During this session of our weekly CARE Reading Group (CRG), we delved a little more deeply into the culture-centered approach (CCA), the heart and soul of all the work we do at CARE. Here is a brief summary of what we discussed during this session. JT opened the session with a story of his experience with a dentist in America. He had chosen a particular dentist because she was Indian. To JT, that marker became significant for his conception of cultural membership; in other words, he hoped that the dentist would be more understanding and compassionate because they were both Indian. Unfortunately, the dental services were as cold, clinical and profit-motivated (i.e., expensive) as any other dentist in America. In the end, JT sent a picture of his teeth to his parents in India. They took it to a local dentist and sent his instructions and prescription back to their son in America. There were a number of lessons that emerged as we dissected JT’s story. First, culture is more than just about the colour of your skin. Ahmed rightly pointed out it was also about the space where the interaction takes place. Second, I was impressed at JT’s demonstration of agency when faced by these obstacles that prevented him from getting proper dental care. He mobilized social and technological resources, and ultimately was still able to take care of his teeth. That, to me, was a clear example of how an individual is not only hindered but also enabled by his/her environmental constraints. Third, the group discussed how much power a medical professional wields, especially in dictating a person’s right to health. This power is institutionalised within the medical training system. Medical knowledge is clearly shown to be politicized. In its presence, all other forms of knowledge become delegitimized. Fourth, we touched upon how medicine is a capital enterprise, which calls into question: is health a basic human right, or a right to only those who can afford it? The discussion moved on to more stories of health. Ahmed shared a story of how his wife and sister faced reproductive health problems, specifically irregular periods. He was shocked at how disinterested and unconcerned these women were toward the wellbeing of their body, and he often found that he had to take the initiative to help them seek medical information and the appropriate treatments. Ahmed commented that in this context, culture was a barrier to reproductive health, and the local women needed to be educated and made aware of their reproductive health. Ahmed’s comments set off a few warning bells among some of the group. We had to interrogate further. I was especially concerned because, in my assigned chapter, viewing culture as a barrier was distinct from CCA. The focus was on removing cultural obstacles, but to maintain health standards according to the status quo. Satveet and Pauline, as the only women at the table, were pretty sure that Ahmed’s wife and sister only appeared disinterested in their health. They likely did not want to confide in him as he was male. These two points moved the discussion on to the concepts of culture and structure. We discussed issues of gender politics and reproductive health education in schools as possible socio-structural constraints. We also speculated that the women were likely talking among themselves, but not with their husbands. (Satveer shared how a relative would rather discuss her reproductive health problems with her sister than her husband.) On a reflexive note, this discussion was a little strained, probably from the discomfort of the men discussing the topic. We talked about how boys would be separated from girls when it came to reproductive health education. Women’s reproductive health is a gendered topic, and in some contexts, relegated to the invisible realms of feminine oppression. Periods are a woman’s problem, which raises issues when in some cultures, a woman’s access to health care is solely through her husband or father. Which goes to show that health is perhaps not a cultural problem as it is a communicative one. A communication problem caused by differing meanings of health.
CARE Reading Group: Sarah Leading the First Discussion[/caption] The CARE team dedicates Wednesday afternoons to reading, debating and discoursing the CCA approach. Fundamentally, the team seeks to further strengthen understandings of the framework as well as critique various interpretations and ideas applicable to the approach. The first series seeks to critically think about how CCA is relevant to health. Drawing from Dutta’s (2008) Communicating Health: A Cultured Centered Approach, the group parleys about health, culture and marginalized communities. CARE Reading Group One – Why Aren’t You Listening? The first reading group saw a robust debate on the ownership of health. Who gets to push health agenda? What gets constituted as appropriate forms of healing and what does not? Is biomedicine the only correct way of treatment? Who is medicine man and why?