In her guest lecture, Professor Patterson made reference to poet and eco-activist, Gary Snyder, who says that you can “choose to live in a place as a sort of visitor, or try to become an inhabitant.” Comment on the relevance/application of this idea to the practice of medicine and public health.
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In a “place,” people always socially construct their own understanding of health and disease, which presents an additional complicating layer in the practice of medicine and public health. The first example that comes to mind is Dr. Scully’s lecture about the religious and cultural construction of rape during the Vietnamese immigration movement. In that particular place—country and moment of time, rape was understood as an ancestral punishment by karma and a sacrifice for the ultimate good of the family. Though encouraged by their community to suppress their emotional trauma, the victims found themselves displaced in the United States, where society approaches rape differently. Western healthcare providers can struggle with these contradictory understandings of health that come from different places. In terms of visitor/inhabitant, the victims are confronted by two polar worlds and may not exactly know how to go about identifying themselves. This is a clear example of a socially constructed understanding of health between two different places.
In the process of socially constructing communities, places adopt unique characteristics that often become categorical identifiers. The example that Dr. Patterson used in class was the “Appalachian” community as “hillbillies.” A region identifier, mountainous regions tend to have poor nutrition due to lack of fertile ground for agriculture. The impression of lack of education may also unfold. In the practice of public health, the challenge goes to researching how geography plays a role in community health but maybe even delving into the health psychology of the inhabitant. What also is interesting place is how the inhabitants perceive themselves and how they think outsiders maybe perceive them. I enjoy the comment of a physician/public health expert as an eye from an outward place looking inward. An important lesson in medicine, a doctor’s perception can significantly determine how he or she goes about treating a patient.
People inhabit and visit places, and therefore, place is integral in the study of the humanities. When healthcare providers strive to humanize health, they must take to account place.
In order to become an inhabitant of a place one must understand the cultural significance of medical practices and appreciate the people’s explanatory model for different diseases and ailments. In this sense a physician cannot provide effective treatment if he remains merely a visitor in a setting. The word visitor implies outsider status and paints the picture of a person with traditions and customs contradictory to those of the natives. In regards to medicine these differences could prove fatal as the collaboration and partnership between the patient and the provider is an important part of treatment. It is thus crucial that the two parties are able to communicate. In order for effective treatment to be implemented each must support the viewpoint of the other and integrate their differences to establish a form of effective care.
One point that was brought up in this week’s lecture was the idea of place as property. Ownership of place changes perspective in regards to the best way to use it; mankind is more conscious of the consequences of his actions when his own environment is at risk. A person in a place as an inhabitant will show more concern towards the wellbeing of the place than will someone who is simply a visitor as they have poured part of their soul into their environment and hence become a stakeholder in its proper treatment. In her lecture Professor Patterson brought up the relationship between landscape and disease. Different cultures believe that healing can be provided by fresh air –for example the literal translation of malaria is “bad air” and the suggested remedy is to escape to nature and surround oneself with good air to treat the ailment. If a physician who operated as a visitor came to one of these villages and attempted to treat those afflicted with malaria by means of traditional western medical practices he would likely be met with opposition. His treatments would not be complimentary for the people’s explanatory model of the disease and would therefore not be as effective as it would cast the physician in a domineering role as opposed to a cooperative one.
It is only by becoming an inhabitant that one can adapt the member’s meaning and apply them in a health care setting. The concept of visiting a place versus inhabiting a place directly relates to how well an individual is able assimilate to the various traditions and customs of the group. In regards to medicine it is not uncommon for inhabiting to involve forgoing traditional practices in favor of those that match up with a group’s cultural framework. As Dr. Scully mentioned in her talk on culture and gender it is important to recognize that culture is not static and American practices involving mental health are fundamentally “other” to the rest of the world.
In the western world the practice of counseling someone through psychological trauma is often an effective practice due to the American explanatory model of mental illness. However it is by no means a universal solution and cannot be effectively integrated across cultures with fundamentally different belief systems. Attempting to blindly export this protocol to other cultures would cast a physician in the role of a visitor as by acting in such a way he fails to address the spiritual and emotional pillars of health and will thereby ultimately be unable to guide the patient towards holistic health. We cannot demand of individuals that they feel a particular way simply because it fits into the western framework. In order to implement effective treatment in a foreign culture it is imperative that a physician assumes the role of inhabitant as being a visitor won’t allow for comprehensive care.
