Reporter Volume 25, No.6 October 7, 1993

By David Himmelgreen
Reporter Staff

In order to understand the complexities of health and illness,
physicians and researchers must appreciate that humansQwhile
biologically similarQare groups of individuals who share unique
geographic and sociocultural experiences. This uniqueness often
determines the types of illnesses that people experience and how they
perceive them.
	Understanding this heterogeneity is the concept behind
"Geographic Medicine," a new course being offered to fourth-year
medical students and advanced graduate students, by the School of
Medicine and Biomedical Sciences, the Department of Anthropology, and
the Department of Social and Preventative Medicine.
	"We want to introduce geography and anthropology into the
medical school curriculum so as to better inform students about the
geographic and ethnic determinants of human disease," said Richard
Lee, professor of pediatrics in the Department of Medicine and adjunct
professor in the Department of Anthropology.
	While courses exist in international health and transcultural
health care issues at Case Western Reserve University, Harvard, and
the University of Arizona, this is a first for UB, Lee said. 
	"The goal, in the broadest sense, is to make medical students
aware of the importance of behavior as a factor in health. Since our
medicine is strongly driven by biological models, behavior is often
given secondary importance," said A.T. Steegmann Jr., professor of
anthropology, who added that more parity is needed between biological
and behavioral causes of illness.
	And it is hoped that this could grow into something larger,
especially given the "natural alliance between the anthropology,
medicine, and health and housing" at UB, Steegmann added.
	While medical students are attuned to cultural differences in
illness, they need an "intellectual framework" to work in, in order to
better understand how different illnesses, and the perception of these
illnesses, are manifested in different cultural groups, said Donald
Pollock, assistant professor of anthropology. 
	"Geographic Medicine" also provides graduate students from
other fields, such as anthropology and social and preventive medicine,
with "clinical information that could be useful to them when working
in other societies or in minority groups in this society," Steegmann
said.
	During the one-month elective course, students are exposed to
various perspectives and frameworks by faculty from different
departments, Lee said. The curriculum includes lectures on the
cultural and environmental determinants of disease, traditional
concepts of health and healing, cultural aspects of fertility, the
biological aspects of nutrition, and ethnicity and biology.
	In addition, students participate in laboratory exercises that
focus on diverse topics such as the microscopic identification of
intestinal protozoa and helminths, and learn how to assess nutritional
status through anthropometric measures of growth and body composition.
	Students are invited to participate in discussions with
faculty, Lee said, and lively discussions often ensue, especially when
those with different professional backgrounds voice different
opinions. Still, the course has provided a great forum for clinicians
and researchers "to sit around a table for a sustained period and
understand each others' concerns and perspectives," Steegmann said. It
is also "a process for hammering out future topics for the course."
	The course also examines new diseases such as AIDS and Lyme
Disease in the context of human behavior. Lee points out that the
emergence of the latter (transmitted by deer ticks) clearly shows how
human activitiesQsuch as deforestation and greater contact between
humans and a rising deer populationQmodify the environment and
increase the risk for disease.
	Human migration patterns also change the distribution of
disease, Lee said. For example, in Buffalo, home to many different
ethnic groups, one can find "exotic" diseases such as Schistosomiasis
or liver flukes, both parasites usually found in Third World
countries. "Physicians are often naive about these diseases," Lee
said, and need some understanding about the minority groups they see
in their medical practices.
	Changes in behavior have a striking impact on the rise of ill
health. Increasing violence and the use of guns must be understood in
the context of poverty, and physicians should have some familiarity
with the causes of this violence, Lee said.
	Finally, "we can use anthropology to understand how ethnic
differences contribute to increased stress and anxiety, which in turn,
can have a negative impact on health. This is generally not taught in
medical schools."
	Although "Geographic Medicine" as been successful as a
first-time venture, there is room for improvement in planning for the
future, Lee said.
	"Hopefully, we can organize the course around a cross-cultural
experience where students will be able to spend some time in a Third
World community," Pollock said, "and experience what it's like to do
medicine under very different circumstances."
	Other possibilities include having students work with U.S.
minority groups in urban clinics and rural settings, areas that are
generally underserved, Steegmann added.