1. printed by www.postersession.com Many people in Mexico, Guatemala, Honduras, Nicaragua, Panama, and Costa Rica receive no regular health care or dental care. By partnering with communities in need and globally-minded volunteers, Volunteers for Intercultural and Definitive Adventures; Provides basic health care and dental care through medical brigades and dental mission trips to those who would otherwise not receive any medical or dental attention. Supports other international nonprofits in their commitment to the communities they work in as well as provide support to remote and isolated communities. Aims to be a truly nonprofit organization that will have no other motives (religious or political) than to bring people together to make this world a better place through service learning. Offers hands–on, eye-opening, and mind-enriching international volunteer experiences to students and professionals of medical, dental, veterinary, and other fields from around the world. VIDA was created to be a resource volunteers can depend on to support their cause of helping fellow human beings Volunteers for Intercultural and Definitive Adventures, or VIDA, is a non-profit humanitarian association based out of Costa Rica that helps to empower individuals and provides free medical, dental, and veterinary assistance to needy communities to improve quality of life. Cross Cultural Communications in a Clinical Environment A COMMON GROUND BETWEEN ANTHROPOLOGY AND BIOLOGICAL HEALTH SCIENCE Johnson, Thomas M., and Carolyn Fishel Sargent. Medical Anthropology: a Handbook of Theory and Method. New York: Greenwood, 1990. "Healthcare in Nicaragua." Un Enfoque Diferente - Nicaragua - a Different Focus. 2 Sept. 2009.. Helman, Cecil. Culture, Health, and Illness. London: Hodder Arnold, 2007 Paul, B. D. "Anthropological Perspectives on Medicine and Public Health." The ANNALS of the American Academy of Political and Social Science 346.1 (1963): 34-43 VIDA Volunteer and Travel - Home Page. Web. 04 Nov. 2010.. WHAT IS MEDICAL ANTHROPOLOGY VOLUNTEERS FOR INTERCULTURAL AND DEFINITIVE ADVENTURE THE SYMBOLISM OF A TOOTH BRUSH BIBLIOGRAPHY RESEARCH IN THE FIELD: CLINICAL WORK IN NICARAGUA & COSTA RICA CULTURAL INFLUENCES ON ORAL HEALTH There are several ways in which culture can affect a persons health, for example, Peter J. Brown and Marcia C. Inhorn propose two mechanisms which allow culture to play a determining role in patterns of disease and death in populations; 1. Culture may shape behaviors such as diet, activity, sexual practices, etcetera, that give individuals predispositions to certain diseases. 2. People actively change the nature of their environment through culture in ways that often affect their health. The majority of the observed cultural effects on health during this study were results of the first mechanism. The observed cultural effects could further be broken down into lack communication/education of bio-medical knowledge, and cultural customs and beliefs. Lack of Communication/Bio-Medical Education Example 1. No baby teeth—No problem. It is a common belief amongst many of the patients encountered, as well as their family members, that baby teeth are of little or no importance. It is thought that because new teeth will come in and replace the baby teeth, it is fine if they are decayed and/or removed before the new teeth are ready to come in. However, baby teeth have significant purpose, not only in mastication, but in acting as “place holders” for incoming permanent teeth. Tooth decay is typically the result of infection. An infection in the tooth can lead to infections in the gums, which may allow bacteria to enter the blood stream, possibly causing other health complications. Any type of oral infection should be treated, regardless of the status of the teeth. Example 2. Misinformed Pre-Extraction Preparation On the first clinic day in Nicaragua, I encountered the patient who perhaps had the greatest emotional effect on me. He was there waiting at the clinic when the bus containing the volunteers and equipment arrived. With his hand against his swollen cheek. His first upper molar was rotted completely, and his surrounding gums had a sever infection. He came for an extraction. Unfamiliar with how clinical extractions work, he thought that copious amounts of alcohol consumption was an adequate and necessary painkiller. Unfortunately, according to the dentist in charge, the alcohol in his system would render the anesthetic ineffective and not allow a blood clot to form over the socket if the extraction occred, therefore, we could not extract his tooth. All we could do was give him a cleaning and ten days worth of antibiotics and painkillers– not enough to make a permanent difference. While I was cleaning his teeth he kept patting my arm and motioning for me to pull the tooth. The only words he spoke were “No hablo” (I can’t speak). Confused, I ask “¿Porque tiene dolor?” (Because you’re in pain?). He nodded, I told him I was sorry. Because we were not returning to that site, the extraction could not be done by VIDA once he had sobered. Example 3. Coca-Cola in the Baby Bottle Going along with the misconception that baby teeth are not important the acidic and caffeinated beverage Coke is given to children at very young ages. Along with lack of brushing, this results in observed situations where children around 5 years of age have already rotted every single remaining tooth in their mouth. Baby teeth and permanent teeth alike rot at rapid rates due to the combined over consumption of coke, and absence of adequate brushing. Cultural Customs and Beliefs Example 1. Local Superstition There was a sudden change of pace in the dental clinic on the fifth day. There were virtually patients for extractions, and