Places change. People, places, medicine, and culture are ever-changing. To understand this concept is to understand that healthcare provision is best served by a community’s inhabitants. It is naïve to think that one can come into a community and immediately provide healthcare services based on that community’s values. This is true, not only across countries, but from city to city. Different areas have different demographics and, thus, will have different illnesses, insurance coverage, diet, lifestyle, and exposures. For instance, as Dr. Scully mentioned in her lecture on Tuesday, the Appalachian region is a coal mining region and many doctor visits are mining related. Likewise, a healthcare provider moving to Naples, Italy may not realize that much of the illness and deformity found in the surrounding area are a result of pollution from German waste. My town has the highest unemployment rate in Virginia which has a tangible impact on the type and quality of healthcare people can afford. A doctor should be aware of socioeconomic and cultural factors that will influence how they prescribe treatments. One must inhabit an area before they can truly understand how to provide health care services for the community.
As I previously stated, places change. Atlanta is a very different place today than it was 50 years ago or even ten years ago. The same can be said for Atlanta’s healthcare system. Grady is a prime example of this. Grady Hospital was built for segregated patients (thus the “H” shape). This design became a significant challenge for Grady as they were faced with the need to expand and restructure their units. Grady also lost millions of dollars in government assistance when Georgia became one of twelve states to reject the Affordable Care Act. Their emergency room care has greatly suffered as a result. Georgia’s resistance to the AFA has also had an impact on insurance coverage in Georgia which impacts the types of healthcare patients can afford. If a doctor moved to Atlanta and began providing care without this knowledge, they might be frustrated by the apparent limitations in care. However, if they became an inhabitant, this resentment and lack of understanding might turn into admiration of the resilience of the Grady community and a keen understanding of what is needed to improve the system. One must be an inhabitant before they can truly understand and serve an area – especially in relation to medicine and public health.
(I accidentally posted before I finished)
In terms of public health and medicine, an inhabitant will provide care with compassion and a keen understanding of the community – of each persons cultural and religious values along with a knowledge of diet and lifestyle factors. This knowledge and understanding enables them to provide the care best-suited for each individual whereas a visitor can only offer care based on their own cultural background and shaped perceptions of the community in which they are working.
One thing I would like to consider is the location of care services. Many communities practice health in the home. Doctors travel to the patients home and see the family as a unit when providing healthcare services. Many therapists offer care in a welcoming, “homey” office to make patients feel comfortable. What does it say about our mode of healthcare that the patient/healthcare provider interaction takes place in a small room with white walls? Can either the patient or the provider ever truly inhabit the doctor’s office? Should they? If no one inhabits the place in which healthcare is provided, how can it be effective?
Despite the feeling of awe a visitor may have when experiencing a new place, they may still be a visitor at the end of the day because that new place is not “theirs”. As we touched on a bit in our discussion on Thursday, there is a great deal of significance in believing you have some sort of stake in a place or person. While you may not own the place or person, something about it/them makes it/them feel like “yours”. As a visitor, one usually does not have that strong sense of responsibility and care for the new place; you’re usually just exploring. However, as an inhabitant, that place has meaning to you and that personal significance creates a sense of responsibility.
Growing up in Orlando, Florida, a place that sees many visitors, I knew what it meant to have visitors in the place I inhabit on a daily basis. While it was nice to meet people from different countries on a frequent basis, there were many cons that came along with having a mass of people viewing your home as just a place to explore. They were usually minor setbacks, such as people from Orlando knowing exactly when to avoid International Drive because we knew traffic would be backed up with lost tourists or it would have the occasional person driving on the wrong side of the road. However, sometimes it felt like a major attack on my place, such as extensive littering or news of tourists disturbing the peace. At the end of the day, people come to Orlando and then go back to the place they inhabit; the place they call home; the place they actually have a stake in. After they leave, the inhabitants of Orlando are left to deal with the aftermath; especially during a time such as Spring Break.
