Fear Of Social Isolation Research Articles

Gender and tuberculosis control: Perspectives on health seeking behaviour among men and women in Vietnam

This study explores the perspectives of tuberculosis patients on which factors influenced their health seeking behaviour, with special reference to gender differentials in terms of delays in health seeking. In 1996, a multi-disciplinary research team carried out 16 focus group discussions. The study was done in four districts in Vietnam, both in the south and north of the country and in urban and rural areas. Qualitative analysis of data was performed following general principles of modified grounded theory technique. Participants in the focus groups described three main factors as contributing to delay in health seeking. These were fear of social isolation, economic constraints and inadequate staff attitudes and poor quality of health services. A model illustrating different factors influencing health seeking was elaborated and served as a basis for discussion of the findings. The main factor contributing to delay among women was described as fear of social isolation from the family or the community. Stigma was described as closely related to contextual factors such as gender-roles, socio-economic status and level of education and seemed to be mediated via denial and concealment of tuberculosis diagnosis and disease, thus causing delay. The main factor contributing to delay among men was described as fear of individual costs of diagnosis and treatment. Staff attitudes and quality of health service facilities were described as not always corresponding to people’s expectations of appropriate health services. Women saw themselves and were seen by others as being more sensitive than men to poor service conditions and staff attitudes. A typical feature of the described health seeking behaviour of men was that they neglected symptoms until the disease reached a serious stage, by which time they tended to go directly to public health services without first visiting private health practitioners. Women, on the other hand, were described as having a tendency to seek out private services and practice self-medication before seeking care at public services. In conclusion, there is a need for better understanding of behavioural factors and for developing strategies, that take these into account. Health workers need to better understand gender and social aspects of tuberculosis control, particularly aspects that influence the likelihood for achieving equity in diagnosis and cure.

Problematizing Impairment: Cultural Competence in the Carolines

This article examines Western concept of impairment by reference to ideas Micronesian (Caroline Island) atoll dwellers hold about personhood,(2) and contributes to growing anthropological attention to disability and related notions of handicap and impairment (e.g., Bruun and Ingstad 1990; Ingstad and Whyte 1995; Jenkins 1993; Susman 1994). Specifically, I suggest distinguishing between impaired parts and impaired persons. Influenced by such things as phenomenology, hermeneutics, and critical theory, most contemporary anthropologists define culture as socially constructed, learned communicative code based on shared system of meaningful signs. In order to acquire and manipulate this code, human beings everywhere rely principally on hearing and speech; culture learning is at once aural and oral. Thus human beings everywhere find that whatever interferes with normal hearing and development or maintenance of normal speech is threatening because it inhibits or even prevents cultural transmission. Persons without culture are genuinely disabled. In identifying common psychiatric themes in Polynesian and Micronesian cultures, Howard (1979:126) notes that the fear of social isolation, not only in sense of social rejection and withdrawal of support, but in literal sense of physically left alone constitutes a focal point of anxiety. Self-imposed isolation is common symptom of onset of mental disturbance in these societies, and isolating oneself from community, either socially or physically, carries particularly powerful message (1979:136). Polynesian and Micronesian communities are group-centered and their members are other-directed. The centrality of group over individual in social life is emphasized by virtually every ethnographer who has worked in these islands, as is importance of external social controls over internal personal controls in maintaining behavioral conformity (Howard 1979). The person in these island communities exists not so much as an autonomous self (as in West), but rather as part of larger community of selves (cf. O'Brien 1993). This group-oriented rather than individual-oriented view of person presents challenge to concept of impairment that is widely used in West: any loss or abnormality of psychological, physiological, or anatomical structure or function (WHO 1980:27). Taking lead from Alkire (1992), I will argue that Caroline Islanders do not see most physical impairments (impaired parts) as disabling, where disabilities are defined as any restriction or lack (resulting from an impairment) of ability to perform an activity in manner or within range considered normal for human being (WHO 1980:28). This is because in most such cases individual continues to participate in everyday web of social relationships, even if at limited or reduced level. Taking further cue from Peter (1992), I maintain that even serious physical impairment (e.g., paraplegia or blindness) is not necessarily disability in these island communities as long as impaired person can construct new roles that permit active contributions to household and community life. Drawing on my research on Namoluk Atoll and on work of colleagues who have conducted studies in other Caroline atoll communities, I argue that evidence favors limiting concept of impairment to those chronic or permanent conditions in which self is socially isolated--in which person either no longer wishes to be or no longer can be constructively enmeshed as an involved participant in community life. In these communities it is primarily various sorts of psychological or mental conditions that are disabling, and attention to psychological conditions leads directly to Caroline Islanders' concepts of personhood. The richest discussion of personhood in Caroline atoll communities comes from Lutz (1985, 1988). …