hardly any for cleanings– a stark contrast to the non-stop flow of patients the previous four days. A medical patient told the dentist this was because it was raining. It is apparently a local superstition near San Blas, Nicaragua that it is bad luck to have a tooth pulled on a rainy day. It is possible that because of this superstition, locals who were in need of dental care choose not to take advantage of the two day window of free care VIDA offered. Example 2. Cavity Care– Nicaraguan Style Many patients coming in had metal foil wrapped around the teeth that were causing them pain. This is how some Nicaraguan dental clinics would deal with cavities. Unlike the western method or drilling to remove decay and bacteria, and filling both to fill the new hole, and to aide in aesthetics and mastication, the Nicaraguan method consisted of scrapping the surface of the infected tooth, and wrapping it with foil. Too many patients seen in the VIDA clinics had severe infections thriving under these foil wrapping. Example 3. Pointed Tirbal Beauty As part of pre-clinical training, volunteers were shown pictures of the teeth of some of the women from the indigenous tribe, Ngobe Bugle, from Panama. These women practices a form of body modification where their teeth were either filed to a point, or to two points, with a V in the middle. They said it was not very painful, and consuming large quantities of hot soup helped with the process. Anthropology is the study of humans, their biology, their culture, their language, and their past. Medical anthropology is a biocultural discipline integrating medical science and biology with social and behavioral sciences. - Cecil Helman There are two varieties of medical anthropological studies; 1. 1.The investigation of the role of sociocultural effects on the source and prevalence of certain diseases. 2. 2. The study of the effect of social and cultural differences on the outcome of public-health programs in intercultural settings. This study is a brief examination, using both variants, of the cross-cultural clinical experience of a medical team composed of pre-health undergraduates from the United States, health care providers from both North and Central America, and translators from North American, European, and Central America. Each clinic day in Central America, surpluses of crayons, stickers, and tooth brushes would be given out to children and adults visiting the clinic. Every child showed extreme joy and excitement upon receiving these items. In contrast, while volunteering with the UWF Pre-Dental society at a kids camp here in the United States giving dental education, few children were excited about receiving a toothbrush, crayons and stickers, most were indifferent, and one refused to take a toothbrush. The first time I cried on this trip, I was leaving my host family in Costa Rica. The tears were not entirely due to sadness, knowing I was going to miss them, in fact, they were mostly tears of joy. This family that I had been living with for four days had no tooth brushes in their home. When they walked me and my house mate to meet the bus, we surprised them with enough tooth brushes for every family member we met. To most people living in North America, receiving a tooth brush is no big deal. To this family, it was. I couldn’t hold back the tears nor the smile as I watched the youngest family member bounce around with happiness over his new tooth brush, excited about the colors, saying he would use it “todos los días y todas las noches” (every day, and every night). This experience can be contrasted to the experience with my Nicaraguan host family, which, unlike my Costa Rican family, were quite above the poverty line. The first morning I excused myself from breakfast to brush my teeth, upon rising from the table, I was ask if I needed a tooth brush. Observations were made during a 12 day period while traveling with the organization VIDA. Most clinical observations occurred in the dental clinic; few occurred in the medical clinic. Cultural observations were made throughout the 12 days, in every setting. Both clinical and cultural observations were made in a public hospital in Managua, the capital of Nicaragua. Four of those 12 days were spent in Costa Rica, two of which were spent in satellite clinics set up by VIDA. The remaining eight were spent in Nicaragua, with four clinic days. Costa Rica is ranked first in Latin America for developments in curative and preventative diseases. In fact, Costa Rica has both a lower infant mortality and a higher life expectancy than the United States. This could be attributed to the fact that Costa Rica’s health care system is subsidized through the social security system, providing low-cost medical care for naturalized residents. Clinical observations for Costa Rica were made in northern Costa Rica in a town near the city of Puntarenas. The majority of the patients seen were immigrants from Nicaragua, and therefore were not eligible in Costa Rica’s health care system. Nicaragua has widespread underemployment and has one of the highest degrees of income inequality in the world. Though Nicaragua has progressed toward macroeconomic stability, annual GDP growth has been far too low to meet the country’s needs, forcing reliance on international assistance. A study carried out during 2007 and 2008 by Ministerio de Salud found that 58% of Nicaraguans are unable to access adequate healthcare and treatment due to poverty and social exclusion from health services. This study also found that 20% of children under five years of age suffer from chronic malnutrition and 6.3% from severe chronic malnutrition. Clinical observation were made in two separate clinics near the city of Jinotepe, and one clinic near Granada.