The Culture Brokers: Medicine and Anthropology in Global Miami, 1960-1995 [electronic resource].

9781088309698

Ann Arbor : ProQuest Dissertations & Theses, 2019.

1 online resource (343 p.)

Access is available to the Yale community.

This dissertation examines the interplay of biomedicine, concepts of culture, and global discourse in the late twentieth century. It centers on the city of Miami, whose location in the Caribbean basin and proximity to Latin America has made it a crucial locus for exploring the multicultural forces that shape modern medicine. In the decades following the Cuban Revolution, as hundreds of thousands of immigrants and refugees arrived in Miami and altered the city's social order, health became a crucial site for the management of bodies, race, religion, and culture and for re-negotiating social, political, and scientific boundaries. Spanning from the 1960s to the 1990s, this study begins with the geopolitical conditions that transformed Miami from a resort town to a cosmopolitan city and an ideal site for anthropological research. It ends with the emergence of modern global health to examine the role medical anthropology—and a particular concept of "culture"—has come to play in regulating medical encounters and re-articulating and Cold War racial politics.The first chapter, focusing on a program to retrain Cuban refugee physicians at the University of Miami (UM) School of Medicine, aims to understand the convoluted projects of integration and modernization in the realm of medicine as Cuban exiles became an ethnic enclave in Cold War America. The program expanded over the decade to include physicians from across Latin America, who were expected to receive postgraduate training in Miami and then export modern, American-style medicine abroad.By the 1970s, as international medical education seemed to be thriving in Miami, so did "alternative" health practices like rootwork, espiritismo, santeria, and private prepaid "Cuban clinics", to the frustration of local Anglo-American physicians who found themselves unable to deliver primary health care services to a multi-ethnic patient population. The middle chapters of my dissertation trace the disciplinary formation of medical anthropology through the Health Ecology Project, a groundbreaking study directed by Hazel Weidman, a co-founder of the Society for Medical Anthropology and a social anthropologist at UM's Department of Psychiatry. Weidman's team worked to restructure biomedical practice to accommodate diverse patients' needs and implement community-based health care. She invented the "culture broker" as a new professional role in medicine. The professional culture broker facilitated transcultural health care by mediating between "orthodox" medicine and the "ethnic" patient. Then, in the late 1970s, UM's Psychiatry department organized the Cross-Cultural Training Institute, which brought hundreds of mental health professionals from across the U.S. to Miami to learn about ethnic health cultures through an immersive week-long course—an evocative contrast to the medical school's postgraduate program for Latin American physicians in the previous decade.In integrating the culture concept into biomedical practice, anthropologists produced new categories to make ethnic others legible to the established health system. The last chapters assess some of the outcomes of that process of knowledge production and its application in the health arena and beyond. One chapter follows the transformation of unlicensed Cuban clinics into some of the first examples of Health Maintenance Organizations (HMOs), revealing how concepts of culturally appropriate care became coopted by neoliberal health policy and the rise of managed care. Another chapter examines the interplay of medical anthropology and forensic anthropology through the construction of "ritualistic crime" in Miami. In the 1980s, as ethnic tensions seemed to worsen and the city gained a reputation for drug crimes and homicide, the police department consulted the cultural expertise of those affiliated with Weidman's team. While they sought training in cultural sensitivity, they also sought further knowledge of what they saw as criminal aspects of Afro-Caribbean religions, from animal sacrifice to suspected ties to the illicit drug trade. The dissertation ends with reflections on the history of medical anthropology's role in the field of global health. The epilogue discusses Hazel Weidman's mentorship to physician-anthropologist Paul Farmer, who became a leading advocate for global health equity. Farmer's relationship with Weidman grew in the 1980s as he passed through UM's Office of Transcultural Research and Education on his way to fieldwork visits in rural Haiti and found in her work a resource for both understanding and alleviating the suffering he encountered. The epilogue concludes with remarks on how place matters in the history of global health, especially those in-between places and spaces—between North and South, university and community, clinic and church—that too often evade critical attention.

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January 17, 2020

Thesis (Ph.D.)--Yale University, 2019.

Yale University. History.