Although I gave examples that seem far away from the topic of medicine and health, this concept applies. Considering the body as a place, the thought of a physician having ownership over a person is off-putting and may be the cause of many tensions between the patient and the physician. However, if the physician has a stake in that patient’s well-being, similar to the stake we have in the places we inhabit, this can change the dynamic between the patient and physician. This would emphasize the physician does not “own” their patient’s place, but the patient is also not completely othered because the physician recognizes they own a similar place. This recognition of similarities may result in a greater sense of responsibility and care because the healthcare provider would expect certain level of attention to their similar place. This would not only include the best physical care, but also respect for personal wishes, the recognition of religious and social expectations, and the place being as preserved as possible.
Dr. Scully mentioned this with the treatment of women who have experienced cases of sexual assault. To expect someone to react in a certain way can suggest trying to control how someone manages their own territory or place. As Dr. Patterson mentioned on Tuesday, place is a socially constructed and, therefore, its definition is always changing. However, I believe it is possible to argue that there is a personal construction that comes along with it. As with the victims of sexual assault, they have their own, personal definition of their current place that may not be the same as another women’s definition of what their place should or shouldn’t look like. This is a dangerous position to fall into and one that physicians and healthcare providers must be aware of. By not treating the patient’s place as an “other” place to visit, one still should not act as if they are colonizing that other person’s place. A physician, healthcare provider, or anyone coming to a new place, can be in a middle ground where they may be a visitor, but treating that place with the respect of an inhabitant. Such an approach was successfully implemented in the Quave reading with the scientists working together with the inhabitants of the land. They recognized they were visitors and they did not ignore the fact that the land was the home to someone. Therefore, in their typical explorative nature as a visitor in a new land, they consulted with those who were already there to best preserve and respect that habitat.
Looking back at the art piece by Emerson, there may be a slight downside to this wide-eyed display in terms of medicine and health. It is a beautiful thing that we can travel, see, and explore a new place. However, what suggests the attempt to become an inhabitant or have a stake in that place? The quote from Dr. Patterson’s lecture states “you can choose to live in a place as a sort of visitor, or try to become an inhabitant”. The key to this quote and its application is to “try” to become an inhabitant. In many cases, we can observe and try to soak in everything about a place, but what does that mean if all we do is look? That may be a great approach to nature alone, but I am not too sure about this approach to medicine and health. I would even suggest a better image in relation to the health field would be to have that giant observing eye protruding from the chest of the individual. This would not only suggest putting a great deal of oneself into looking at the new environment, but the emotional stake and investment one would have in trying to become an inhabitant.
The image of the traveling eyeball, as a metaphor that is Ralph Waldo Emerson, really strikes at various prompts and topics we’ve had this semester. In addition, through various topics, we have explored components of the self, the world around us and how the world of healthcare, in conjugation with the humanities, helps us really see, change the status quo and be at the forefront of the human experience by allowing people to have a story. Thus, it is why I appreciate and honor storytelling in medicine and health. The human story is a powerful tool that reflects the life of an individual that is a part of the world around us, living, breathing and thriving. It’s easier said than done not to rob someone of who they are or their story, but we can learn so much from the right choice of words collected in profound, delicate thoughts spoken to the world. I’d like to believe that medical professionals see how challenging, but rewarding medicine is because it is scientific, but at the same time, human in that we are connected by places, identities and realities. Therefore, how we see evidence or the world around pervades our actions, thoughts, feelings, ethics and religious values – our eyes can act as ways for us to see the world we choose, the world we may not be looking at properly and by looking around us a bit better and in a more knowledgeable fashion. However, depending on how we see, we can focus on particular details or the big picture. And place is a concept that is affected by this chosen view and our own stories coming together. When we inhabit a place, we are a part of that place and have a particular knowledge or tie to that place. When we visit a place, we can still be aware of these views, this knowledge and be more of a listener to see who we are and how we are in a particular place. However, whether an inhabitant or a visitor, there are complexity to how we see place, how we develop the concept of a particular place and how that affects the internal and outer world of who we are.
