This descriptive and epidemiological study examines completed suicides among the Apache, Navajo and Pueblo Indians of New Mexico from 1957 through 1979. Death certificates constitute the primary source of data. A number of demographic and situational variables are examined for the cultural groups and similarities and differences are noted. Significant findings include a high male to female ratio ranging from 7.4:1 to 10.4:1; an age range of 10-39 for 75.4%-93.4% of the completed suicides; and a high percentage of both males and females using extremely lethal methods, i.e., firearms and hanging, to commit suicide. Suicide rates for the Apache and Pueblo groups have been rising since the mid-1960s, while Navajo rates have been rising since the early 1970s. The Apache had the highest suicide rate, followed by the Pueblo and Navajo, for the period 1957-1979. The age-adjusted rates range from 1.7 to 4.9 times the U.S. rate in recent years. Age-specific trends show an increase in youthful suicide rates similar ...
Through a longitudinal study of neighborhood health centers for the poor in the United States, this paper presents an analysis of the political economy of change within reform organizations. In the final accounting, we seek to explain the shift in the role of poor people participating in health care decision making from that of program developer and change agent to the role of program restrictor. We conceptualize the neighborhood health center (NHC) as a reform organization whose initial objective was to use health care as a tool for achieving political and economic development within low-income rural and urban communities. The analysis, based on a prospective study of NHCs between 1965 and 1977, using interviews with citizen board members, NHC project administrators, NHC physicians, HEW decision elites, and oral history interviews with former Office of Economic Opportunity (OEO) administrators and directors, exemplifies the generic social organizational problem of how social, political, economic, and ideological forces shape the emergence and performance of a new reform organization.
Recent political changes in Nicaragua provide the context in which to analyze the relationship between politics and health (Bossert 1982; Halperin and Garfield 1982). The specific focus of this paper will be on the organization and function of community participation in health delivery before and after the Revolution of July 19, 1979.
Drug use research that involves transnational populations in their worksite nations and in their countries of origin requires special consideration for human subjects. These populations are exposed to similar, if not greater, research related risks than other vulnerable research subjects. If they are to be protected adequately, Internal Review Boards (IRBs) need to become familiar with transnational populations and the possible risks that their members face when participating in research that targets their drug use behaviors and practices. Addressed in this article are a number of challenges that IRBs in United States universities and research institutes encounter in assuring protections against possible research risks. Specific areas of concern are: the dearth of binational IRB reviews, IRB inexperience with transnational populations, mandatory written consent, limited research ethics training for researchers, the absence of a vulnerable population research advisory board, and the need for measures in case of a breach of confidentiality. The discourse of each one of these problem areas includes a recommendation for rectifying it. The article ends with five suggested measures that IRBs should consider in protecting transnational migrants from research related risks in the United States and in their homeland. The discussion of human subject problems and of the measures introduced to alleviate them are based on the author's experiences with preparing human subjects protocols for his ethnographic substance abuse research in both the United States and Mexico.
With the collapse of socialism, the number of nongovernmental organizations in Eastern Europe increased dramatically, as part of democracy and capitalism building. In the West, NGOs have served as key players in shaping the response of the HIV epidemic, reflecting both the withdrawal of the state from service provision in line with neoliberal reforms and the activist roots from which many of these organizations originated. As a result, AIDS NGOs and the people who work in them are often characterized as engaging in an activist endeavor in order to affect social and political change that will enable better prevention and care. This article explores the extent to which a similar framework applies to AIDS NGOs in Poland and Eastern Europe, more generally, where the notion of "anti-politics" and disengagement from political activism remains strong. As they developed in Poland, AIDS NGOs have focused on caring for clients, cultivating a professional identity, and abstaining from politics, to the eschewal of advocacy activities on behalf of their clients. This orientation has implications for the types of HIV prevention programs these organizations offer, as well as the possibilities for collaborating with researchers and service providers from the West.
