We are the canaries: self-care in multiple chemical sensitivity sufferers.

This ethnographic study investigates the experiences of living with multiple chemical sensitivity (MCS), a condition increasing in prevalence but medically contested, on which very little qualitative research has been done. Participant observation included two treatment centers, a support organization, an Internet chat room, and conversations with MCS sufferers, activists, and educators. Semistructured interviews were conducted with 33 people with MCS, recruited to reflect a broad demographic range and severity of illness variation. This article describes several methodological issues associated with doing "peer research" and then describes self-care for symptom management. With no known cure, MCS sufferers manage their symptoms through three main avenues: prevention/avoidance, detoxification, and emotional self-care. Implications include education of health care providers and a warning from those who have MCS: "We are the canaries in the coal mine; what has happened to us will happen to many others unless we clean up our environment."

Health as continuity and balance in life.

Research on immigrant health emphasizes that the elderly are more vulnerable than other age groups in many immigrant populations. This study describes the meanings of health, illness, and disease for Iranian elderly immigrants in Sweden and their relationships with life disruptions. Analysis of interviews using an interpretive-phenomenological method illustrates that the participants, experience health as continuity and balance in life. Any disruption of this balance creates a sense of illness that is only partially related to the emergence of disease. Participants did not view health and disease as polarized. Rather, disease is just one component among many that may disrupt the experience of health. Health is perceived as a sense of well-being, can be achieved in spite of disease, and can be disrupted even in the absence of disease. This description of the meaning of health, disease, and illness contrasts with the Western biomedical perspective and is similar in its holism to various non-Western medical systems and complementary approaches. This knowledge can foster more culturally sensitive care.

Pregnancy, birth, and disability: women's health care experiences.

This qualitative study examined the pregnancy, birth and postpartum experiences of 12 women with mobility-limiting physical disabilities. Analysis of semi-structured interviews of one to two hours revealed that the women's experiences were influenced by their own perspectives and the characteristics of health care system within which they were treated. The woman's experience included the effect of her disability, her resources, and her personality and approach. Health care system factors included provider attitudes, knowledge about disability and structural and political factors. Implications for health care providers are described.

An ethnographic study of a day care center for Iranian immigrant seniors.

Late-in-life immigrants are often at risk for psychological stress and social isolation because of language problems, small social networks, and cultural differences from the host society. Community intervention programs can reduce such stress and isolation. In this article, the authors describe a Swedish municipality's culturally appropriate intervention program for elderly Iranian immigrants based on ethnographic data gathered during a 12 month period. The description includes the activities provided by the program and the experiences of the elderly Iranian immigrants who participate regularly in these activities. The findings document the positive impact of regular participation in the center's activities on the elders' well-being and health.

Cultural aspects of disability.

This article describes cultural and social issues related to disability based on the authors' experiences as researchers, clinicians, and activists and personal experience. They address the complexity of the topic of disability subculture by arguing that there is not one disability subculture and then describe common themes that characterize the social context of people with disabilities and one highly visible disability subculture. Clinical and research implications are mentioned. The definition of culturally competent care should be broadened to include disability.

Information sources, menopause beliefs, and health complaints of midlife Filipinas.

Although the perimenopausal transition is a universal experience for women who live long enough, its cross-cultural variations have been explored only recently. In this study, we investigated some of the expectations and health beliefs of 165 midlife Filipina Americans using focus groups and a short-answer questionnaire. Participants reported on (a) how they learned about menopause, (b) who they talked to about menopause symptoms or issues, (c) how Filipino women and men feel about menopause, and (d) the most common health complaints of midlife Filipinas. Findings revealed that midlife Filipina Americans primarily obtain their information from and talk about menopause with female relatives and friends. They usually viewed menopause as a normal life phase, yet knew less about how Filipino men feel about menopause. Health complaints of midlife Filipinas were mainly estrogen-related menopause symptoms and negative affect symptoms.

Afghan refugee issues in the U.S. social environment.

Since Afghan refugees began coming to the United States in the early 1980s, the Afghan community of the San Francisco Bay Area has become the largest in the United States. This population copes with a number of stressors that negatively affect their health and psychological well-being. Based on an ethnographic study, we focus on the social context in which Afghan refugees find themselves, describing Afghans' perceptions of their interactions with mainstream American citizens and health and social service providers. The theme running through all such interactions is information--its scarcity, character, and cultural differences in type, purposes, and means of transmission. Quotes from interviews illustrate four types of problems: economic and occupational problems, health-care access, family and children's issues, and immigration issues/ethnic bias. Policy and program recommendations are applicable to other recent refugee populations that experience similar information problems with regard to the dominant society.

Menopausal transition of Korean immigrant women: a literature review.

The menopausal transition needs to be understood in terms of the multiple mediating factors within the context in which women experience it. For immigrant women especially, the menopausal experience is complicated by multiple transitions and social marginality, so it cannot be adequately explained without considering this complexity. In this paper we review the literature on the menopausal transition of a group of vulnerable immigrant women in two ways: describing the transitions themselves (menopause, immigration, and housewife to employee), and describing factors that mediate the menopausal transition experience (family norms, meaning of menopause and women's work, and health practices). We emphasize the context and suggest areas of needed research.

Health issues among Afghan women in California.

