Critical Medical Anthropology
Critical medical anthropology is the medical anthropology approach that focuses on the political and economic factors that shape influence on health, disease, and health care (Joralemon 2010:41). In contrast to applied medical anthropology, I believe that critical medical anthropology employs a broader big picture view of health issues. The big picture involves patients of all cultures and therefore also requires cultural competency.
Joralemon (2010) mentions the work of critical medical anthropologist Merrill Singer in Hartford, CT. Singer (1995) addressed the local Puerto Rican population's health issues, such as alcoholism, substance abuse, etc., on local, state-wide, and national-wide levels. Instead of addressing the issues of individual patients, he addressed the issues of the entire Puerto Rican population and sought political action to find a resolution. This example of critical medical anthropology lead to the creation of a state-wide sterile needle exchange program to resolve healthcare problems related to the transmission of disease among substance abusers and to promote better health through AIDS transmission prevention.
In Anne Fadiman's book, I don't remember specific mentions of economic factors in Lia's case. Although the Lee family lived on welfare, there were no mentions of the Merced Community Medical Center declining any medical attention to Lia. In fact, Dr. Ernst estimated that over the years, Lia's case had cost at least $250,000 (Fadiman 2010:254). The major issue involving political factors would be the Child Protective Services episode. Although Nao Kao and Foua did not read English or numbers, the main issue with the medication compliance issue, as we discovered from reading the entire body, had less to do with language and more to do with the Hmong's interpretation of epilepsy. Since the Lee family did not view Lia's epilepsy as an illness and certainly not having been caused by brain damage, they didn't believe medication, especially Western biomedicine, would benefit Lia. However, U.S. state laws defined child endangerment as a form of child abuse, and Dr. Ernst decided the medication non-compliance met this definition. Perhaps if critical medical anthropologists had been employed in Merced at that time, then maybe the cultural conflict between Hmong cultural beliefs and the culture of Western Biomedicine would have been discovered. That might have lead to cultural diversity programs being implemented at medical institutions to better understand the patient population and might have avoided Lia's Child Protective Services episode.