I think ideally, place should be understood in its all boundaries. It’s kind of like how when we live in a particular home or dorm for some time, we should know every nook and cranny of our place – this can also apply to our hometowns, our communities and our schools. Knowing a place means knowing the culture, the languages, the customs, the people, the local eateries, the places to go for fun, the sociocultural history – lots of things that go into a place – however, this is the ideal, not always the reality. We may not know everything immediately or truly be able to do so because of lack of access or knowledge – we may find out that there is a hidden door in our dorm or a certain history that explains graffiti on a wall, but we can think, act, and learn in order to get a better view of the realities in front of us and the people around us. Visiting a place isn’t a bad thing per say because it opens our eyes to a different world from us and teaches us about the diversity that is human life, but when we never truly inhabit a place, we miss things. We may not know a place and may rob a certain place of what it could ideally be because of our own assumptions and lack of understanding of the parts of a place and the people of that place. We also may not be as open-minded or as curious as we thought because of our lack of awareness or inability to see. I think Dr. Wolpe did a good job illustrating this in the doctor-patient model on an individual level – when a doctor interacts with a patient, the physician is bringing his knowledge, history, background and a story with him as is the patient to the doctor – they are coming to a place to talk from where they are “placed” in society, their homes and their lives. Although doctors do want to provide the best care possible, sometimes this care is limited or not fully exhaustive of what the person truly needs because of a lack of understanding of different components of a place – this immediately brings up Week Two’s Prompt on Health Literary and Week Six’s Prompt on Culture and Gender. If medicine works and continues to do so with public health and the humanities, it can provide the tools and the vantage points to try to meet eye to eye with someone since both the sciences and the humanities should and can work together to really uncover who someone is and what they truly need. Without it, someone can be misplaced, particularly in the context of health literary or in the case the Vietnamese women who were raped and hurt.
So, how do we tangle with place? I think, like exploring the nooks and crannies of our houses, I think it’s important to be aware of who we are, our places in life, and try to have a view that is respectful of our place and someone else’s place. On an individual level, this may mean being aware of our privilege – if we are not aware, someone’s current space as we talk in a place is invalidated. In a group or an institution, exploring and recognizing the diversity in lifestyles is good. It is important try to pay attention to ethnobotany, languages, customs and social norms to be more aware. For example, we may travel and never really know a particular dialect or language, but we can listen and be compassionate to understand someone who does know. And, we can then bring that knowledge back with us to understand ourselves better and know just a bit more. In the context of healthcare and medicine, by being more aware of current issues in economics, racial disparities, health literary, gender and sexuality studies, bioethics and other topics that are tied to common conversations that have been going on for centuries, we can really know people and the places we both inhabit and visit. Like Emerson, we can have wider, open eyes. And if we can do that, maybe the room where we meet a doctor or a healthcare professional can be a meeting of two people from different places trying to meet a universal truth or aid a particular problem to find an answer or at least, a next step. Even if we can’t know everything, we can at least try to know a lot of things, including places.
Place, in every sense of the word, greatly impacts the practice of medicine and public health. As Dr. Patterson mentioned in her lecture, place has three main meanings. Places can be created through description, and are therefore fluid in their meaning. Place can be thought of as the human body; we place ourselves in a geography of life. Place can also be defined in terms of power, as in who owns the place. All of these definitions can be summarized with the idea that place is culturally constructed. As Gary Snyder’s quote indicates, there is a tangible difference between being a visitor and an inhabitant in a place. How we perceive our surroundings in a place is impacted by the practices, behaviors, geography, and ideas of that culture.
Dr. Patterson’s idea that “all that matter, matters” couldn’t be more accurate. A prime example of how the matter in a place matters is illustrated with the issue of food insecurity. Many organizations and public health programs try to combat the widespread issue of food insecurity by providing any types of foods that are available. While their intentions are good, these programs are not always successful since they fail to take into consideration the effect of place and culture on food. If a program attempts to feed people in an area with foods that are unfamiliar to that culture, then it will be difficult for the program to succeed. To aid in ending food insecurity, the term “food sovereignty” should be used instead of “food security” since food sovereignty is the idea of providing culturally appropriate foods to everyone.
