Sunday, October 21, 2007


Nothing new to mention here, really, so I figured I'd share with my hordes of loyal readers some of the dazzling foliage I've been enjoying lately:

Sunday, October 14, 2007

Status Update

So now that I've managed to bore you with several technical posts, I figured I'd fill you in on my latest trip-prep developments.

I have officially been granted health clearance, and I've also been fully immunized against a whole host of diseases. I've been given a prescription for malaria medication--Mefloquine--that can allegedly cause vivid dreams. Mine are pretty vivid at present, so any amplification could be pretty interesting. I've also gotten my visa, and I'm buying my plane ticket this week. A bit more paperwork to follow, and I'll be good to go!

Otherwise, I've been enjoying Vermont. I'm using the 'downtime' to read--both for fun to keep up with new developments in arsenic-related research--and to relish my last days of rural solitude before moving to the most densely populated country in the world. Not a whole lot else to report, so I'll call it quits for now.

And for the sake of adding a visual element to this page, some pictures of fall in Vermont:

Thursday, October 11, 2007

The Role of Anthropology: Part II

According to recent studies, the high degree of variability of arsenicosis symptoms elicits a comparably wide variety of responses in terms of treatment-seeking (Ahmed, Adams, Chowdhury, & Bhuiya, 2003; Ahmed, Petzold, Kabir, & Tomson, 2006; Edgeworth & Collins, 2006). Many of the symptoms characteristic of initial phase arsenicosis are shared with other maladies—thus, internal inflammation caused by arsenic exposure can be confused with other gastrointestinal disorders; arsenicosis-related anemia and fatigue are attributed to other common maladies. Such ailments go untreated, or they are addressed by home-treatment (Ahmed et al., 2003).

The most visible—and readily recognizable—symptoms (keratosis, melanosis, hyperpigmentation, etc.) are manifested on the hands, feet, and trunk. As noted above, many reports have indicated that such symptoms are often believed to be caused by leprosy, thus individuals exhibiting ulcerations on hands and feet are highly stigmatized. According to surveys in affected areas, these symptoms are occasionally treated by medical specialists (Paul, 2006). However, the majority of affected individuals are unaware of arsenicosis’ life-threatening potential. Consequently, few are prompted to seek health care, allowing the disease to progress to the advanced phase.

Paul & Tinnon Brock (2006) have found that, in the instances of recognized arsenic poisoning, treatment delay is most strongly influenced by three factors: 1. A tendency of waiting to see if symptoms will go away, 2. A feeling of embarrassment (or feeling burdensome) in asking for assistance, and 3. A failure to recognize the importance of the symptoms. In addition to these, socio-economic and demographic dynamics have also served to prevent and/or promote health-seeking behavior (gender, age, occupation, years of education, availability of financial resources), but reportedly to a lesser degree (Ahmed et al., 2000).

While some investigations have begun to explore the complexities of health-seeking behavior (HSB), there remains a great deal of room for expansion. The two theoretical models of health-seeking behavior could be employed simultaneously, shedding light on both the behavioral stages leading to pro-health activity (the ‘pathways model’), and the external factors that influence an individual’s health choices (the ‘determinants model’) (MacKian, Bedri, & Lovel, 2004).

It will be of further importance to examine what types of home- and alternative-treatments are being employed against arsenicosis symptoms, particularly when they are not immediately assumed to be the symptoms of arsenic poisoning. In understanding the existing systems of ethnomedicine in Bangladesh, for instance, it will be possible to assess the role of traditional practitioners in offering care for arsenicosis symptoms. Similar studies have been conducted in other parts of the world, and there have been marked successes in treatment by local health-care workers who have been trained to offer disease-specific care, either in the stead of or in conjunction with traditional methods (Amarasiri de Silva, Wijekoon, Hornik, & Martines, 2001; Marsh, Mutemi, Muturi, Haaland, Watkins, Otieno et al., 1999).

NOTE: If you would like full bibliographic information for any of the above citations, please let me know.

Sunday, October 7, 2007

The Role of Anthropology: Part I

Various modes of education have been employed in recent efforts to raise awareness about the dangers of arsenic poisoning. Door-to-door information campaigns have been very successful in fostering behavioral change in pilot studies (Madajewicz, Pfaff, van Geen, Graziano, Hussain, Momotaj et al., 2007; Opar et al., 2006). More broad-based media operations have been shown to elicit a similar increase in popular knowledge, yet are less likely to result in community-initiated well testing (Madajewicz et al., 2007). Several investigations have shown that sensationalization of the problem elicits the most powerful responses from community members. “Drinking arsenic-contaminated water is like drinking poison” is a slogan that prompted a widespread demand for safe water in affected communities, particularly from concerned parents (Hadi, 2003). In communities where there have been limited education campaigns, however, the gravity of the situation is not widely understood, and thus change has been slower to reach these areas (Caldwell, Smith, Caldwell, & Mitra, 2005; Ushijima, Inaoka, Kadono, Murayama, Nagono, Nakamura et al., 2001).

The education of rural inhabitants is of crucial importance in curbing the spread of arsenicosis, yet a more concrete mode of information transmission must be developed in order to reach all of the individuals at risk (Rahman, Sengupta, Ahamed, Chowdhury, Lodh, Hossain et al., 2005). A theoretical framework of risk communication has previously been employed in relation to other public health crises, and is an area that could well be explored further with respect to the epidemic of arsenicosis (Driedger & Eyles, 2003). For instance, is risk better understood on the large scale (macro) in terms of statistics, or on a smaller scale (micro) that emphasizes the disease burden felt by individuals/ community groups? Studies have also examined the use of a common sense model (CSM) in risk assessment (Severtson, Baumann, & Brown, 2006). To what degree is common sense applicable in the context of rural Bangladesh?

Education initiatives enable individuals living in affected areas to list—and use—sources of safe water, and they have begun to accurately associate symptoms such as melanosis and keratosis with arsenic poisoning instead of leprosy (Caldwell et al., 2005). Despite these advances, arsenicosis is still widely believed to be a contagious condition, ultimately perpetuating the associated stigma. A study of stigma toward leprosy victims in Bangladesh indicated a lesser quality of life and a poorer mental health status in patients than in the general populous (Tsutsumi, Izutsu, Islam, Maksuda, Kato, & Wakai, 2007). According to stigma theory, being marginalized from a group causes one to feel reduced to only part of a person, or to feel discarded from the remainder of society (Major & O'Brien, 2005). A parallel study could be conducted with sufferers of arsenic poisoning, potentially shedding light on the interaction of victims within their villages and on the changing perceptions of arsenic as popular knowledge is increased.

NOTE: If you would like full bibliographic information for any of the above citations, please let me know.