Although Latino and other immigrant populations are the driving force behind population increases in the U.S., there are significant gaps in knowledge and practice on addressing health disparities in these populations. The Avance Center for the Advancement of Immigrant/Refugee Health, a health disparities research center in the Washington, DC area, includes as part of its mission a multi-level, participatory community intervention (called Adelante) to address the co-occurrence of substance abuse, violence and sex risk among Latino immigrant youth and young adults. Research staff and community partners knew that the intervention community had grown beyond its Census-designated place (CDP) boundaries, and that connection and attachment to community were relevant to an intervention. Thus, in order to understand current geographic and social boundaries of the community for sampling, data collection, intervention design and implementation, the research team conducted an ethnographic study to identify self-defined community boundaries, both geographic and social. Beginning with preliminary data from a pilot intervention and the original CDP map, the research included: geo-mapping de-identified addresses of service clients from a major community organization; key informant interviews; and observation and intercept interviews in the community. The results provided an expanded community boundary profile and important information about community identity.
Demographers frame international adoption primarily as an unusual kind of migration. This insight offers anthropologists new ways to think about kinship. Drawing on demographic scholarship and anthropological kinship and migration studies, this article develops a new and hybrid approach to international adoption as a complex social process that is both migratory and productive of kinship. Viewing international adoption as a form of migration reveals how the stated "push factors" and actual "pull factors" of international adoption do not align perfectly. Using an anthropological life course perspective, the article then explores how the experiences of these "migrants" and those close to them, over time, are better understood as racialization than solely the product of migration. Looking at adoptees' lives through a migration lens reveals some of the persistent discomforts that prevent open conversations about racial difference and minority status in an adoptive context, that is, one where children have been caused to migrate, recruited into families. This article draws on data from ethnographic fieldwork with Spanish parents who have adopted Peruvian children to argue that international adoption is a unique form of immigration that produces a minority category within a majority population.
This paper discusses a methodology for observing and describing interactions between clinicians and patients in an inner-city pediatric clinic serving families of diverse ethnicity. The framework is derived from Michael Agar's concept of ethnography as an interpretive, problem-resolving method. In Agar's model, the participant-observer moves cognitively and analytically from focusing on breakdown (awareness of a problem in understanding) to resolution (applying knowledge structures or schemas to bounded phenomena or strips) and ultimately to coherence. This framework applies not only to describing what the ethnographer does, but also stages in the clinician's efforts to communicate. Awareness of repeated breakdowns allows the ethnographer to document fundamental differences in expectations and premises that affect communication between clinician and patient. Two major types of breakdowns are discussed: those occurring between clinic staff and families, and those occurring between staff and ethnographer. Terminological and analytical modifications of Agar's method are recommended to reflect more accurately the ethnographer's degree of involvement in the communication breakdown (active resolution versus passive resolution). The paper concludes that Agar's model provides a useful structure for developing a systematic ethnographic language that can readily be demonstrated and communicated to clinicians.
Based on ethnographic research in Addis Ababa, Ethiopia, this paper describes NGO efforts to encourage AIDS care volunteers to eschew material returns for their labor and instead reflect on the goodness of sacrificing to promote the survival of people living with HIV/AIDS. Consensus analysis of motivational survey data collected from a sample of AIDS care volunteers (n=110) suggests that they strongly share a sacrificial and prosocial motivational model. These results may be explained by several factors, including the efforts of the organizations to shape volunteers' motivations, the self-selection of volunteers, positive reinforcement in seeing one's patients become healthy, and social desirability bias. In-depth interviews examining the motivations and behaviors of volunteers reveal a more complicated picture: even ostensibly devoted and altruistic volunteers strongly question their service commitments. The complexity and ambivalence of volunteers' motivations reflect the profound uncertainty that they face in achieving improved socioeconomic status for themselves and their families amid widespread unemployment and sharply rising food prices. Their desires for economic opportunities explain why local NGOs exert so much effort to shape and sustain-and yet fail to completely control-their motivations. This recasts economically-insecure volunteers' consent to donate their labor as a process of negotiation with their organizers. Future research should explore how models of health care volunteerism and volunteer motivations are shaped by individual and collective experiences in political-economic context.
