Keywords: medical anthropology, Association of Medical Anthropologists, Rossotrudnichestvo, turn to the East
Abstract. Medical anthropology is a relatively new science that has been developing in the last hundred years or so (taking into account the formation of a special section of physical/biological medical anthropology). Its emergence and formation took place in various forms in Western countries, where it subsequently gained recognition, and in Russia. Due to the post-Soviet features of the transformation of healthcare, as well as the collisions of the 1990s (political, economic, cultural, religious, national, linguistic, etc.), medical anthropology has found itself in a very specific place in Russian reality. In particular, the greatest demand for its development was formed by the public and by concerned scientific circles, while the official health care and state-administrative apparatus had little interest in it (a situation similar to that which existed in other countries of the world). The issue of official recognition of medical anthropology as a scientific discipline and professional specialty in the country has not yet been resolved. Currently, medical anthropologists in Russia are concentrated in their professional affiliation in the Association of Medical Anthropologists (AMA); this movement can receive further impetus for development in cooperation with interested state structures.
The greatest potential for mutual ties and mutually beneficial cooperation is the possibility of building interaction between Rossotrudnichestvo and AMA. Its development will help to activate the role of the agency and Russia as a whole in the international arena within the framework of building global healthcare systems; to find new areas and prospects in joint work with compatriots and to strengthen the popularity of Russian medicine abroad. At the same time, it will allow medical anthropology itself to collect unique scientific information and improve this most important, fairly new area for Russia, as well as an auxiliary profession that should be included in the healthcare system.
Introduction
Medical anthropology as an interdisciplinary scientific field covers the study of health and health-preservation issues in broad socio-cultural and biocultural contexts, various historical and cultural forms of human experience related to the response to the threat of disease, numerous systems of healing that existed in the past and present, and other issues. It originated in Europe more than a hundred years ago. Viktor von Weizsäcker, a German physician and physiologist, first introduced the term “medical anthropology” into circulation in 1927. On the one hand, he was a supporter of the ideas of National Socialism in Germany, and in the clinic he headed, research was conducted in 1941-1945, including attempts to prove the theory of “racial purity”, which could have influenced the perception of his ideas in Soviet healthcare. On the other hand, Soviet medicine sought to unify treatment, preventive and rehabilitation approaches on a scientific basis, gradually moving away from folk methods, which were quite actively being studied by ethnologists. In fact, medical and anthropological problems remained mostly under the jurisdiction of medicine and were developed mainly within the framework of the development of normal anatomy. Scientists working in the mainstream of “physical anthropology” joined the study of these problems somewhat later.
The development of medical anthropology proper in its modern interpretation began in the 1960s in the United States, when some medical faculties began to try to create training courses for future doctors on the diversity of medical systems and approaches to treatment. This was a consequence of anti-racist tendencies, the expansion of medical services, foreign military conflicts, the problem of migration, and the organization of state programs called Medicare and Medicaid.
In the 1970s, the first program for teaching medical anthropology was created. Europe, faced with unprecedented migration pressure, entered the process of establishing and developing science. Large migration waves sharply raised the issue of “mutual understanding” of different mentalities and cultures. It was not possible to find common ground and mutual understanding within the framework of medical and preventive work exclusively by doctors and nurses. Health care systems adapted to the cultural and mental characteristics of migrants from different countries by developing medical anthropology and applied ethnocultural mediation. These and related disciplines are very actively promoted at the domestic and international levels.
In the framework of theoretical research throughout the 20th century, studies were conducted on the health care systems, treatment, etc. of various nations, which could then be applied in practice or remain exclusively academic findings. After overcoming colonial dependence in the second half of the 20th century, governments and individual scientific institutes of new countries attempted to organize their own national medical systems, which included scientifically proven approaches to medical sciences other than the European one, some of which were included in the health care system, and some continued to exist independently of it. This was also due to economic reasons: in contrast to “expensive European treatment”, local developments were much more accessible to the population, providing minimal health maintenance with access to European methods in the event of a significant issue.
The peculiarities of Russia were the mass access to medical care formed in the USSR and the “open door effect”, when accumulated knowledge and views on medicine from European to Eastern quickly flowed into the country, which was combined with a deficit in hospital funding in the 90s. Like many other things, the formation of a demand for “more human-oriented medicine” and the humanitarization of scientific medical knowledge came “from below” from the environment of patients, and then doctors, researchers and scientists, with little impact on the governing bodies. In 2013, the Association of Medical Anthropologists was founded, which took on the development of relevant problems and requests, while simultaneously trying to solve them within the scientific and legislative field of Russia.
Currently, medical anthropology has not received its due place in the Russian healthcare system. Despite the existence of the Association, the specialty “medical anthropology” is not official. The official lack of recognition and funding also leads to limitations in the possibilities of conducting research and scientific activities, interaction with official state medicine. Meanwhile, as ethnology and anthropology in general, medical anthropology could have a significant positive impact on the development of the healthcare system in Russia at a new level and its interaction with medicine in other countries.
As part of the turn to the East and strengthening of the partnership of the Russian Federation with the countries of Africa, Asia and South America, the healthcare systems of the corresponding countries will sooner or later find themselves interacting in all their diversity with the state-owned Russian healthcare system. This is certainly facilitated by the formation of relevant platforms in such organizations as BRICS, SCO, EAEU with the intersection of various interests, including in medicine, which, in the context of an ambiguous understanding and attitude to the situation, will certainly raise many questions, which medical anthropology is called upon to answer.