Afghan refugee women are part of the largest refugee population in the world. In the United States, they deal with loss of family members, property, and status and cultural, familial, religious, role, and generational conflict in making the transition from a traditional patriarchal society to a more egalitarian postindustrial society. Findings from a San Francisco Bay Area Afghan community health assessment conducted from 1992 to 1993 are presented. The assessment included 38 telephone interviews, seven community meetings, and a survey of 196 Afghan families. Six years of ethnographic study with more than 200 Afghans and their health providers provide contextual data. We describe cultural characteristics that influence women's access to health care, women's approach toward preventive care, control of information regarding sexuality, and spouse abuse.

Afghan Health Education Project: a community survey.

This study assessed the health concerns and needs for health education in the Afghan refugee and immigrant community of the San Francisco Bay Area. The study used a telephone survey, seven community meetings and a survey administered to 196 Afghan families through face-to-face interviews. Data were analyzed qualitatively and statistically. Health problems of most concern are mental health problems and stress related to past refugee trauma and loss, current occupational and economic problems, and culture conflict. Physical health problems include heart disease, diabetes and dental problems. Needed health education topics include dealing with stress, heart health, nutrition, raising children in the United States (particularly adolescents), aging in the United States, and diabetes. Using coalition building and involving Afghans in their community assessment, we found that the Afghan community is eager for culture- and language-appropriate health education programs through videos, television, lectures, and written materials. Brief health education talks in community meetings and a health fair revealed enthusiasm and willingness to consider health promotion and disease-prevention practices.

Changing roles of Afghan refugee women in the United States.

Refugee women face many challenges, such as traumatic flight, loss of family members and property, and dramatic cultural differences in the country of resettlement. We examined the adjustment issues and role changes of Afghan women refugees in northern California. Afghans comprise the largest refugee population in the world, and continuing political turmoil prevents most Afghans in the United States from returning home. Data are presented from interviews with 32 Afghan women. These interviews were conducted as part of a larger ethnographic study that included participant observation and interviews with 90 Afghans and the American health and social service providers who worked with them. Although similar issues were expressed by most Afghan women, generation influenced the experience of such issues. The elderly suffer from social isolation and lack of respect; the middle generation shoulders the triple burden of housewife, employee, and mediator between children and spouse; and young and single women face culture conflict and the lack of appropriate mates.

Afghan refugees in California: mental health issues.

Refugees are a particularly vulnerable population that is at risk for mental health problems for a variety of reasons: traumatic experiences in and escapes from their countries of origin, difficult camp or transit experiences, culture conflict and adjustment problems in the country of resettlement, and multiple losses--family members, country, and way of life. Afghan refugees comprise the largest refugee population in the world, at its peak numbering more than 6 million, living mainly in Pakistan and Iran. Based on an ethnographic study of Afghan refugees in Northern California, this article describes common antecedents to and examples of mental health problems in this population, such as depression, somatic symptoms, and posttraumatic stress disorder. It reviews some of the literature on traumatized refugees and makes some suggestions to mental health providers.

Health issues of Afghan refugees in California.

Since the 1979 Soviet invasion of Afghanistan, more than 6 million Afghan refugees have become the world's largest refugee population. Although refugees in Pakistan and Iran are now beginning to repatriate, continuing political turmoil in Afghanistan and children's acculturation and educational opportunities will keep many Afghans in the United States permanently. Although there are no accurate statistics, local resettlement agencies and Afghan community leaders estimate that there are 10,000 to 35,000 Afghans in northern California. They suffer from a variety of problems common to refugees: language, economic and occupational problems, and substantial challenges in psychological, family, social, and cultural adjustment to the United States. Although many Afghans are doing well, many others have depression, psychosomatic symptoms, and posttraumatic stress disorder.

The cultural consultant in mental health care: the case of an Arab adolescent.

Limited understanding by mental health providers of an immigrant's cultural background can lead to misdiagnosis and inappropriate treatment. A case involving the psychiatric hospitalization of an adolescent from Iraq is described, as are the role of a cultural consultant in clarifying cultural issues and the positive consequences for diagnosis and treatment. Implications for the training and function of cultural consultants in mental health care are discussed.

Ethnicity and health among five Middle Eastern immigrant groups.

The relationships among immigration, ethnic identity, and health were investigated in subjects who emigrated from the Middle East to the United States. Egyptian, Yemeni, Iranian, Armenian, and Arab immigrants (N = 88) were interviewed to determine the relationship among ethnic group (country/culture of origin), strength of ethnic identity (four factors and perceived ethnic identity), and mental and physical health (perceived health, physical and psychological symptoms, and morale). The findings show significant differences among the five groups on cultural attitudes, social attitudes, family orientation, the number of physical symptoms, the number of psychological symptoms, perceived health status and positive morale. Subjects who perceived themselves to be more traditionally ethnic tended to have more physical symptoms and less positive morale. Ethnic group accounted for a significant percentage of variance in positive morale and perceived health status. Ethnic identity accounted for a significant proportion of variance in physical symptoms. The results support the need for considering ethnic identity as well as country of origin in providing care for clients.

Esther Lucile Brown--a memorial.

Esther Lucile Brown, who died in 1990 at the age of 92, was a social anthropologist at the Russell Sage Foundation for more than 30 years. Among her contributions were ground-breaking studies of the professions and stimulation of the development of medical social science. Her research on nursing stimulated professionalization and nursing education's move into the university. The accuracy of her research findings on nursing and psychosocial aspects of patient care led many to assume that she was a nurse. This memorial focuses on her contributions and personal impact on friends and colleagues.