Diagnostic Emplotment in Q'eqchi' Maya Medicine.

Medical diagnosis is a process of illness discrimination, categorization, and identification on the basis of careful observation and is central in biomedicine and many traditional medical systems around the world. Through a detailed analysis of several illness episodes and healer interviews among Maya communities in southern Belize, we observe that the diagnostic processes of traditional Q'eqchi' healers reflect patterns of narrative 'emplotment' that engage not simply the individual patient but also significant spiritual and cosmological forces. Three diagnostic techniques of the Q'eqchi' Maya healers are described and their connections to Maya concepts of personhood and cosmovision are presented. This research fosters an appreciation of how Indigenous knowledge systems shape clinical encounters and healing dramas, widening the spheres of clinical narrative co-construction and dialogue beyond the material and physical contexts implicit within Western clinical encounters.

Gendering the Burden of Care: Health Reform and the Paradox of Community Participation in Western Belize.

Belizean health policy supports a primary health care (PHC) strategy of universal access, community participation, and multisectoral collaboration. The principals of PHC were a key part of Belize's emergent national identity and built on existing community-based health strategies. Ethnographic research in western Belize, however, reveals that ongoing health reform is removing providers from participatory arenas. In this article, we foreground a particular moment in Belizean health history--the rise and demise of multisectoral collaboration--to question what can constitute meaningful community participation in the midst of health reform. Many allied health providers continue to believe in the potential of PHC to alleviate the structural causations of poor health and to invest in PHC despite a lack of state support. This means that providers, the majority women, are palliating the consequences of neoliberal reform; it also means that they provide spaces of contestation to the consumer "logic" of this reform.

The role of sensorial processes in Q'eqchi' Maya healing: A case study of depression and bereavement.

Theory and research on the healing practices of Indigenous communities around the globe have often been influenced by models of "symbolic healing" that privilege the way patients consciously interpret or derive meaning from a healing encounter. In our work with a group of Q'eqchi' Maya healers in southern Belize, these aspects of "symbolic healing" are not always present. Such empirical observations force us to reach beyond models of symbolic healing to understand how healing might prove effective. Through the extended analysis of a single case study of rahil ch'ool or "depression," we propose to advance understanding of forms of healing which are not dependent on a shared "mythic" or "assumptive world" between patient and healer or where therapeutic efficacy does not rely on the patient's ability to "believe" in or consciously "know" what is occurring during treatment. In this we demonstrate how the body, as a site of experience, transformation, and communication, becomes the therapeutic locus in healing encounters of this kind and argue that embodied mediums of sensorial experience be considered central in attempts to understand healing efficacy.

Sebaceous cysts with unpleasant twists: cutaneous myiasis with Dermatobia hominis.

Dermatobia hominis (human Bot fly) causes furuncular myiasis (larval infection) in Central and South America. This report describes a case in a member of the UK Armed Forces who had recently taken part in an overseas training exercise in Belize. The importance of clinical history (including travel history) is highlighted. We also describe the outcomes of conservative treatment and surgical intervention for separate lesions in the same patient.

Venezuelan equine encephalitis in a teenager visiting Central America.

BACKGROUND: Stupor, coma, and other alterations of consciousness are among the most serious life-threatening emergencies faced by the emergency department physician. When a patient arrives with altered mentation from Central or South America, the usual causes that occur in the United States must be considered; however, other unusual tropical disease must be excluded, such as Venezuelan equine encephalitis (VEE). OBJECTIVE: This study aimed to review the clinical features of VEE. CASE: A 17-year-old female traveled to Belize and developed vomiting, diarrhea, fever, headaches, and myalgias. Over the next few hours, she became disoriented and had a generalized seizure. She was given diazepam, 50% dextrose, phenytoin, mannitol, and vitamin K. A computed tomographic scan of the head was unremarkable. Her parents arranged for a medical air transport. After eliminating other possibilities, she was diagnosed with VEE, which was confirmed in the laboratory. Over the next week, her mental status improved back to her normal neurologic baseline. CONCLUSIONS: Venezuelan equine encephalitis is an acute viral disease that causes acute illness in equines and humans, with symptoms ranging from a mild, flu-like syndrome to encephalitis or death. Laboratory abnormalities are common and include elevated hepatic transaminases, lymphocytosis, eosinophilia, and thrombocytopenia. Treatment is supportive, and complete recovery is expected within several weeks in most patients.

National and local vulnerability to climate-related disasters in Latin America: the role of social asset-based adaptation.

The Latin American region is particularly prone to climate-related natural hazards. However, this article argues that natural hazards are only partly to blame for the region's vulnerability to natural disasters with quantitative evidence suggesting instead that income per capita and inequality are main determinants of natural disaster mortality in Latin America. Locally, the region's poor are particularly susceptible to climate-related natural hazards. As a result of their limited access to capital, adaptation based on social assets constitutes an effective coping strategy. Evidence from Bolivia and Belize illustrates the importance of social assets in protecting the most vulnerable against natural disasters.

Comprehensive functional vision assessment of patients with North Carolina macular dystrophy (MCDR1).

