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.

 

Covid-19 Updates: New information! New research issues!

by Mark Nichter, Phd

“Calm, everything will be okay” Image by Cristiana Basto, Lisboa, Portugal, April, 2020.

Thank you Cristiana for the image from the streets of Lisbon.

Cristiana Bastos
Institute of Social Sciences | University of Lisbon | Av Anibal Bettencourt, 9 | 1600-189 Lisboa, Portugal https://cristianabastos.org/

Covid-19 Overview by Mark Nichter, UPDATED 3/31/20

Dr. Mark Nichter is an experienced  medical anthropologist actively engaged in global health research and outreach. This slide show is intended for a general educated audience, university professors wanting to educate their students  and engaged social scientists. This presentation was originally created during  the week of  March 12-18th and will be updated weekly.

UPDATE MARCH 31, 2020

Information on Covid-19 is changing rapidly. Many thanks to Mark Nichter for his work on integrating new information into this resource.

Photo by Ylanite Koppens on Pexels.com

If you are interested in writing a blog for our community, please contact me, Liz Cartwright, carteliz@isu.edu. It would be great to hear from all of you out there. What is happening in your communities around the Covid-19 pandemic? What are your theoretical ideas on ways to better understand cultural interactions, treatments, forms of personal protection, and the larger issues of power abuses, biosocialities, vulnerable populations, etc.?

Elizabeth Cartwright, RN PhD, is a medical and visual anthropologist who works in Latin America–mostly. Her work is focuses on environmental health, social justice and anthropology with an applied focus; she is a professor at Idaho State University in the lovely Rocky Mountains.

Visualizing the Pandemic by Jerome Crowder, PhD

Crowder is a medical and visual anthropologist. His research focuses on the conceptualization of illness and help seeking behavior among urban migrants. Crowder’s books, articles and exhibits explore how migrants define and maintain community; he is currently the president of the Society for Visual Anthropology.

Visualizing Covid-19

As Covid-19 wreaks havoc across the globe and close to home, one of the virus’ features that makes its spread so disconcerting is our inability to SEE it. Knowing its molecular structure or viewing its image from an electron microscope doesn’t help us avoid contracting it. How can we visualize Covid-19 in a way that is meaningful? 

First, we can see it’s impact on our society by viewing our preparation for its arrival and our reaction to its infection. These are material manifestations of the virus, which are culturally informed and expressed. They are different everywhere.

Covid-19 offers us a unique opportunity to reflect on our cultural assumptions and expectations about infectious disease. I immediately conjure up images from The End of Polio by Sebastião Salgado (2003), dramatic black and white images documenting the final stages in the eradication of that virus… what new images will Covid-19 bring us?

Early in the outbreak I was mesmerized by television images from the Chinese response to Covid-19, images of building temporary hospitals, people walking down the streets wearing face masks, gloves and smocks, empty roads, packed clinics. I also thought about the images we don’t get to see, the faces of the health care workers skillfully attending to their patients, families huddled together worried about a relative in quarantine, or public health officials in heated conversations with politicians obsessed with keeping the status quo. Over time, images will emerge that tell the stories we have not heard, they will help shape new facets in our understanding of what Covid-19 means.

As Covid-19 spreads, the images we see show how cultures respond to it. Even though the virus was discovered in South Korea and the USA on the same day (January 20, 2020), reviewing images from the news reveals a decidedly different approach to the rapidly spreading infection. Images from S. Korea show lines of people waiting to be tested, health care workers wrapped head to foot in disposable gowns with masks assisting patients on hermetically sealed gurneys, and teams of white-coat clad individuals with pump-sprayers walking in single file spraying the nooks, crannies, and surfaces where Covid-19 may reside. 

Meanwhile images published in the US show a president rebuking Covid-19’s danger, streets, parks, and malls heavily congested with people, and sign-clad residents in San Antonio protesting the arrival of Americans from China evacuated to US bases for quarantine and observation. And of course, the cruise ships not allowed to dock so infected travelers and well persons could disembark and seek appropriate attention.

