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Vania Smith-Oka, "Becoming Gods: Medical Training in Mexican Hospitals" (Rutgers UP, 2021)
00:49:05
An interview with Vania Smith-Oka
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- [00:00]
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- [00:27]
Dr. Vanya Smith Oka
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- [02:02]
Narrator/Advertiser
Welcome to the New Books Network hello everyone.
- [02:05]
Regan Gillum
Welcome to New Books in Anthropology, a podcast channel on the New Books Network. I'm Regan Gillum, a host on the channel and today I'm talking to Dr. Vanya Smith Oka, who is the author of the book Being Becoming Medical Training in Mexican Hospitals published by Rutgers University Press. Dr. Smith Oka, welcome to the show.
- [02:28]
Dr. Vanya Smith Oka
Thank you so much, Regan. I'm really honored to be part of this.
- [02:33]
Regan Gillum
Yeah, thank you so much. And I'm really excited to talk with you about your book. And so I wanted to begin by situating you within anthropology because you're a cultural anthropologist and a medical anthropologist and your Work focuses on motherhood, specifically indigenous motherhood, medical institutions, and the culture of medicine. I wondered how you came to focus on medical anthropology as your particular field of study.
- [02:59]
Dr. Vanya Smith Oka
Yeah, that's a great question. As it's probably the case for most of us who are scholars, it was a series of small steps, a bit of a winding path that eventually brought me here as an undergraduate student. Forever ago I was a biology major and I didn't actually pick up anthropology until my junior year. And my interests at that time were in ecological anthropology. So that was a topic that occupied my interests for probably about half my time during my PhD and for that I was actually interested in examining indigenous medicine in Mexico and the ways that healers and lay people would go to the forest and collect plants and, you know, how they would choose them and manage the forest. It was a very sort of ecological, political, ecological questions. And so my interest in medical anthropology as a topic itself or as a field didn't really develop until I first went to the field for my dissertation research. So I was a fourth year student and I get to the field and I realized that there were many more interesting questions about healing and well being beyond simply a question of traditional medicine. And so the more I spoke with the women who I interacted with on a daily basis, the more they would share with me their problematic interactions with clinical staff. And that was how I began to slowly shift my focus to encompass more medical anthropology. Questions about the body, about well being and healing, and in particular, how questions of power shaped or continue to shape people's interactions. So I ended up focusing on indigenous motherhood and how it was often criticized by development and health institutions and systems that aimed to make the idea of indigenous motherhood as something modern. So they were trying to sort of modernize the women in the village and other regions to fit with mainstream Mexico's ideas of what was good motherhood. And so it was a sort of winding path that took me from ecological anthropology to this medical anthropology perspective. And I've pretty much stayed in that so far. Thank you.
- [05:22]
Regan Gillum
And your book, Becoming God's Medical Training in Mexican Hospitals. It follows a cohort of interns as they learn to become doctors in public and private hospitals in Puebla, Mexico. And so what led you specifically to write the book Becoming Gods?
- [05:39]
Dr. Vanya Smith Oka
Yeah, so in the time between my previous book, which emerged from the research I just described, and then this one, I spent about maybe six years carrying out ethnography in public hospitals in the city of Puebla. My original work was in rural Mexico. And so the city of Puebla is a large city of about 2 million people, and it's located in central Mexico. Like any big city in a country such as Mexico, it's highly stratified economically. So socially, politically. And so I was interested in, I was still interested in questions of sort of power dynamics, but I was really focusing much more on maternity wards, especially in the labor and delivery rooms themselves. And the more I was working in these spaces, the more I witnessed a tremendous amount of mistreatment towards the female patients, most of whom were impoverished or were on public healthcare systems or fell into what they were defining as that the doctors were defining as problematic motherhood or somehow reproducing outside of the norm. So many of them were considered to be too young or too old to be having children. They were sometimes unmarried, they were often less well educated. And so any of these social categories put them into this definition of being problematic in some way. And so many of them were treated callously or even negligently by doctors and nurses, and they were threatened with violence. I saw them being shouted at. I saw them being shamed or humiliated for their sexuality, for having children. They were subjected to unnecessary procedures like cesareans or episiotomies. And so all of this added up to what is now being referred to as obstetric violence, which in a nutshell, just, it consists of emotional or verbal or physical mistreatment of women during childbirth. And so after witnessing all of these for so many years, I really wanted to figure out why. Why was this violence so prevalent? And was this something that doctors learned in medical school? Did it come from some of the first interactions with patients and it somehow shifted their perspective on medical care? Or was it something larger, something maybe threaded through Mexican society at that point, around 2012, 2013, I decided to shift my focus to ethnography with doctors, as opposed to observing doctors as the antagonists of patients. At first I started research with medical students at some of the medical schools, and then I eventually shifted to working with medical interns in hospitals, as I could then witness their lives as they learned hands on practices, as well as, you know, seeing how they. How they grew and developed over the course of their one year internship. And honestly, I went into that research thinking of doctors as the enemy. I had spent the better part of a decade writing about them in negative ways, but the more time I spent with them and the more nuanced my perceptions of them became. Sure, they could still be violent, they could still have pretty problematic interactions with some patients. But some of this I describe in the book, but they also cared deeply about their patients as well as medical care. And many of them also experienced violence in their own training, which I also mentioned in the book. I think the book becoming gods for me at least, and I hope the reader would think this as well, it sort of fleshes out the idea of a doctor. It shifts it from a one dimensional perspective into a more complex, three dimensional, flawed, but also caring human being.
