock down on social relations within households /families 
    • Gender relations – shifts in responsibilities 
    • Generation – inter and intra generational
    • Domestic violence 
    • Family support in person and on line and by phone
    • Extended and nuclear family decision making about staying in place, 
  • Community support 
    • What kinds of crises and safety net  support existed before COVID-19 and how mobilized now during lock down
    • New forms of support that have emerged –private and public 
    • How is support accessed 
    • Neighbors helping neighbors, intergenerational 
    • Virtual community services offered  during lock down  (free art classes, operas, virtual tours)
    • News ways of engaging in virtual interactions  ethnography of zoom culture
    • School related  support for kids out of school 
    • Access to wifi for low income kids out of school
  • COVID-19 and  mental health
    • Impact of sustained stress levels  and uncertainty  
      • HCW, and community essential service providers  
      • Families of HCW  , service providers 
      • General public 
    • Impact of  social isolation during physical distancing 
    • Impact of 24/7 news on COVID-19
    • Fear of/Impact of losing job, health insurance, business 
    • Food insecurity and mental health 
    • Idioms of distress that are culturally meaningful
    • Resiliency and idioms of concern
      • factors and activities contributing to a sense of psychological, emotional, and spiritual well being 

7. Precarious Populations (in addition to all the aforementioned issues 1-6)

  • Food security and feeding the hungry
    • Food scarcity, where is food acquired  when no resources to purchase ?
    • Feeding and subsidized food programs -how implemented and received? 
    • Children out of school who depend of school vouchers
    • Migrants on the move 
    • Availability of essential foods and rise in prices 
    • Homeless populations
    • Shame associated with household lack of food 
  • Migrant and refugee populations and precarity
    • Refugees
      • How fear of the virus is affecting life in the camps as environments of risk 
      • Limited resource for ‘compliance’: hand washing, physical  distancing
      • Language issues – minority language issues – translating, etc.
      • Movement of refugee and migrant populations –from cities to rural areas, places with few resources to places with more resources – reasons for leaving
    • Undocumented migrant workers
      • Being undocumented and also an ‘essential’ worker
      • Access health care and fear of accessing health services
  • Prisoners
    • Inability to abide by physical distancing recommendation
    • Elderly prison population have increased risk, 
    • Using exposure to infection as a punishment 
  • Native populations 
    • How fear of the virus is affecting life on  reservations  
    • Access to health care 
    • Care of the ill using traditional ceremonies and/or treatments
    • Access to water, supplies and other necessities
    • How virus is conceptualized 

8. Health service research questions 

  • Availability of essential resources (PPE, ventilators etc.) and their distribution and use in various settings 
    • Who is privileged and sacrificed–regarding treatment decisions 
    • COVID-19 impact on essential health campaigns, vaccination programs etc.
      • Delay in use of clinics and hospitals for other serious health conditions 
    • Staffing and payment of HCW issues 

9. Death-Rituals and Burials in the time of physical distancing 

  • Alternative funeral arrangements during COVID-19,  changes in rituals which previously  involved social gatherings and contact with bodies
    • How are bodies disposed?
    • Burial patterns/cremation/marking the graves
    • Memorial services –virtual, planned in future

Current anthropological articles on COVID-19:

  • Alyanak, O. (2020). Faith, politics and the COVID-19 pandemic: The Turkish response. Medical Anthropology, 1.
  • Ali, I. (2020). The COVID-19 pandemic: Making sense of rumor and fear. Medical Anthropology, 1.
  • Ennis-McMillan, M & Hedges, K (2020). Pandemic Perspectives: Responding to COVID-19.  Open Anthropology. Vol 8: 1

 

  • Manderson, L., & Levine, S. (2020). COVID-19, risk, fear, and fall-out. Medical Anthropology, 1.
  • Raffaetà, R. (2020). Another day in dystopia. Italy in the time of COVID-19. Medical Anthropology, 1.

 

5 thoughts on “Call to Action: Influence of Medical Anthropology for COVID-19 Response

  1. This is great. I am using it in my medical anthropology week for my intro to anthropology students- why not? Thank you all!

    Like

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