As the infection spread to Italy and Iran, images depicting their plight revealed mask-wearing clerics, empty street markets and quarantined families standing in windows singing across to each other. The images are as strikingly different. By reviewing these images we get a taste for how Covid-19 is being conceptualized and addressed. Granted popular images published in magazines and newspapers have political intentions, but check out images posted on social media to really understand what is important about Covid-19 for people to share with others.

While medical anthropology’s eye is trained on people’s understanding of the outbreak and its potential ramifications to community health, my visual anthropology eye searches for scenes that reflect that understanding (or lack thereof). 

Escaping Houston’s urban center a couple weeks ago for Galveston Island, I was astonished to see the beaches filled with friends and families enjoying themselves for spring break. The Gulf side parking along the seawall was as full as were the cantinas across the street.  That’s an image burned into my mind’s eye, as three days later the County asked all guests and visitors to leave the island, residents were asked to practice social distancing and restaurants became take-out portals. Immediately, signs appeared in the windows indicating new hours of operation, reminding patrons to keep 6’ between themselves, and stores listed items they no longer had in stock (mostly TP, water, eggs, milk and pasta). 

Walking through the grocery I noted which aisles and shelves were bare and which remained well-stocked. While I couldn’t find rice, there was plenty of quinoa and couscous. What do these bare shelves tell us about our dietary preferences and cuisine? Upon entering a restaurant, I note the hostess was replaced with signs indicating which bags were for takeout or Grubhub/Doordash pickup, the lighting was cut back and the chairs were stacked on tables. 

While we all endure the trajectory of Covid-19, keep in mind its visual manifestations in your own community; what’s a unique response and what’s more general to your region or state? Keeping our eyes open for subtle changes in visual expression to the virus help us peel back the layers to better understand what Covid-19 really looks like and how we visualize the experience that will forever affect our society.

Jerome Crowder, PhD is a medical and visual anthropologist who has conducted fieldwork in the Bolivian and Peruvian Andes, east Houston, and most recently in Galveston, Texas. His primary research interest focuses on the conceptualization of illness and help seeking behavior among urban migrants.Crowder’s books, articles and exhibits explore how migrants define and maintain community; he is currently the president of the Society for Visual Anthropology.

Recent Book: Anthropological Data in the Digital Age (Palgrave 2020)

Articles:

Optimizing Community Bioethics Dialogues (Narrative Inquiry in Bioethics)

A Journey through Chronic Illness (Medicine Anthropology Theory)

Visualizing Tensions in an Ethnographic Moment (Medical Anthropology)

Covid-19 Overview by Mark Nichter, PhD, MPH

Dr. Mark Nichter is an experienced  medical anthropologist actively engaged in global health research and outreach. This slide show is intended for a general educated audience, university professors wanting to educate their students  and engaged social scientists. It was created during  the week of  March 12-18th and will be updated weekly.

March 23, 2020 UPDATE

Thanks to Mark Nichter, PhD, Professor Emeritus, University of Arizona for this great resource powerpoint. The presentation covers Covid-19 disease etiology, anthropological insights and future directions for research. Please pay attention to dates and recognize that information is changing very rapidly.

Guest blogs and information are welcome! Email me at carteliz@isu.edu if your are interested in contributing information, research ideas or perspectives from your fieldsites in the US and in other countries.

Eco-risks and Covid-19

NOTE: Please contact me at carteliz@isu.edu if you’d like to do a guest post on this blog. !!

Photo by Arun Kr on Pexels.com

“Everyone was trying to be pleasant… but the faces of the old people were scared. They’ve been around, and today at the grocery store, they were scared.” Small town, Idaho, March 18, 2020.

How do humans understand danger? This is perhaps the most enduring question that I’ve brought to my work in medical anthropology. What makes us afraid? What makes us change our behaviors or seek the help of experts? How do we protect ourselves from dangers large and small?

Covid-19 is our current danger. For some it is a fearsome specter, a death-bringer. For others, it is an inconvenience, a nuisance. The world is focused on this virus with an intensity that is unprecedented.