- [09:41]
Regan Gillum
Yeah, that definitely comes across in the book. And I wanted to ask you then about the interns that you focus on as you, as you just really just explained for us, because the interns seem to inhabit this intermediary period after medical school but before becoming fully fledged doctors. And you mentioned in the book that medicine is a bachelor's degree in Mexico, which I assume is different from the United States where it is. We'll go to med school after undergrad. And so I wondered if you could situate them for us what stage of their education they're in and what their responsibilities are in the hospital.
- [10:21]
Dr. Vanya Smith Oka
Yeah, definitely. What's interesting about medicine in Mexico, as well as many other parts of the world, is that it actually is a bachelor's degree. In the U.S. as you say, it's very different. Students do undergraduate degree first and then they go to medical school. In Mexico, they will enter medical school just after high school, which sometimes makes them feel so very young. In Mexico, medical school is six years long. Students take classes for four years where they cover the basic sciences, questions about community health, as well as some of the specialties. They take classes in obstetrics or pathology, rheumatology, what have you. During this time, they also engage in minor rotations in clinics and hospitals once or twice a week, maybe a few hours a day. And it's at these points that they start to get the hang of doing things like suturing or drawing blood, or as well as starting to understand how hospitals work, for instance, where they need to stand during a surgery or how to enter into a patient room, how to introduce themselves to patients, et cetera. At the end of those four years, all medical students engage in a year long internship at a hospital. And so these are the interns I speak about in the book. Then the sixth year, which I refer to a little bit in the book, it's when all medical students participate in a mandatory year of social service to the nation. They usually posted to underserved areas of the country to practice medicine in, usually quite small remote villages, clinics in villages. In the internship, they're still technically students at their medical school, but they spend most of their waking hours at the hospital. There's some variation really in the structure of internships depending on the hospital where they're at. But in general, interns will rotate every couple of months through different hospital sections, such as they'll spend a couple of months in emergency rooms. They'll do a couple of months in internal medicine, obstetrics, pediatrics, surgery, et cetera. Through these rotations, not only are they to get a sense of actually learning the practices of each of these, but also it's a year of discernment for them to determine what kind of medicine they want to practice after medical school. In terms of their duties, one could probably classify interns as sort of trainee or lackeys or junior medic. Their duties can range significantly and can include anything from patient intake and examination. They might be asked to run samples to the laboratory. They might do rounds with doctors like going into patients room and asking questions and learning what it's like to interact with patients. They often will do presentation of clinical cases in front of an audience where they have to get to know a particular case and then be an expert on it and elicit answers from their audience. And they might also do small procedures like removing sutures or drawing blood or inserting a catheter. But what really was striking in all my research with these interns was that paperwork was a huge part of their duties. They were in charge of writing the patient progress notes. They had to check that the patient clinical histories were up to date. They had to ensure that all notes sent forms were in the patient's chart and the doctors had signed the forms. Right. So we sort of, as I note in the book, though, the interns didn't really articulate this overtly when they would talk about what they did during their internship year. And as I witnessed what they were doing, they tended to describe a progression from sort of mundane or basic care to more complex and more interesting forms of care. And as they got closer to the end of their internship, you could tell that they just had a greater sense of responsibility for their patients as opposed to the attending doctors as patients. So they were sort of shifting their whole sense of self.
