Striving for a Healthier World

By Katherine Lewis

Persuading African Women to Screen for Cervical Cancer

In Botswana, people go to hospitals when they’re sick. The concept of screening or preventative medicine is quite foreign, and very few individuals are knowledgeable about cervical cancer or pap smears, says Ditsapelo McFarland, Ph.D., an associate professor of nursing. As a result, Southern Africa has seen an increase in new cervical cancer cases, even as rates in the developed world have fallen.

“The only people who were informed were those who had health insurance because they were able to access private physicians,” Dr. McFarland says. But even nurses at clinics in Botswana admit that they aren’t proactive about their own health.

“Some of them have never even had cervical screening, or if they did, it was just because they had problems, and they never went back to look at their results,” she says. “They screened 10 years ago.”

She developed a brochure to educate women about cervical cancer and gather information, which she implemented in Botswana last summer. The majority had no education at all about pap smears, so she gave them information about cancer incidence and has recently issued follow-up surveys. “I’ll be able to see if the brochure was effective or not effective,” she says.

Quite a number of the women she interviewed had never had a pap smear. While healthcare is free in Botswana, the hospitals are swamped and equipment is limited. Most new cases of cervical cancer are appearing in developing countries because of the lack of screening, Dr. McFarland says. “They have a difficult time understanding what is cancer of the cervix,” she says. “They were told by some people that it could be related to sticking some corrosives into the cervix or traditional medicines.”In the future, she hopes to complete ethnographic studies by going into villages to understand what they really know of cancer and the traditional beliefs.

Inclusion for Indian Children with Disabilities

One challenge when trying to improve health outcomes is understanding the cultural context. When you talk to Indian families about inclusion for children with disabilities, the word cannot be translated—it has no meaning, says Pavan Antony, Ed.D., an assistant professor of education. So even though India has adopted several U.S.-based policies of educational inclusion, implementation is a genuine challenge.

“What happened in the 1970s with children with disabilities in this country is still happening in many places, including India,” Dr. Antony says, referring to a practice of shunning children with disabilities and segregating them in separate schools or group homes, rather than striving to educate and integrate them with typically developing children as much as possible.

In a study of parents of children with disabilities, he found no difference in the social, cultural and educational attitudes toward disabilities when looking at different education levels of the parents or across religions.

“It was fascinating to find out there were no differences between the upper class and the lower class. They had the same challenges,” he says. “All were hoping for a cure for their child’s disability.”

In the United States, families of Indian origin bring with them many of these perspectives. Teachers and parents alike must be educated to bridge the cultural divide. For instance, in many Asian cultures, families are much more interdependent than in the United States. So the notion of any child acting independently is foreign and parents may not support the skills being taught in school, unless they’re coached.

“Teachers should take the time to understand their cultural background,” Dr. Antony recommends. Something as simple as whether families use utensils or eat with their fingers can lead to wasted effort and crossed signals.

In a recent study, he encountered Indian parents who differed with school officials over whether their child, who has cerebral palsy, could use a communication board, a board containing pictures and symbols for the child to indicate his wishes and needs. After officials denied the parents’ request for the board as unhelpful, the family stopped reading the individual education program. Therefore, they never saw a note that the child failed to meet standards of hygiene, and didn’t know the teachers were spending valuable time trying to teach the child to hold utensils—when the family ate with their fingers at home. If the family and teachers had been working together, the child would have been spared the frustration of receiving unnecessary training and would have learned skills more targeted to his needs.

 The Compelling Power of Chinese Medicine

Bridging cultural divides is an age-old challenge. A century ago, missionaries in China were frustrated by local women eschewing Western medicine in favor of traditional healing, according to recently published research by M. Cristina Zaccarini, Ph.D., an associate professor of history.

Dr. Zaccarini studied letters, unpublished and published documents and missionary periodicals of Western physicians and travelers to reconstruct the healing role of Chinese barbers in the late 19th and early 20th centuries, which was rooted in Buddhism and in Daoist mythology and health practices.

“My study illustrates the affordable and wide availability of Chinese healing practices such as acupressure and massage, through the traditional Chinese  barber, to most of the population, including women,” she says. “To the horror of Westerners, these practitioners were unlicensed, unregulated and capable of doing some damage at times, when unsterilized instruments brought unpleasant results. However, such practices as acupressure and massage were just as often, by the admission of the foreigners themselves, quite invigorating and efficacious.”

While male elite Chinese came to associate Western medicine with progress and accept it, many marginalized individuals, including women, held fast to Chinese cultural healing practices. That represented an act of defiance against the patriarchy and the spread of Western ideas.

“For example, some early 20th century Chinese women exercised their autonomy by calling first on Chinese midwives who adhered to Daoist understandings of childbirth, and only later, the Western physician,” Dr. Zaccarini says. “One family insisted on relying upon a Chinese midwife and fortune teller who understood such phenomena as the relationship between one’s birth date, behavior and the fluctuation of the seasons as an accurate prediction of whether the mother would give birth successfully.”

Many Chinese adopted Western medicine while also successfully continuing to utilize their own traditional practices, such as acupuncture, herbs, food therapy and energy movement exercises. “They could often achieve prevention and cure with both systems, even while leaders in China might have defined national progress according to the degree of progress made in the incorporation and utilization of Western medicine,” she says.

Even in the United States, Chinese women often chose the Chinese physician over the Western doctor a century ago. “This was a pragmatic choice based on Chinese medicine’s rich history of specific prescriptions for a woman’s specific health needs,” she says.

Incubating and Spreading Entrepreneurship in India

Modern medicine is just one possible resource for Indian villages, thanks to new technology that universities are incubating and distributing to rural areas. A new paper by Gita Surie, Ph.D., an associate professor of management, marketing and decision sciences, finds that university-industry linkages are critical to solving rural socioeconomic challenges and spreading entrepreneurship.

“Investment has increased, new markets have formed using information technology,” Dr. Surie says. “In order to have development take place, you need to catalyze entrepreneurship and you need to catalyze some kind of capability building.”

It’s not enough to simply introduce technology; you also need social innovation for individuals to break from their old ways of doing things. For instance, introducing an Internet kiosk to a village can suddenly pave the way for children to be educated via university tutorials online. It can also provide farmers with weather reports and crop insurance, or let villagers create businesses online. Once their neighbors see that they’re making money, the entrepreneurship bug begins to spread.

In a case study, Dr. Surie describes how a leading technical university formed a telecommunication and computer networking group to develop innovations and support entrepreneurship. The group helped solve local problems, such as by promoting wireless phone adoption, and connected villages to the Internet through kiosks with local-language software.

Moreover, cell phone networks became cheaper and more user-friendly for rural Indians through a new base station and secondhand handsets. And banking was streamlined through a venture by a university graduate who created a low-cost ATM machine that was deployed by major Indian banks and used biometric authentication. That avoided the problem of keeping a PIN number secret in a village culture that doesn’t include secrecy, not to mention the challenge of illiteracy.

“Universities use these innovations to jumpstart entrepreneurship. The village is reconfigured by its link to the university,” she says. “You have a virtuous cycle of entrepreneurs.”