Another way in which place plays into the practice of public health is seen more directly with the doctor patient interaction. As Kayleigh mentioned in her post, many therapists embrace the practice of homecare. Patients tend to be more comfortable in their own homes as compared to a doctor’s office with white walls. In the comfort of their own homes patients feel “in their place”, whereas in the doctor’s office they are more likely to feel “out of place”. For more complete and effective health care, public health practitioners must consider the importance of educating themselves to be culturally competent in delivering medicine.
Gary Snyder states that one can “choose to live in a place as a sort of visitor, or try to become an inhabitant.” I must emphasize the idea of choice in the aforementioned statement, because society constructs place. Therefore, an individual can decide whether or not he or she wants to adopt the culture of a place to become an inhabitant.
As previously discussed in this course, culture influences medicine and public health. Thus, becoming an inhabitant of a place will benefit an individual in the context of both fields. For example, a public health official who assimilates into a culture will implement a project more easily than a “visitor” of a community. I experienced this scenario when living in Nicaragua. For instance, I participated in the town’s rituals, such as attending church, playing soccer, and cooking and conversing with the families. As a result, the community accepted me as a resident of Nancimi rather than just a foreign aid worker, which enabled me to gain the trust of the community members to implement my project.
Furthermore, trust shapes in the success of patient-physician relationship as well. For example, as Lauren articulated in lecture, one can classify the body as a sense of “place”. Therefore, physicians should not break the trust with the patient by intruding in the sacred place without permission or consent. Moreover, the patient-physician relationship relies on the idea of perception. Emerson’s photo with the one-eyed person illustrates the role of perception of the “outsider” on place. For instance, the physician must perceive the signs and symptoms of a patient’s place to determine the health of the individual. In addition, if the physician does not perceive a symptom that the patient may express, then distrust could arise as well.
Moreover, the word “inhabitant” possesses a connotation of investment. Thus, an inhabitant of the medical field, an invested physician, and an inhabitant of public health, an invested community worker, will have greater success in their respective fields because of their commitment to cases on a case-by-case basis.
In a religion class that I took with Dr. Patterson, we discussed the idea of sacred spaces and places. These places transform based on whether someone is an insider, an inhabitant, or an outsider, a sort of visitor. We learned in Dr. Quave’s lecture on ethnobotany that the environment holds botanical secrets, which can be of benefit for public health and medicine. When outsiders enter an environment, it would be hard to explain all that the land can offer because this aspect is truly valued by the insiders, the inhabitants. While outsiders may understand the medicinal benefits and necessity to keep the environment safe and habitable, they are not able to view the sui generis, the unique and indescribable meanings, of what their place is, means, and echoes.
Anthropologists always struggle to balance their role in being a participant and being an observer. Dr. Quave conducts research in Ginestra, Italy. As she speaks to locals about their plant knowledge, she also enters their private, insider, spheres. However, she is also conducting these interviews and meetings as an observer, an outsider, to remain objective in her findings. In public health and medicine, it is the practitioner’s or professional’s job to try to understand the insider perspective (through storytelling and narrative), but also remain an outsider to make objective and informed decisions.
I have also studied how spaces and places can be constructed and deconstructed through perception and function. For example, when a patient enters into a territory dominated by the doctor (a doctor’s office), boundaries are questioned. To what extent can the patient share his or her story, and assert his or her right? To what extent can the doctor make decisions on a patient? By going to the doctor’s office, it’s important to note that the space in which the patient remains, is designed to be neutral. It is usually not the space that the doctor considers his or her own – it is a patient room. I this room, the patient enters first, waits for the doctor, and the doctor comes to visit.
Being an inhabitant or visitor of a space affects the interactions that occur between patients and medical professionals. For this reason, it is important to find a balance – easier said than done. There are fine boundaries between both, but taking some of these ideas into consideration creates awareness about the significance of storytelling and listening.