- [15:02]
Regan Gillum
I guess, to pick up where you just left off. The students, they seem to be becoming transformed into doctors. And so that's. That you're, you know, that you're looking at and describing in the book. And, and this there, that involves like a shifting of self, which I'll get, I'll ask in a little bit. But also you talk about how gender plays a really integral role in the education process in how they're being socialized as doctors and how they're being addressed according to their gender identity. So I wondered, how is the process of learning medicine gendered? And how do the students navigate this?
- [15:40]
Dr. Vanya Smith Oka
Yeah, thank you. This is a great question. So I found that notions of gender were threaded through so many of the interactions. So the more time I spent in the hospital shadowing the trainees, the more I would hear them say that women can't be trauma doctors. In fact, that's the title of one of the chapters. And it was a refrain that I constantly heard. And at first, I was quite stunned, right, because most of the female interns are interacted with were strong feminist women who I did not think would somehow buy into any hegemonic ideas about their abilities. I started to ask the participants about gender in these spaces. What I discovered was a significant gendered way of being a medical trainee and a doctor. First of all was the idea that though female doctors were seen to be as technically and intellectually competent as men, they were also seen to be more likely to be emotional or sensitive or physically weak. This belief was there despite the equally prevailing stories of male surgeons who would have meltdowns in their surgeries. But somehow it was the female doctors who were constantly being categorized as weak or hysterical. The second thing is that the interns spoke a lot about the gendered nature of different specialties. Some specialties were considered to be male, like surgery or orthopedics, because men were seen to be physically stronger. So this goes back to that original quote of, like, women can't be trauma doctors, while other specialties were female, like dermatology. And this is a quote from one of my participants that I include in the book. And it was because they said that because women like creams and stuff, right? There's something about the cosmetics that women like, and so that's why they want to go into dermatology. So it was just really fascinating to hear these very gendered perspectives from people who were all equally capable, regardless of the gender, of doing the labor of an intern. But as I really dug into this more, I realized that these stereotypes hit a much deeper gendered issue of abuse. The abuse towards women took the form of sexual harassment and what I term in the book dirty trade, where women had to try to balance being trained with rejecting constant invitations for coffee or dates from male doctors. So, for instance, if they asked a male physician for advice on a procedure or a technique, they sometimes ran the risk of being asked for date in exchange for the knowledge. So that was the experience of the female interns. But then the men, on the other hand, tended to be trained with a much harsher, harder hand. And so we're more likely to be targets of bullying or just harsher training in general, more humiliation, that sort of stuff. Of course, the stories I share in the book are not all negative. In fact, one of my favorite vignettes, the book is about an intern I call Samantha, who was constantly being harassed by a surgeon. And she deftly shut him up by turning the tables on him and calling out his bs, literally in front of his peers, which earned her the name of la respitada, which basically translates as the one who owned the situation. I have lots of stories of these gendered interactions, but some of them are more negative in the sense of they're really showing some of the difficulties. But others, like Samantha's, show that despite these gendered ways of interaction, that many of them could overcome them, move through them, manage the situation, et cetera.
- [19:51]
Regan Gillum
As you chronicle these doctors and their training over this year as an intern, they're developing what you call a medical self. In chapter three, which you call the soul of the hospital, you discuss how students form these medical selves in becoming skilled doctors. And I'm going to quote you from page 95 where you write a medical self incorporates bodily, sensorial and self making processes such as how to navigate a medical space, how to exemplify expertise, how to embody medical institutions, unwritten and written guidelines for being a doctor, or how to act in a doctorly manner. And so I wondered, how did you see students developing these medical selves during your research?