Statewide statistics suggest that problems relating to alcohol abuse represent a major public health problem for Native Alaskans but very little is known about alcohol use on a community level, due to deficient reporting mechanisms and a lack of relevant research. The research reported here was designed to begin to fill this stated need. Alcohol use patterns, the extent of drinking, and associated problems as perceived by residents of two Alaskan Eskimo villages are documented. The structure and effects of alcohol programs in the villages, which represent local attempts to manage alcohol, are also examined. The research demonstrates that it cannot be assumed that all Native Alaskan communities have the same scale of drinking and consequent problems. Differential response to alcohol programs, which have essentially the same structure, is demonstrated and related to the recent development of contrasting levels of community organization in the two villages, which share a common cultural tradition. The utility of a comparative case study approach in examining alcohol problems in Native American communities and the need for expanded research for informed alcohol program planning and implementation are emphasized.
This is a case study in techniques for combining qualitative and quantitative data in local community service needs assessments. Problems in available administrative statistics when applied to local communities are illustrated and discussed. Supplementation of epidemiologic estimates and utilization statistics with ethnographic, historical, and sample survey data is shown.
The usefulness of "stake in society" theory, a form of transactional theory employed by John J. and Irma Honigmann to explain abandonment of frontier-type norms regarding alcohol use by modern Arctic townsmen, is tested in conjunction with differential response to treatment by a group of 110 Navajo alcoholic men.
In a modified usage, "stake" is operationally defined by type. It is postulated that many of the men had suffered initial loss of stake in the context of lack of negative sanctions regarding heavy alcohol use in Navajo culture. Navajos who regained a stake in the old society during treatment tended to conform to new norms in the family context, while those who acquired concurrent stakes in both old and modern society were even more outstanding in their adherence to new norms. The failure of those with modern stake alone to acquire new norms regarding alcohol use is tentatively explained in terms of lack of a reference group other than the drinking fellowship, suggesting that what appears to be a preferable stake may not be regarded as such when it is in the context of what the Cornell study (Leighton et al. 1963) refers to as interference with essential striving sentiments of love and recognition, hence in such cases new norms will not take precedence over old. A model for the wider use of stake theory is presented.
Increasing numbers of individuals are surviving to retirement age in relatively good health. With the loss of the work role and other roles typically associated with middle age, they are faced with the dilemma of the "roleless role," an absence of well-articulated, age-appropriate expectations and standards of behavior by which to structure everyday life. Recent anthropological, sociological, and psychological studies indicate the possibility of the development of alternate roles and age-appropriate normative systems in age-homogeneous environments. An example of one such alternate behavioral system is provided from data collected on a small retirement community in the Midwest. A normative system seems to have developed in which personal qualities such as trust, friendliness, and concern for others are more highly valued than former achievements or occupational status. Residents most frequently cited as having made a good adjustment to aging were not necessarily those who were most active, but rather those individuals who showed a determination to "keep going," lacked self-pity, kept mentally alert and aware, were willing to help others, and showed a sense of responsibility to the community. Various roles were developed and were expected to be assumed by incoming residents: alternate "work roles," represented by committee memberships and volunteer activity; "family roles," represented by the supportive or helping relations adopted toward other residents; and leisure-type roles. These behavioral standards and expectations helped to structure the relationships and everyday life of residents within the community.
While more than 99% of all American babies are delivered by obstetricians, the majority of Taiwanese babies are delivered by midwives. The history of traditional and professional midwives in Taiwan is reviewed. Taiwanese midwives operate their businesses according to the principles of client-centered health service. They also serve many social and religious, as well as health, needs of their clients. This system contrasts with that in operation in the U.S. where pregnant women utilize physician-centered, not client-centered, maternity care. The role of the Taiwanese midwife in the management of childbirth is described. Postpartum care provided by the midwife includes nutrition information and initial care of the infant once the mother returns home. The role of the midwife in relation to abortion, adoption and other obstetric and gynecologic services is explained. The American system of childbirth might be made more flexible and acceptable if the client-centered features of the Taiwanese system could be incorporated into the modern American health care system.