I believe the Visitor versus inhabitant model is very relevant to human health and medicine. Firstly because inhabitants tend to treat places differently than visitors, as in the reading when the affluent would travel out of metropolitan areas in order to find more pure and natural areas that were thought to promote health. These places were given sacred value due to their “medicinal” value and preserving nature was more of an economic and medicinal motive, and as people switched more towards inhabiting places these precious resources lose their sanctity and begin to be exploited.
This also reminded me of Dr. Quave’s lecture, where she as a visitor was more interested in obtaining local knowledge of medicinal plants for medical research while the villages’ inhabitants had a vested interest in these both culturally and survival important plants. This duality of beings leads to differential uses of these plants for entirely different populations, and in a globalized world it is highly likely the sacred/cultural value of traditional medicinal plants will be lost for the purposed of medical research and public health work
And in the practice of public health this is also an important issue, as often many communities are distrusting of “foreign” officials coming into their home and telling them that what they are doing and that their lifestyle is wrong. We constantly see public health initiatives fail because this model is flawed, as making people feel bad about how they live their life does not promote healthier lifestyles. Rather their is a movement to use community based programs where inhabitants of the community are used to promote health and encourage community members to abide by the health program, as inhabitants are more trusted and are more likely to go about their business in a more socially conscious (to the particular community) way than an outsider might.
And at the end of our class we briefly spoke of how this applies to the institution of medicine. And how the doctor is often the inhabitant with the patient being the outsider/visitor, harkening back the unique power structure of the doctor-patient relationship. We see hospitals and doctors’ offices as these sacred places of healing and often that patients should see their doctors as these godlike people. It is often this dynamic that allows doctors to domineer their patients and control the situation rather than facilitating an open dialog or a more whole treatment plan. It is this patient (Visitor)- doctor (Inhabitant) duality that brings back the complexity of Dr. Wolpe’s Clinician-Patient encounter, a problem that desperately needs to be solved if we hope to provide more effective medical care to our patients.
As mentioned already I think of Dr. Patterson’s reference to “bad air” in malaria cases. This represents a paradigm shift from a “normal” doctor’s visit in which a patient is assumed to be the visitor and the doctor the inhabitant. When in reality it should be how it was in the malaria case where the doctor becomes the visitor. I cannot think of an instance where a patient is a visitor. A doctor is visiting a patients habitat whether it be their actual habitat, or the spiritual journey that occurs with the illness they have. Dr. Patterson’s piece on perception resonated with me as well, as she stated that one must be generous with themselves when traveling. In the malaria case the doctor must realize they are entering into literal foreign ground and it is not their domain. I believe this should apply to all health encounters.
I am pretty sure I mentioned this before but in another health class I took on health among South Asians we discussed how to really connect with certain religious groups one must appeal to the pathos of family. This is important for peoples from/in South Asia as many times Global Northerners lack the wherewithal to actually try to connect with Global Southern groups of people.
Another important topic Dr. Patterson brought up was how places change. One notion we have of a place may no longer exist and we must account for that. We must believe that the people in certain places have the capacity to change for the better.
Dr. Patterson’s reference to Gary Snyder’s quotation highlights a number of key issues and values in the practice of medicine and public health. As several of my peers have already mentioned, attention to place establishes the difference between mediocre practice and good practice of one’s medical or public health skills. Without a thorough understanding of the overarching socioeconomic, political, and cultural factors of a patient’s environment, a healthcare professional is unable to become the “inhabitant” that Gary Snyder subtly draws distinction to.
The article by Gregg Mitman for our unit on place also supports the substandard connotation a “visitor” holds: “dangers…arise when environmental historians fail to consider scientific knowledge as a product of time and place” (198). The connotation is that the visitor is not as dedicated to knowledge and awareness of the location as the inhabitant, and the dangers that Mitman mentions are not solely limited to environmental historians as my classmates have pointed out with various examples on what happens when there is a lack of attention given to place. Attention to place offers insight into a patient’s life when they are seeking help during a particularly vulnerable point in their lives. The visitor approach is much more impersonal than the inhabitant approach because the medical profession lacks the involvement to have the depth of awareness of their patient’s circumstances.