- [20:42]
Dr. Vanya Smith Oka
I saw them developing their medical selves in all ways. They did this through learning how to use technology like needles or scalpels. They did this through learning how to talk about patients and cases. They also did this by shifting from the periphery of the action as observers in procedures, to being more central to the action as surgeons, assistants, for instance. I'll share a couple of examples that I think might best illustrate this concept of the medical self, which as I point out in the book, is constantly being created through interactions with patients and colleagues. It isn't just a one time thing that develops over the internship. In fact, as I argue in the book, it's something that they keep on forming over the course of their medical career. But so one of the one of the examples I want to talk about is Carlos, who was assigned one day to cut off. It was a full body cast of this four year old toddler who had been born with congenital deformities. And, you know, she was really wiggly, really scared. She screamed the whole time. Any, anytime anyone in the white coat would walk into the cubicle where she was with her, with her parents. And so Carlos had. So the soul had. The cast had to be sawn off, Right. So they had to use a specialized saw for this. And Carlos had never used a saw before, a cast saw before. And he, you know, in consequence, he used it quite poorly. So at first, the doctor who was in charge showed Carlos really quickly how to use it. He cut one of the sides of the cast along the little patient's leg. And then with almost no supervision, Carlos was then told to continue doing this, even though his patient was literally like, screaming hysterically. And then the sore itself kept on overheating so much that Carlos had to periodically stop it and let it rest. And so he's doing this with only a nurse occasionally sort of telling him, well, you might find it easier to cut here, or why don't you try this other thing? But for the most part, it was just Gardlow's like, leaning over the patient who was screaming, and he's like, trying to get this. This saw to work, but it kept on overheating. And so every time he stopped to let the sore rest, he was assigned to a new patient in the emergency room. So by the time he finished sawing off the cast, at least an hour had passed, right. And he'd attended to maybe like five or six other patients in the emergency room. That was one example of the ways that this medical self is being developed through how they're sometimes just thrown into the deep end. They don't really know what they're doing, but they just have to figure it out, even in really complex and heartbreaking situations like this one. The second example I wanted to talk about is something that the interns had to do almost monthly, and it was the presentation of medical cases. And so this was a way for them to perform their identity verbally as doctors by using all the technical terms. They also would work alongside an expert doctor. And also it was a way for them to learn how to boil down patient subjectivity into useful, objective, seemingly objective nuggets for others. So this example that I'm going to share is by Cesar, who presented the case of a woman who had arrived almost at midnight on December 31st. And so he described just the real basics of her biography. Like, when he starts his presentation, he's like, talking about her age, her gender, her marital status, etc. And then he proceeded to explain what he called the patient's pathological background. So he quickly shifts from the patient's subjectivity to just focusing on the pathology, which included her symptoms of breathlessness, how they got worse over her time in the emergency room, the types of tests and conclusions that the doctors were running and coming to based on the tests. But what was key, not only, I mean, I'm using one example of a case presentation, but this is what was, is pretty typical for all of them, is that when they presented these clinical cases, they were considered the expert on the topic. And so they were expected to present some of the details to the interns in the audience and then use a Socratic method to try to get all of these interns to work through the differential diagnosis themselves, such as what labs they would request and why and what conclusions they would come to because of that. And then, and these are usually like a 45 minute to an hour long presentation. And at the very end there would be like the big reveal, like, okay, so this is actually what the patient had. But in the process, these interns would sort of elicit the responses, the ideas from their peers. So what became obvious while observing the interns was that much of the knowledge and practice of the internship was about figuring out just how to do things and then repeating them, often until they became familiar. They moved from fragments of knowledge, fragments of information, actually, to conscious knowledge. And their medical self wasn't just learning how to wield an unfamiliar instrument. It also consisted of learning how to enter a patient's room with authority, being able to present a case with confidence. And it was the ability to engage bodily with patients, learning how to cut, how to sew, how to do all of these things, you know, traversing these boundaries of the body, and also to project a confident air to everyone around them.
- [26:57]
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- [29:25]
Regan Gillum
Are really great and very descriptive glimpses into your, into your field work and into your research and also into the different stories that you share in the bulk that were really just so illuminating and really great for the reader to help to understand, you know, what's going on in these spaces. Yeah. And they're very demonstrative of your, of your concepts, which I know other people would really, you know, find, find rich and engaging as they read the book. And I wanted to ask you then, I guess about your research process as well, out of which these scenarios came out of, because the book is very ethnographic and you seem to spend quite a bit of time in the hospital with the interns this is a really close ethnography of their learning processes. I wanted to ask just how did you gain access to the students? How did you decide who to follow? And really just anything you would want to share about the research, the ethnographic research process that you undertook?
