Medical Geography

My guru used to tell me: “Geography brings things together like no other discipline can. Within geography, the sub-discipline of medical geography does this more than any other.”

Today, we take a brief look at medical geography (also known as ‘health geography’).

Consider these:

• Tsunami 2011 in Japan and the fear of disease from the damaged Fukushima nuclear power plant
• Earthquake 2010 in Haiti and the outbreak of cholera
• Tsunami 2004 spraying of bleaching powder on dead bodies
• Seasonal changes and the rise of allergies
• Climate change and the expansion of certain kinds of diseases from warmer areas to areas that are warming up
• HIV/AIDS and its spread
• Prevention of HIV/AIDS and culture

All these have a very strong geographical angle. In fact, if we don’t understand the geography behind these, we don’t get a grip on the situation.  A medical doctor who does not understand the geography of health and disease cannot be effective.

Look at the geography of HIV. HIV’s first mention in general public discourse came in 1982 when a few men were diagnosed with a mysterious illness that was soon connected to a virus. The virus damaged the immune system of the patient. It was subsequently found to be related to a similar virus in monkeys (Simian Immunodeficiency Virus – SIV) in western Africa. At some point, SIV had crossed over to the human population and mutated (changed) into the Human Immunodeficiency Virus (HIV).

How did a virus in monkeys in Central Africa become a global human issue, a pandemic? (A pandemic is a disease that crosses national boundaries.) Knowing this was vital for the world to address the issue. (I will not go into that here now; I’ll provide links online for you to follow the story.)

Trying to address the HIV/AIDS has been faced with many challenges in every country in the world. Every country has its own cultural, political, geographical, and other factors to contend with. In ‘traditional’ societies, it was not acceptable to talk about HIV even though it was spreading. People travel, blood products travel (serum, blood, organs for transplant), and so do carriers (vectors) of disease.

Look at patterns of factors that lead to any disease, and you will find there are spatial (geographical) patterns to it. Here are two maps from the World Health Organization (WHO) – one shows the reported cases of cholera worldwide and the other shows patterns of influenza. Geographical implications? People traveling one zone to another could carry specific kinds of influenza with them, spreading the disease. Which particular vaccine is most urgently needed for which area? What are the new kinds of influenza developing and where are they developing? This means new vaccines have to be developed and delivered. How much of each kind of vaccine to supply to which area?

Medical geography brings together

• Geography (places and their human and other characteristics; movement of factors such as disease carriers, pathogens, etc.,),
• Biology (the processes by which organisms produce diseases),
• Medicine (how to prevent or respond to a disease),
• Social sciences (the politics, economics, cultures, power structures, etc.).

Look at the traditional medicines (geographically speaking, they are often called indigenous – locally originated, or folk medicines because they are localized). The raw materials for these medicines are localized – they occur in certain areas not everywhere. It ultimately depends on the soils, climate, slope, water, etc. of a place – in short, geography! The medicine practised in one area may not work in other areas. So, the knowledge and practice of these systems tends to be localized.  Home remedies vary from place to place. Living in the USA, when I got the flu, my doctor asked me to drink lots of chicken noodle soup. My own instinct was to drink my mother’s remedy (a common remedy among south Indians) – milk boiled with turmeric powder and pepper powder.

Often, the occurrence of a ‘new’ disease can lead to serious social disruption. In a village near Mandya, in the late 1990s, a farmer contracted HIV and died of AIDS. Soon, his wife also died of AIDS. People from around the area, stopped intermarriage with people of that village – the men and women of that village were shunned as potential marriage partners.

In 1998-99, two teachers at the local government school, who commuted daily from Mysore, decided to raise awareness about the issue. They taught their students about what HIV is, what AIDS is, how it spreads, why it is important to take precautions but not to stigmatize, why it is important to get tested, and so on. The village had a high illiteracy rate. So, the teachers decided to use a traditional cultural model of viral disease.

Certain viruses cause poxes (e.g.: chicken pox, measles, small pox). In traditional cultures of south India, poxes are called “amma” (mother). The belief is that the female goddess (amma) inhabits the patient’s body and will do so for a duration. During this period, the patient is given certain kinds of food, certain quarantine practices are followed, and in due course the pox passes. During this period, and indeed during the onset of summer when poxes are very likely, special prayers are offered at the local mother goddess temple. (This may possibly be true elsewhere also — if you know of other places where this is true, please leave information in the comment section below this post).

These two teachers decided to adapt this model to educate illiterate villagers by using the ‘amma’ model and treating this as a pox — however, a deadly one. They set up a small open-air shrine next to a nearby goddess temple. They put up two small stone slabs with paintings of the structure of the HIV (the virus).

When people came to the temple, they saw these two new stones, and asked about them. They were told about HIV and AIDS, and given a lot of information about it in simple language.

In time, villagers started offering flowers and worshiping at these two stone tablets with the belief that that would safeguard them against HIV.

If we don’t gain understanding of geography, we will not be able to put things together to develop sensible prevention or treatment strategies. Medical geography is a very exciting field to study and to build an intellectually, socially, and financially rewarding career.

Some online resources: (all links open in a new tab/window)

• Images (mainly maps) that show different medical geographies. You can follow the links to the original pages and learn more.
• Information about medical geography – what it is etc.
• Wiki page on health geography
• HIV: Geography of an epidemic – an article about geography of HIV
• A brief write up about Dr Melinda Meade, a medical geographer. Contains a map of malaria spread.
• Histories of medical geography – full text, large PDF file.
• World Health Organization Global Health Atlas — with links to many resources (some given below)
  • Global Health Observatory Map Gallery — several maps of diseases worldwide
    • Example map: Mean fasting blood glucose levels among males age 25+

Where can you study medical geography?

Several universities in western countries offer formal courses in medical geography. Unfortunately, not in India.

TIIGS offers a workshop on “Geography of HIV and AIDS”
for diverse audiences of ages 16 and above.
Please contact us if you would like to organize a workshop
for your group/institution.