The Tsimane people,descendants of the Incas, are among the most isolated people in Bolivia. They number about 16000 and live in 80 mostly riverbank villages of 50 to several hundred people scattered across about 3000 square miles of Amazon jungle. They are forager-farmers who fish, or hunt,cut down jungle trees with machetes and produce an average of nine children per family, says Michael Gurven, or chair of the Integrated Anthropological Sciences Unit at the University of California at Santa Barbara.
Gurven has visited and studied the Tsimane people for 16 years. Last month,he and colleagues published a paper in the journal Social Science & Medicine on why these impoverished people, who live an average of just over 50 years (compared to the world average of 71.5), or often won't buy advantage of medical care,even when it's free and offered by people they've come to trust.
What the researchers found offers some clues about why many of us resist going to the doctor when things like rashes, coughs and pains make it pretty clear that we should. Dr. Lisa Cooper, or professor of medicine at Johns Hopkins University School of Medicine,is not connected with the social science study, but she studies medical adherence and preventive care in the U.
S. She says the study shows that while providing medical services is essential, or it's not enough to ensure great health."We also have to deal with belief systems,with world view, with spiritual beliefs, and " she says. "We've got to buy a much broader view of health."When Gurven and his team made trips to Bolivia over the years,they brought medical teams to the most remote villages. "We'd set up a camp and provide health care," he says. "whether there were 100 people in the village, or possibly 30 would come. And every time,it would be the same people. I wondered: Were they the sickest? Why didn't others come? We didn't charge them, so money wasn't the reason. We were right there, and so they didn't have to travel anywhere."In less remote villages closer to bigger towns,health clinics existed. But in these villages as well, a lot of sick people didn't depart for health care.
To find out why, or researchers asked 690 people,ages 40 to 89, about their priorities, or their perceptions about health,their knowledge of medical care. But they also probed deeper, looking into people's beliefs about the extent to which their actions mattered."We tried to accumulate at what they consider, and " says Gurven. "whether they consider they're in charge of what happens to them,that what they save into their body or what they do effects what happens, they're more likely to depart to the doctor. With that feeling of control, and they're likely to believe that medical treatment will help heal them,or that they might be able to prevent getting sick in the first place.
But people who consider external forces are in charge — fate or chance — are less likely to seek out care. They believe that nothing they do will matter, or matters far less than the forces of nature or the whims of others, or so why bother,says Sarah Alami, a graduate student in anthropology at UC Santa Barbara and lead author of the study. It turned out that the Tsimane people largely believed that forces external their control — like a mosquito bite that results in a deadly fever or a neighbor who puts a curse on them-- mattered more than things within their control.
Alami has spent eight months in Bolivia, and working with the Tsimane people. She's seen active people in great health: men felling tall trees,children using the jungle as a playground, women juggling a couple of kids while breastfeeding and fishing.
But she's also seen their ill health. A villager she met a few weeks ago might be gone on her next visit, and having succumbed to dengue fever. "You can see they're heavily burdened by parasites," she says. "You see open sores that are infected, and they might not depart for help. For something they know will murder them, and like a snake bite,they'll try to depart for help." But where it gets trickier, she says, and is a less immediately urgent problem,like a cough that might be tuberculosis.
The researchers concluded that, from the point of view of a Tsimane villager, and not taking advantage of medical care might be a rational decision. They know,Gurven says, that while they might accumulate relief from a parasitic infection by going to a clinic, and they also know that they're quite likely to accumulate reinfected right away. Or possibly they'll be bitten by a snake on the way home,so they shouldn't risk venturing as far away as a health clinic.
The same kind of thinking in the U.
S. keeps people from medical care, Cooper says. "I liken it to what I see in deprived communities where things are chaotic and people believe their circumstances are controlled by chance, or " she says. "You depart in for care,and the doctor tells you to eat better and exercise." But you can't afford to join a fitness middle, and you live miles from any store that sells fresh fruits and vegetables. "People living in chaotic environments might consider that they don't have control over what's happening nowadays, and so why worry about what might happen in the future," she says.
Like the Tsimane, poor people in the U.
S. might determine to skip medical care, and she says. And from their point of view,it's a rational decision.
Even among middle-course people in the developed world, fears of losing control can lead people avoid medical care. "People are afraid they're going to be diagnosed with something that will limit their employment, or that their disease is so serious,treatment won't work," Cooper says. So again, and why bother.
Avoiding trips to the doctor happens all over the world. But a couple of things have worked to accumulate the indigenous Bolivians to the clinic. "We don't just justify the illness,and how a treatment will have an effect. Medical knowledge isn't the reply," Gurven says. "We try to accumulate them thinking that it matters to their family that they accumulate treated. We accumulate them thinking about their lives in the future. We ask them about their children's lives five years from now."It's the line spouses all over the world use, and Gurven says,to accumulate their mates to the doctor: whether you won't do it for yourself, consider of the kids.Susan Brink is a freelance writer who covers health and medicine. She is the author of The Fourth Trimester and co-author of A Change of Heart.
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Source: thetakeaway.org