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Dr. Vanya Smith Oka
Yeah, absolutely. I first want to say that I just love hospital ethnography. I never thought I would. I think most of us, we've all been patients at some point, and many of us sort of dread hospitals for different things, different reasons. But just being on that side of the experience really sort of transformed my ideas about the hospitals themselves. And just I love being in these spaces. And I find it such a rare opportunity to get behind the scenes in places that are both incredibly familiar to us as patients and also really unfamiliar as, like, the lives of doctors. We don't really know that much about their lives outside of our interactions with them. So I have found over my experiences that access to hospitals is a slow process of interacting with the gatekeepers, working through the requirements of their ethics boards, which vary enormously in different types of hospitals, then also establishing rapport with the directors of research. These directors of research are the ones who are in charge of medical training at any given hospital. After I went through that process, which took close to a year prior to my starting this project, I met with the interns as a group and I explained my research, and most of them agreed to participate in a first interview. And there I started to establish rapport with them. So, as any ethnographer knows, part of the way of gaining access is just to be there and, you know, to be seen. So I was hanging out as visibly as I could. I would hang out in the passages and in the classrooms where they would do their work, and I would try not to interrupt their work. I really grew to value just how little time they had for most things. Never mind an inquisitive ethnographer asking for them pretty dumb questions about, like, well, why did you decide to do this? And what are the steps to go from A to Z in this particular procedure? Right. So I tried not to be a nuisance, but at the same time, I knew that my questions were pretty basic, but they just really were so lovely. And as. As we chatted and we got to know each other, I would ask them, could I accompany them into some of these places, these spaces that they were going into, and try to witness the procedures that they were doing. So in a way, the two places I did the most work were the emergency room and then the obstetrics wards. So my interest, as I mentioned at the very beginning of today's conversation, really sort of has gravitated around reproduction and motherhood. And so that's why I tended to find my interest more towards the obstetrics wards themselves. But then there was something also about the emergency room that attracted me because it just sort of put so much of their duties, their responsibilities, under a really bright light of the emergency. They couldn't sort of take slow decisions. They had to take pretty quick decisions about procedures. And so I tried as much as possible to follow all the interns so I could get a general picture of their practice. But some of them, as is the case in any ethnographic research, some of them did become closer interlocutors who seemed to care about my research question just a little bit more or really asked sort of more questions about what I was doing there and why. And so they would reach out to me and let me know that there were procedures I should check out, or they would text me and say, hey, we have a birth coming in. There's going to be a cesarean in a while. So they would sort of alert me to things that I probably shouldn't miss. So with your question, when you say, is there anything else I want to share about, about my research, I do want to add something that I mentioned only briefly in my book, but it actually was a larger part of being an ethnographer for this project, and that was actually being able to do ethnography in the field while also having my 5 year old daughter with me. So she's 11 now, so at that point she was 5. So balancing research and motherhood was a really interesting challenge. I had a research assistant, her name is Megan Marshalla. She was a former student of mine and she's now doing a residency for obstetrics. I met her when she was an undergraduate and she had experience in Puebla. She was really interested in the topic and she was trying to do a gap year between undergrad and med school. So I said, hey, why don't you come along? She and my daughter already got along. So I said, well, you know, let's combine it all. And so she came to the field with me, both as a research assistant and as a babysitter. And because of her, I was able to extend some of my hours in the hospital that I would not have been able to do otherwise. So, you know, in the morning we would drop off my daughter at a little preschool and then head to the hospital for several hours. Megan was an amazing researcher and we would go into procedures together. She would interview some of the people, I would interview others. But at other times we would be collaborating in the same space. And then she would leave at around midday sometime to fetch my daughter from school. And then I would be able to spend a couple of hours extra at the hospital being able to enter into procedures or actually staying the full length of a birth or carry out additional interviews that I would have been able to go and fetch my daughter. So the reason I mention this is that many times people think of ethnography as a full time thing. You go to the field, you stay there. It's incredibly immersive, which it still was, but yet many of us have to balance other identities while in the field and we have to rely on the support of others to get the work done. So I just thought that that was important to be able to really sort of illustrate that, you know, when we combine ethnography with additional identities, in this case it was motherhood, you know, it's not easy to. To do it alone.