As an anthropologist I want to understand the processes of how cultures come to grips with a new menace. In past writings, I coined the term eco-risk to explain how cultures try to understand, control, and hopefully vanquish dangers that emanate from the environment. [1]

I use the term “eco-risk” to highlight how individuals and groups  react to dangers that they perceive as coming from their environment (Cartwright 2013). Eco-risk highlights how we create multi-level understandings of risk and danger in three inter-related processes: 1) the process of culturally recognizing and naming the environmental danger; 2) the recognition that is based upon available technologies of perception (pace Foucault), instruments, divination, microscopes and various kinds of ‘tests’ and 3) the articulation of these two things within the legal systems. What counts as evidence?

1) In the case of Covid-19 we have just begun to recognize the danger. As the virus has spread across the map, ideas and information changes. The threat has become more and more real. One by one, cultures are recognizing what this virus can do to individuals, institutions and societies.

2) Our technologies of perception are still faltering. Testing labs, equipment and supplies are inadequate and our protocols are reflecting this weakness. We still can’t see our foe, only those individuals presenting with the most critical symptoms are being tested. The vectors, those individuals with no or less serious symptoms are still untested. The ramifications of testing status, stigma, access to care and to services is another pressing topic for anthropologists to work on.

3) Legal ramifications will come in the kinds of rules we’ll set up for mandating vaccinations (or not), the punishments that we will create for breaking the rules, whatever they will be and the power structures that are established in the wake of this outbreak. 

These three processes play out over time, in ways that reflects cultural values, norms and aspirations.

Environmental threats come in all sizes as Covid-19 demonstrates. We are just getting a glimpse of how our lives are being changed forever by this wee virus that has come out of our environment to confront us.


[1] Cartwright, Elizabeth. 2013. “Eco-Risk and the Case of Fracking.” In Cultures of Energy, edited by Sarah Strauss, Stephanie Rupp, and Thomas Love, 201–12. Walnut Creek, CA: Left Coast Press

Elizabeth Cartwright, RN PhD, is a medical and visual anthropologist who works in Latin America–mostly. Her work is focuses on environmental health, social justice and anthropology with an applied focus; she is a professor at Idaho State University in the lovely Rocky Mountains.

Covid-19 is diagnosing Mother Earth

If we could but look at our lovely planet earth from afar we’d see that iconic blue marble. If we could look more closely, we could see that it is blanketed in lots of microbes; a veritable robe of virus covers her lovely blue roundness. 

And if we could see hot spots, places where the virus break out of their usual routine lives of happily reproducing in their weirdly parasitic way, we could see the places that Mother Earth is calling our attention to. 

I’m a medical anthropologist, I look for patterns both cultural and biological. I see layers and layers of environmental affronts to the earth, of air pollution so bad it is the cause of millions of deaths each year and I see overlaying that pollution, heavy smoking patterns, exceptionally high for men in China and I see lungs that are susceptible to viral infections. Lungs so damaged by years of inhaling filthy air and cigarette smoke that they no longer can mount an effective immune response; they can no longer clean out the garbage from their distal spaces. These lungs will drown once hit with the coronavirus. 

This situation is a good example of what the medical historian Mirko Grmek called pathocenosis.

“By pathocenosis, I mean the qualitatively and quantitatively defined group of pathological states present in a given population at a given time. The frequency and the distribution of each disease depend not only on endogenous—infectivity, virulence, route of infection, vector—and ecological factors—climate, urbanization, promiscuity—but also on frequency and distribution of all the other diseases within the same population” (Grmek, 1969). 

As Gonzalez et al continue, in their recent application of this concept, “Thus, for the first time in the history of medicine—beyond a nosological framework that encloses diseases in a frozen disciplinary framework (e.g., respiratory diseases, arboviral diseases, sexually transmitted diseases)—Grmek offered a temporal and spatial approach to understand the dynamics of infectious diseases and their interdependency.” Ecohealth. 2010 Jun; 7(2): 237–241. 

Published online 2010 Jul 1. doi: 10.1007/s10393-010-0326-x

Viral spread is largely about density of people— Asia has the highest density in the world, then Africa (perhaps, the coming storm) and then Europe. Asia and Europe are the hardest hit now, we will see how it will move forward. The African continent is located between Asia and Europe, it is linked economically and socially and I would think it is only a matter of time before the Covid-19 makes an appearance there. 

Oh, and then there are the cruise ships. Talk about population density! 