To add something a little different to the discussion, I wanted to bring up the conversation we had in class during our Engaging Ethics unit about physician motivations for choosing more lucrative specialties such as plastic surgery rather than primary care. If one were to treat medicine as the “place” in this discussion, I would argue that some professionals enter the field as visitors with no intention to become an inhabitant. For example, some professionals enter the medical field solely for the monetary benefits while others are involved and dedicated due to their own intrinsic motivations. Because of this focus on monetary gain, these healthcare providers are not going to be tuned in on the more human aspects of their profession, which includes a knowledge of a patient’s place. In my mind, this knowledge of place as an inhabitant adds another dimension to the skills in empathy and interpersonal skills a healthcare professional needs in fields such as medicine and public health, which are devoted to human wellness. Thus, those who are already in or are eventually aiming to become a public health or medical professional should, as Gary Snyder says, “try to become an inhabitant.”
As it was brought up in class, “place” is beyond the physical location of an enclosed or open area. It can be a metaphysical or abstract idea and the interpretation can be limitless. One example to define a “place” is what Lauren brought up discussion was how an individual can view their body as their place and whatever happens to it can affect their view of the body. When Dr. Scully talked about rape and culture for the Vietnamese refugees, their place and space was violated. This affected how they interacted with others in the community, including the healthcare officials who tired to help them. Even the therapists had to find a way to get permission to enter the raped individuals place in an attempt to help them. In this example the therapist is only allowed as a visitor because the patient has the power to allow or deny access to their physical body and their subconscious, a place many believe the soul to reside.
Another interpretation of place medicine and public heath officials can have usually occurs in the communities they work in. When we discussed ethnobotany and how it combines science, culture, and religion for people and their native plants, I found a similar connection with people and how they view their local communities. For many of the lower socioeconomic regions of many large cities, it can sometime be seen as an invasion when outsiders try to come in and “fix” their area or health issues. Unfortunately there have been times they were ostracized by those with the funds to get access to things they lack, like a good shelter and healthy food options and medical care, so they become more susceptible to illnesses. Unfortunately outsiders try to pair the illness with the race and social status with that environment. But others don’t correlate and cause the two. I believe for healthcare providers, it would be better for trust to develop and to strengthen the patient/ provider relationship by trying to become an inhabitant of the area they wish to improve, rather than viewing as a visitor. It show more meaning and passion, rather than viewing the community as an external community.
When thinking about being an inhabitant or a visitor of a place I first think about duration. While you can think of duration in the literal sense of exactly how long you’ve been in a place, you can also think about duration in terms of how long your presence will effect the place or how your actions will effect a place after you depart from the place. In the literal sense, being an inhabitant of a place requires a longer stay than does simply being labeled a visitor. This can also be looked at from two perspectives, as we mentioned in class. You can think of yourself as a visitor or inhabitant or others can think of you as a visitor or inhabitant. It depends on what perspective you are coming from. I suppose it is possible for your perspective and others’ perspectives to differ when considering your status as either an inhabitant or visitor in a given place.
It is necessary to take into consideration your status as a visitor or an inhabitant when dealing with medicine and public health. It is easy to be a visitor. It can be difficult to become an inhabitant. To become an inhabitant, one must take into consideration all of the cultural dynamics at play as well as the place’s ecosystem, people, ideals or beliefs, and current situation. When people in the public health field go to a different place – often a country or area in need – they need to think about the situation of that place. It would be inconsiderate and potentially unhelpful for them to go to the place blinded to the needs of the inhabitants of the place. They need to stop, put aside their previous assumptions of what the people need (according to the public health visitors), and look through the eyes of the people living there. This requires talking with the people, getting to know them, and working with them to understand where they are coming from. Only then can a public health intervention be successful, and only then can the public health “visitors” become true inhabitants of the place.
In medicine, we can find a similar situation. As we have previously discussed, the physician-patient relationship runs smoothly when there is communication flowing between both parties. The patient is in a way a visitor to the physician’s place, but the physician needs to take that into consideration when seeing his or her patient. So, there is essentially a power balance that needs to be made in order to effectively communicate and have the best outcome for the patient. This includes the physician inquiring about the patient’s “place” and their body’s “place.” Again, only when there is communication on a level where both parties are able to be heard will we have an effective medical system.