- [37:17]
Regan Gillum
Yeah, thank you for that reflection and for sharing that. Because it also disrupts our idea of the lone ethnographer by themselves with their little notebook and pen emphasize the collective. It's not, you know, it's not just us, us. And we need other people to, you know, go about what we do. Thank you. And so your book, it made me reflect on my own education and this process of becoming, or process of being a PhD student becoming someone with a PhD and then a professor. And it made me think about how I learned and, and what I learned to get me to this point. And so I was wondering, it also made me think about like my academic self, I guess, and how I. And so I wondered if your research made you reflect on your own process of education and if you see any similarities or differences between, I guess, your process of education and the interns process of becoming doctors.
- [38:17]
Dr. Vanya Smith Oka
Yeah, so it's interesting that you bring that up as I did a ton of reflecting about my own training in my PhD PhD, as well as the training that we're currently doing in graduate programs in anthropology. So much of the literature I accessed about mentoring and about gendered relations were written by anthropologists who were describing training in academia. So when they spoke about gender harassment or abuse or toxic spaces or other significant issues, I could apply these to the data I had collected and the stories I had heard and the of things I'd witnessed as well as the things I'd witnessed in academia. A topic I discuss in chapter two is about the issues of external and internal violence to the system. So I draw from the work of Mexican sociologist Roberto Castro, who stated that doctors are very attuned to what he termed external violence. So these would be like criticisms from outside medicine about their practice, such as lawsuits or accusations of obstetric violence. But they're equally almost blind to the internal violence within the system, such as gender harassment, bullying, et cetera. So that is, they naturalize these practices in medicine as just part of how things are done. And so the hugely long hours, the lack of sleep, like being awake for more than 36 hours straight, the being scolded and put on the spot as a regular, are part of training or shamed for not knowing something, or even punished by being told to work extra hours a day in the hospital. So all of these are perceived to be natural parts of medical training. All of these made me reflect on how we are educating the next generation of anthropology PhDs, especially how there are certain types of mentors who can be quite hostile or abusive and can create an environment where such a behavior is naturalized. So I do think that departments need to be very aware of how different mentors engage with graduate students who, like the interns, are lower on the hierarchy and have much less power. Then I think an important question is how to identify when abuse becomes systemic or naturalized as normal. Because I think these same things of criticism from the outside and then the blindness to the violence inside are also prevalent in academia. We might be very attuned to someone saying, well, academia is such and such. If that person is from the outside, we might get defensive, though we're perfectly happy to criticize academia from within, but we might not always be aware of some of these micro inequities, these microaggressions or larger forms of aggression and humiliation and shame that are taking place within mentor mentee PhD interactions. That was what really, I think, helped me to reflect about academia.
- [41:32]
Regan Gillum
Thank you. I wanted to turn to, I guess, your work in the classroom teaching medical anthropology, because as a graduate student, I was a teaching assistant for medical anthropology classes and I majored in anthropology as an undergrad. And I also took a lot of classes in medical anthropology. And so I always found medical anthropology really interesting in that it departed from this idea where biomedicine is the only way to understand the body. And it also showed us, as you show, that medicine is itself a cultural world. I would imagine that as a medical anthropologist, you teach a lot of pre med students and other students interested in health fields. And so I wondered if you include these insights from the book in your classroom. And how do you do that?