According to the position stated above, the role of the AMA may be as follows:
- Study of health care systems of the Global South countries, their features, official and unofficial medical systems. Collection and systematization of knowledge.
- Training of Russian medical specialists to work in appropriate conditions, as well as training of foreign medical students.
- Search for ways to bring together the medical systems of Russia and the countries of the Global South to exchange practical and theoretical experience and work together to improve the quality of human life and increase the level of health.
Official recognition of the scientific status and rights of medical anthropology is an extremely necessary political and bureaucratic decision. However, until it is made, medical anthropology needs to interact with other structures of the Russian administrative system that have access to partners abroad.
The most promising option today is such a structure of the Russian Foreign Ministry as Rossotrudnichestvo, since Rossotrudnichestvo is the leading Russian agency whose main mission is to strengthen Russia’s humanitarian influence in the world. The organization is represented in 80 countries by 87 foreign missions. Since 2021, they have received the informal name “Russian House”.
Rossotrudnichestvo is a separate specific structure of the Ministry of Foreign Affairs, but its declared broad development of areas of cooperation between Russia and countries of the world, as well as contacts with compatriots or Russians abroad, makes it very promising in the framework of establishing cooperation in the field of medical anthropology. The management of Rossotrudnichestvo is relatively democratic, interested in developing new areas and methods in the agency’s work. Thus, the success of forming a mutually beneficial partnership will be to a certain extent determined by the development of personal contacts between the leaders of Rossotrudnichestvo and the AMA. Potential cooperation between the management of the organizations can create active points of contact with the agency’s structures with further access to “Russian Houses” outside of Russia.
Foreign centers or “Russian Houses” can help in finding contacts with doctors of a given country, graduates of Russian universities, working as doctors or in the paramedical field, with Russian doctors who have lived and worked in it for a long time, who know the peculiarities of Russian and local medicine. In addition to Russian medical education, they often receive education in the host country, work in local medical organizations, have acquired experience in contacts with unofficial medicine and know the peculiarities of the local mentality. Thus, the AMA can get a large team of researchers on the side, create a kind of international scientific medical-anthropological community and organize a multidirectional set of information that has scientific and practical value.
In addition, Rossotrudnichestvo traditionally recruits students to study in Russia, including in medical specialties. This makes it possible to have a dialogue on the development of a research direction and the introduction of the subject of medical anthropology into the education of foreign students, since in the future they will have to work in conditions differing from Russian ones. It is worth noting that most medical universities in Russia conduct internships in the summer, when some foreign students leave for their countries and during this period can simultaneously conduct interesting research work there.
Also, it would be interesting to mention the international humanitarian program “Mission Dobro” launched in 2021 by Rossotrudnichestvo, which, among other things, provides for visits of Russian medical teams to various countries. If this program is aimed at future expansion and mass participation, then the participation of medical anthropologists in the preparation of teams to a specific country will become an important element of interaction; in the optimal scenario, it is necessary to include a medical anthropologist in the team for both practical and scientific activities – collecting information about the specifics of healthcare and medical systems of the country, as well as about the peculiarities of the local population’s approach to treatment.
It is also necessary to consider such an issue as humanitarian aid to the population of the countries of the South due to natural and man-made disasters. Often, the employees of the Ministry of Emergency Situations, as well as medical workers and those organizers who are directly involved in collecting humanitarian aid, make mistakes that will subsequently lead to insufficient or distorted assistance. Failures also occur in medical interaction, when a large part of the population, due to misunderstanding or miscommunication, may find themselves without medical care and support, especially women and children. Of course, a preliminary study of anthropological data of a specific territory or country, its medical and anthropological features will reduce ineffective costs and increase the efficiency of medical and, in general, humanitarian support. And this, in turn, will increase the role of Russia as a country “that can be relied upon”, its international attractiveness rating. With the active inclusion of representatives of Rossotrudnichestvo in humanitarian aid programs and their optimization, the authority and attractiveness of the agency will also increase.
Thus, the following conclusions can be drawn:
- The development of medical anthropology in Russia was different from that in Western countries, and the AMA was formed in response to the demands of Russian society only in the 21st century.
- Medical anthropology currently has a weak status in the state-administrative system of the Russian Federation, which determines both the non-recognition of the importance and necessity of forming a separate specialty, and the provision of insufficient state support and funding for scientific research.
- The potential for interaction between the AMA and Rossotrudnichestvo is very high and is determined by mutually beneficial conditions for the search for new scientific knowledge, its practical application, and increasing the potential of Rossotrudnichestvo in interaction with the local population and compatriots.
- Building effective interaction between Rossotrudnichestvo and the AMA can potentially lead to an increase in Russia’s authority in the international arena, including in the countries of the global South.
- Building interaction between the medical systems of Russia and the World will lead to a new round of development of medicine as a whole and will contribute to improving the quality of medical care and trust in the Russian system of medical education.
My own opinion is that the interaction between Rossotrudnichestvo and the AMA has very beneficial prospects for both parties. However, at the moment there are quite a lot of obstacles of various levels and nature for potential and mutually beneficial development, which can be overcome only in the case of personal interest.
References
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