Weaknesses show up at many levels. The weaknesses of the institutionalized elderly in the US, (density) and yes, ‘underlying causes’ –weakened immune systems, chronic illnesses and immobility, oh and not so very much social distance at all. 

And not just the elderly, it is the institutions themselves that are weak, nursing homes and hospitals with only the bare necessities and only minimal staffing. In the event of an increase of 10% in the in-patient load many would collapse for lack of staff, lack of supplies, lack of equipment, lack of planning and resources. This article on biosecurity and what hospitals would need to do to effectively respond to an outbreak is from John’s Hopkins; it is very informative. 

What is it that our earth is trying to tell us? If we could see the places on the blue marble most affected, if they lit up brightly, what could we learn? We are in a syndemic, not just of coronavirus, but of multiple levels of pathological states and behaviors.

This virus will surge and it will wane, we will wash our hands, and we will need to be better prepared next time. 

Elizabeth Cartwright, RN PhD, is a medical and visual anthropologist who works in Latin America–mostly. Her work is focuses on environmental health, social justice and anthropology with an applied focus; she is a professor at Idaho State University in the lovely Rocky Mountains.

March 5, 2020

Today in the news there are many instances of people, nations and organizations working together to better understand and combat the Covid-19 virus. There are also instances of people and communities being targeted in negative ways because of fear and racism. 

Blame, fear and conspiracies result in groups of individuals being stigmatized as dangerous, dirty and the sources of the disease. Stigma is negative stereotyping without understanding the underlying complexities of the situation and the harmful effects on the individuals who are labeled in this way. 

Erving Goffman’s work Stigma:
Notes
 on
 the
 management
 of
 spoiled
 identity.

New
York: Prentice‐Hall,
1963,  highlights the process of how people acquire and manage stigmas. How do people live with stigmatized conditions? How do they conceal/reveal them,  to whom do they reveal and why? These questions are just for starters, but point the direction for questions specific to the Covid-19 outbreak. 

How do the patterns of stigma associated with Covid-19 create social contexts where individuals:

  1. might try to hide their symptoms (pharmaceuticals), 
  2. could be afraid of going out in their communities/visiting their providers, 
  3. might be using non-biomedical treatments in lieu of biomedicine?

Here are some great resources on stigma that give us some ways of thinking through how it is playing out in the current moment in this pandemic. 

The first is a refresher on how stigma affects people and what we can do to stop it. Words matter—the pdf you can download from this site has some communication tips. 

The WHO has a good list of Myths about Covid-19 and how to BUST them! Information is power and is an important step forward to combatting stigma.

How is this affecting you as a practitioner? What are educators doing to get the word out to their students. (My students got this post for their discussion next week). Thoughts? Other resources?  If you put them in the comments, I’ll add them into the post.  

March 2, 2020

Monday, March 2, 2020

France has closed the Louvre and the Domincan Republic was infected by an Italian tourist. An entire nursing home in Washington was infected and many will die–facilities like this one will be epicenters of mortality.

This is a virus that will test our ability to be compassionate, to put ourselves (as privileged healthy people) into the shoes of the elderly and the sick, the workers who need to be at their jobs and can’t work remotely and the populations of poor countries that don’t have ventilators and support medical equipment and staff. 

We healthy, potential vectors, need to step up and take responsibility for curtailing the spread of the virus.

This virus is reminding us to think of others. We’ve grown complacent with the same message from the flu. Will we listen to this one?

March 1, 2020

Thought for the day: Start right now to be prepared. Buy extra supplies of the things you already eat and stock up your pantries. Go over your needed medications and don’t forget your pets!

…and know how to shelter in your home for a couple of weeks…

Analysis: Here’s a thoughtful article by medical anthropologist Roberta Rafaeta called, “From Italy: anthropological reflections on coronavirus, COVID-19”

We will be posting information here on the evolving pandemic of COVID-19. Our intent is to gather the most informative information in one place for our colleagues and our students.

We encourage a thoughtful exchange of ideas. We take a critical approach to understanding health and we forefront the structural vulnerabilities of those who are facing this situation with few resources. Our goal is to advance understanding in a timely and responsive fashion and to learn from this difficult situation as it unfolds.