- [42:24]
Dr. Vanya Smith Oka
Yeah, it's funny you should ask as this is the first semester I'm teaching my work. So I agonized this whole summer about whether I should assign the book to the students in my class, which the class I'm teaching is called the Culture of Medicine How Doctors Think. So it felt slightly self serving to assign my own book, but my colleagues really supported me and so I have assigned it to my students. So we will be discussing it next week. So I actually don't have any clue how they'll be receiving it as a piece of work. But to your larger question, what I have found is that pre med students really crave these sorts of anthropological perspectives. For instance, in some of my past classes, premed students had never really thought about biomedicine as a type of culture. They'd assumed that biomedicine was something natural rather than having developed from a particular cultural or historical or geographic context. When I've taught these types of classes, they're often quite taken aback by how cultural biomedicine is and how it's shaped by different factors such as race or class or gender or history and other structures, as well as how it's structured by finances or ideas of what good of bad physicians are. So when students really get to think through what biomedicine is and you give them a chance to sort of look under the hood, the metaphorical hood, and they see the complexity of human behaviors and histories that have gone into biomedicine, they really come away with a better idea of what it is to do medicine. And I hope in the process it also makes them into better doctors because they really sort of reflect much more on medicine is just a set of technical skills. It isn't just knowing, you know, how to put in a suture. It isn't just knowing how to sort of whittle down the whole sort of subjectivity of a patient into these sort of objective, so called objective medical histories. Medicine is a social thing. It's, it's, you know, we inhabit social bodies and the illness of a person isn't just something that occurs in their body. It is something shaped by much, much larger things. And so when pre med students really realize this, I think they find it quite transformative indeed. I mean, there's a growing school of thought that is pushing for more medical students to take medical humanities in any shape or form, whether that's anthropology or classes in the history of medicine, or even sort of film. And the physician learning how are physicians represented in the media. And what does that tell you, not only about the media itself and the medium of film, but then what is it that we're picking up from what a doctor is and how is it then being portrayed and what is being ignored, what is being highlighted, et cetera. And so when students take these sort of more holistic approaches to then reflect back on their biochemistries, on their physics, on their anatomy classes, they just are able to. To get much better skills at observation, at understanding or even empathy than they otherwise would have had.
- [45:59]
Regan Gillum
Yeah, thank you for that. That's so important. Those are some of the things that I took away from medical oncology. And I think it's great that your book and looking at the transformation of medical students into doctors will also help your own students then, and it'll be transformative for them as well in their own journey either towards careers or elsewhere. Because obviously, medical care is such an important part of so many people's lives that. And your work really just touches on beyond people who work in health, but just people in general who interact with these systems.
- [46:37]
Dr. Vanya Smith Oka
Exactly. Yeah. I mean, here I focus on doctors, but obviously medical care is performed by many people, including nurses and orderlies. And medicine is a much, much wider, or the idea of health is much, much wider than what I've described here.
- [46:55]
Regan Gillum
Thank you. And so I wondered, as the final question, we'd like to turn to this question of, now that the book is out, do you have any new projects on the horizon or are you working on. What are you working on now that's sort of advancing your own either research or other teaching agendas?
- [47:18]
Dr. Vanya Smith Oka
Yeah, I do actually have a new project. I have a collaborative project with an anthropologist called Lydia Dixon. She's a medical anthropologist at California State University in Channel Islands. Lydia and I have begun working on a project funded by them, the National Science foundation, on cesarean incisions in Mexico. She's worked for many years in Mexico with midwives, and she was one of the first people to really identify obstetric violence in Mexico. Together, we've been working on this project for probably a couple of years. The aim of this is to investigate whether different incision types. Just as a bit of background, the cesarean has two basic incisions. One is a vertical one and one is horizontal. We're trying to figure out if each of these incision types maps onto different groups based on factors such as class or race or ethnic origin or skin color. Anecdotal evidence from anthropologists suggests that whiter or wealthier women receive a more aesthetic horizontal frontal incision, while darker or less wealthy women are more likely to receive a vertical one. So additional factors that are important that we'll be taking into account include infection rates for each incision type or the scarring recovery rates, effect on perceptions of motherhood, et cetera, that might also contribute to different or inequitable health outcomes. And so, I mean, we just got the grant and of course Covid has been around almost for two years at this point. And so we haven't been able to get to the hospitals yet. We do hope, if fingers crossed, that we will be able to get to Mexico next year and figure out whether these anecdotes do actually pan out to some sort of, of potential, sort of systematic racism or some kind of if there is something about inequities that is being mapped onto, whether deliberately or unintentionally onto birthing women. And if so, what does all of this tell us about the racialized practices of medicine?
- [50:01]
Regan Gillum
Well, congratulations on getting that grant and we'll look out for that work in the future as well. And we wish you the best in trying to navigate the current conditions of COVID and of all the uncertainty.
- [50:14]
Dr. Vanya Smith Oka
Thank you.
- [50:16]
Regan Gillum
I have been speaking with Dr. Vanya Smithoka, the author of Becoming Medical Training in Mexican Hospitals, published by Rutgers University Press. Thank you so much, Dr. Smith Oko, for writing this book and for sharing it with us on the podcast.
- [50:33]
Dr. Vanya Smith Oka
Thank you so much. It's been a real pleasure to speak with you today.
- [50:49]
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