PURPOSE: Previous studies indicated abnormal development of fixation toward the optic nerve head in patients with the inherited retinal disease North Carolina macular dystrophy (NCMD). The implication of this development on functional vision and structural characteristics has not been described. METHODS: The anatomical characteristics of five NCMD-affected individuals were assessed by measuring the retinal thickness of the macula using optical coherence tomography. The underlying physiologic health of the retina was assessed using the multifocal ERG. Psychophysical assessment of remaining vision in the affected areas was done with a new microperimetry system that measures functional visual acuity at 27 discrete locations and the Humphrey visual field analyzer. RESULTS: All patients had better areas of visual sensitivity toward the nasal macula. Follow-up examination showed no changes in the clinical appearance of the retina. Visual acuities ranged from -0.10 logMAR (Snellen equivalent, approximately 20/16) to 0.50 logMAR (Snellen equivalent, approximately 20/63) in the better eye. No significant changes in visual acuity were found over time. Local multifocal electroretinogram deficits were found in all patients. Patients with grade 2 or 3 disease had large patches of decreased amplitudes and delayed implicit times. Results of the anatomical, electrophysiological, and psychophysical tests were consistent. CONCLUSION: The electrophysiological and psychophysical deficits found in patients with more severe disease were consistent with an abnormal development of fixation from the anatomical fovea toward the optic nerve head with the placement of the lesion temporal to fixation (into the nasal visual field).

Steps toward resolving cultural conflict in a pediatric hospital.

A serious and potentially life-threatening disease in a young child was identified and resolved through medical intervention. However, in the course of hospitalization, a conflict arose between the mother and the health care providers that required legal constraints on the mother. A retrospective account of this conflict between Western health care providers and a family from a Caribbean culture lends itself to an examination of the role of cultural considerations in pediatric hospital care. Suggestions for resolving cultural conflict in clinical practice are discussed.

Patterns of growth and malnutrition among preschoolers in Belize

An anthropometric survey of 750 preschoolers was conducted during 1979 in Belize to assess nutritional status in two districts, one coastal and the other inland. Mothers were interviewed concerning reproductive history, child's health and dietary history, and associated factors. Analysis included the recognition of low arm circumference, weight-for-age, stature-for-age, and weight-for-stature. Survey results indicate that about 25 percent, birth to 5 years old, show evidence of stunting, while 2.5 percent show evidence of wasting. Comparisons of rates of malnutrition by ethnic group reveal that the Maya and Garifuna (Black Carib) children are significantly more commonly malnurished than others. Applying a discriminant function to groups of children designated as "poor" and "better than average" growth classes reveals several factors which may be contributory to the etiology of preschool malnutrition in Belize. The frequency of diarrhea and age at introduction to solid foods are significantly related to growth retardation among preschoolers. Analysis of twenty-four-hour diet recalls corroborates the patterning of malnutrition among ethnic groups (AU)

Routine radiographic screening of the chest in pregnant women: is it indicated?

Experience with routine antepartum chest radiographic screening from July 1, 1976, through June 30, 1977, in a city-county hospital which serves a predominantly black indigent population was reviewed. The 5422 routine screening chest radiographs produced an extremely low yield of pathology (11 cases), and only 3 of the 11 cases were not suspected from the history or physical examination. Only 2 cases of active pulmonary tuberculosis were discovered, and both patients were recent immigrants from countries with a much higher incidence of tuberculosis. This low case finding probably reflects the general decline in incidence of pulmonary tuberculosis in the United States and suggests that routine screening chest radiographs (done primarily to exclude tuberculosis) are no longer indicated in our pregnant population.

Routine radiographic screening of the chest in pregnant women: is it indicated?

Experience with routine antepartum chest radiographic screening from July 1, 1976, through June 30, 1977, in a city-county hospital which serves a predominantly black indigent population was reviewed. The 5422 routine screening chest radiographs produced an extremely low yield of pathology (11 cases), and only 3 of the 11 cases were not suspected from the history of physical examination. Only 2 cases of active pulmonary tuberculosis were discovered, and both patients were recent immigrants from countries with a much higher incidence of tuberculosis. This low case finding probably reflects the general decline in incidence of pulmonary tuberculosis in the United States and suggests that routine screening chest radiographs (done primarily to exclude tuberculosis) are not longer indicated in our pregnant population (AU)

Skin colorimetry in Belize I. conversion formulae

Comparisons between skin colorimetry reports have been hampered by the common use of two different types of portable reflectometers, which sample reflectance at different wavelengths. In an attempt to provide direct comparability between the two machines, multiple linear regression equations were derived from reflectance spectrophotometry readings on 308 Black Caribs and 175 Creoles in Belize, Central America, using both machines. Cross validation tests show the coefficients presented are applicable to independent data sets and generally applicable to other heavily pigmented populations. Comparisons with previous published conversion formulae, which were from very small samples using simple linear regression, show a definite improvement in predictive accuracy when using multple regression equations based on a large sample.

Population dynamics of the sickle cell trait in the Black Caribs of British Honduras, Central America

The Black Caribs of British Honduras are an essentially biologically identifiable African population transplanted to the New World. In this population a frequency (.241) of the sickle-cell trait (HbA HbA) was observed. It has been demonstrated that the sickle-cell gene HbS is maintained in this population at equilibrium values due to the greater fertility of the heterozygous (HbA HbS) mothers (fertility ratio 1.45). The most likely explanation is that normal homozygous mothers (HbA HbA) have more pregnancy interuptions. The sex ratio of the offsprings of HbA HbA mothers is low, while that of HbA HbS mothers is normal. It is suggested that because the Black Caribs are exposed to falciparum malaria of medium endemicity, the placenta of infected non-immune mothers might be predisposed to some mechanical injury causing intra-uterine death of fetus. The mothers who are heterozygous for the sickle-cell gene seem to be relatively protected from this type of interaction. (Summary)