This paper reports the results of a survey of 200 households in Boston's Chinatown. The dependent variable, types of medical care, was divided into four user patterns: (1) Chinese medicine only; (2) predominantly Western medicine; (3) predominantly Chinese medicine; and (4) equal use of Western and Chinese medicine. Predictor variables included demographic variables, beliefs about medical practices, and ethnic solidarity. Multiple discriminate analysis was used as the main technique of analysis.
The findings suggest that a significant diversity of user patterns exists within the Chinese-American community studied. This finding casts doubt on those studies which treat ethnic groups as uniform structures. More interestingly, predictor variables were discovered which account for the type of care used, either Chinese medicine, Western medicine, or combinations. Finally, the predictor variables for male respondents were not the predictors for females. Ethnic solidarity, for example, was an important predictor for males but was insignificant for females. Implications for theory are discussed.
In medical school the prescribed course work for medical students takes most of their time. Because of the extensive and fixed scheduling, it is a challenge to find ways to expose students to the concepts of anthropology. One of the possibilities is a short-term elective. Interest in American Indians is at an all time high and medical students share in this interest. For an elective at a clinic in New Mexico serving Navajo, Spanish Americans, and Anglos, we have devised a course which we think does a good job alerting students to cultural and social factors in the definition of illness, the decision to seek treatment, the interpretation of the clinic experience, and the course of therapy.
Described in this paper is a clinical anthropology therapy facilitator role developed on an acute care psychiatry ward of a teaching hospital in Hawaii serving a multiethnic population. The role was developed to provide student clinicians an opportunity to enhance their psychosociocultural evaluation and communication skills on the ward by working with a clinical anthropologist on a case-by-case basis. Discussed is the concept of therapy facilitation, role development, student-staff evaluation of the role, and the types of problems and dilemmas faced by an anthropologist assuming this role.
George M. Foster is the 1982 recipient of the Malinowski Award, presented at the 42nd Annual Meeting of the Society for Applied Anthropology, Lexington, Kentucky. This annual award is given to a senior colleague in recognition of efforts to understand and serve the needs of the world through social science. The following is Professor Foster's acceptance speech. IS A HIGH HONOR INDEED to be the recipient of the Tenth Malinowski Award, thus to be associated with the names of Bronislaw Malinowski and of my nine distinguished predecessor recipients. When Peter New advised me of my selection, I experienced mixed emotions: first, pleasure and appreciation, and second, concern as to my topic. Fortunately, colleagues came to my rescue; several suggested that I talk about the involvement of anthropologists in international health programs, a field to which I have been exposed for more than 30 years. Hence, the title of this address. Specifically, I propose to note the early events that drew anthropologists to the international health field, to take stock of where we are today, and to suggest the opportunities and problems we may encounter in the future development of the field.' To limit my remarks to reasonable length I exclude mental health and family planning, and restrict myself largely to American anthropology. I use the term "international health programs" to denote those national and international efforts designed to improve the health care services of peoples who, until recent years, have relied largely or entirely on indigenous medical resources. These include most of the people, both urban and rural, in developing countries, and substantial numbers of minority ethnic groups in some industrialized countries. The common characteristic of these programs is that they are cross-cultural: historically, health care providers and health care recipients have represented distinct cultural, social or ethnic groups. Whatever the setting, the basic problems associated with planning and delivery of health care, and utilization of services, are essentially the same. A generation ago physicians and anthropologists alike defined the problem of providing better health care for traditional peoples as how to persuade them to accept scientific medicine. As anthropologists, our fundamental research task was to learn those things about the health beliefs and practices of these peoples that would enable health care providers to convince them of the superiority of modern medicine over their traditional therapies. Our practical goal was to further effective cross-cultural communication which, we assumed, would lead to scientifically acceptable health beliefs and behavior.