I agree with what my classmates have said which is that places are different. Not even two communities within the same city have the same issues. Last semester in my philosophy class we looked at a post that compared statistically similar communities in the United States with other communities around the world. When we discussed this article in class, we concluded that it was unfair to compare the United States, a developed country with developing countries especially since there was great differences for what caused the economic issues (e.i culture, traditions, politics). Some of the comparisons it made were immigration in L.A with immigration in China, and healthcare in Washington D.C with healthcare in Moscow. While these communities might have similar numbers and statistics, it doesn’t mean that the way to address these issues should be the same.
With this I would like to into the comment that Professor Patterson made about being either a visitor or an inhabitant of a place. One way that a person can be a visitor of a place is by looking simply at statistics and book findings about a place and then feeling like they know the place without actually interacting with the people or the environment. The way to become an inhabitant, is by interacting with the environment and the community. In healthcare and medicine it is very important to become an inhabitant of a place before actually trying to aid the community. Many times health care programs are implemented in communities without first interacting and the community doesn’t accept it because it goes against a tradition or belief that they have. Therefore it ideal for a health care providers to go to communities and become inhabitants of the place so they can understand the community and then be able to help them.
In his essay, “The Porous World” Snyder writes: “One can choose to live in a place as a sort of visitor, or try to become an inhabitant.” I think this phrase to me says a lot about how we can choose to experience our ecology. Ecology is ultimately about the relationships of organisms to one another and to their surroundings. Whether we decide to make relationships deep or shallow is up to us. Space is malleable. Space is perceived and at the same time constructed; it varies with the individual and the cultural group. I believe that we determine how important place is and we perhaps inadvertently invent the cues that determine our behavior. In this sense, I think we are creators of place out of mere space. I also want to mention that I find the word ‘try’ in Snyder’s sentence to be interesting. Trying to become an inhabitant can be easily understood as something requiring much more effort than living as a visitor.
I think in the practice of medicine and public health, the concept of place is uniquely relevant. I share Akanksha’s thought on how certain doctors choose to see their profession as a job/career rather than a vocation. Amy’s comment on trust contingent on a certain amount of inhabitation, or investment into a space in order for meaning to be present is also something I can agree with. Dr. Quave did mention that the study of ethnobotany works best when scientists invest in communities, work together, and give credit for knowledge, rather than show interest in their plants and plans for commercialization.
On a different note, I think what interests me most is the concept of body as place. If the body can be likened to a place, are we visitors or inhabitants in our own bodies? Is our body just taking up space here, or is it our place? It’s additionally fascinating to me how the body can be both secular and sacred at the same time. Some people take seriously the religious notion that the body is a temple and that humans were made in the image of God, while others do not. The body, therefore, although tangible, is at the same time fluid and the perceptions regarding it are flexible. I find a connection to Dr. Scully’s lecture on culture and gender to this topic, too, especially given the case study of the Vietnamese refugee community. Although at first virginity was valued, once dangerous ocean migration happened and the threat of rape became real, that original value of virginity/purity was compromised for the “greater” purpose of survival. Furthermore, the community’s narrative around it changed to blame the victims, allude to the power of karma and Buddhism – which ended up ostracizing the women who had sacrificed their bodies and psychologies in a very real way for the good of their community. I can argue in unison with my classmates that because place is culturally influenced, our perception of our body can be culturally influenced as well. Increasingly, at least in Western culture today, it seems as if, because of the way we relate to the body (shaming it, starving it, etc.), we are perhaps more visitors rather than inhabitants. We do not honor our bodies and have moved away from certain practices that connect them to the earth and the environment around us. Especially women, I think, have been socialized to compromise their femininity for the demands of contemporary society.
In the end, I think what I mean to conclude with is pretty simple. Understanding place and the connections of every other factor to it, may help us understand our body. Understanding how a patient views his or her own ecology of place (in the family, in society, the architecture of his life) as well as his or her own body, through the stories he or she tells, may provide context for the identity of the patient and his or her culture, that is more substantial than seeing a patient as a disease or another statistic. Being aware of this context may lead to important adjustments in approaches to care and effective preventive measures.