During the summer of 1972 in-depth interviews were conducted with 96 Shoshone and Arapahoe Indian women living on the Wind River Reservation in Central Wyoming. All were aged 15-49 and were users of the reservation health service. It was found the women fell into 4 groups: current contraceptive users, 42.7%; pregnant or seeking to become pregnant, 10.4%; infertile due to menopause or sterilization, 18.8%; and fertile never-users, 28.1%. The contraceptive users tended to be older, married, and have as many children as they want. The fertile never-users tended to be in their teens and generally unmarried. When asked why they did not use contraception their answer was ''because I am not married.'' It is suggested that general education on contraception be provided the younger women so that when they achieve desired family size they will be informed as to family planning methods. It was found that religious belief against contraception was important to the young never-users, but not to the women who had completed their families. In fact, 73% of the users said their religion, which most identified as Roman Catholicism, had no influence on their contraceptive use while 27% said they were aware of church disapproval but used contraception anyway.
An axiom of family planning programming is the importance of culturally-appropriate communicators and motivators. Traditional midwives seem ideal for this task but few studies have been done to verify this assumption by analyzing the midwife's social role as perceived by the community. 325 married women and 81 unmarried girls from a "model village" near Shiraz were interviewed by female undergraduates. 82.5% of the women are of childbearing age; 66% married before 14 years; 33% use contraception, mostly the pill, but most want large families because they expect high child mortality rates. Most of the older women are able to assist in childbirth but none, except the village's one recognized midwife, who is considered to have divine backing, will do so except in an emergency. The midwife's activities cause her to be held in low esteem by the community because 1) she has contact with a woman's sexual parts and this fact is public; 2) she has contact with vaginal excretia which are, in Islam, polluting; and 3) she is paid for her services, which labels her as a woman "without shame". The midwife is, however, widely used since women and their husbands fear the trip to the hospital and treatment by a male doctor much more than a midwife-supervised birth. The midwife in the study village had been there only 2 years and feels that she is not fully trusted. She is not consulted on birth control at all, because women expect the pill to be dispensed by doctors and consider other methods as a matter strictly between husband and wife. The midwife's role seems to complement that of the government health authorities rather than compete. The midwife's low status and circumscribed sphere of activity, the weak respect in which her advice is held and the pattern of having only 1 recognized midwife in a village at a time make the midwife a poor agent for family planning services. Her effectiveness as an agent of social change could be improved by training her in hygienic practices of childbirth and by redefining her role-relationship with the community. Studies should be done to identify the areas where traditional birth attendants are the best family planning communicators and those where that role is best left to others.
This paper reports on the use of two lead compounds, greta (PbO) and azarcon (Pb3O4) currently being used as folk remedies in Mexican-American communities. These compounds have produced cases of acute lead poisoning. The compounds are two of more than 100 treatments for the culture-bound syndrome "empacho" A survey of over 2,000 informants in 35 clinics indicates that at least one person in approximately ten percent of the participating households had been administered this remedy. A subsequent concurrent clinic and household survey demonstrated no significant difference in use by clinic populations as opposed to a community-based sample. Data are also presented on other potentially toxic substances used to treat empacho. The results of this research suggest that analysis of other ethnomedical systems should be undertaken to determine whether or not toxic substances are present in them as well.
The free neighborhood health center in a Midwest U.S. town was developed in response to a report that indicated that infant mortality rates were higher for the Black community than for the community-at-large. The health center soon took on the full range of health problems brought by clients regardless of client's race, ethnicity, or income. The processes for managing health care problems in an environment where racism was the rule rather than the exception are considered in this study.
Since the death of Chairman Mao the emphasis of primary health care in China seems to have reverted to the "old days" (before 1949) when rural health care was non-existent. There is some evidence that recent shifts toward high technology medicine and specialization mean a return to urban, hospital-based care. This paper will review briefly the history of health care from the time when medical missionaries first introduced Western health care to the changes which the current government brought about from 1949-1976. I will analyze the possible consequences of renewed emphasis on specialization and high techology medicine.
The Barefoot Doctor policy of the Peoples Republic of China (PRC) has recently been changed. Rather than remaining a permanent corp of paraprofessionals, Barefoot Doctors (BFD) are to be upgraded, certified, and paid wages for full-time medical work in a process of slow professionalization. This article includes a brief historical description of BFD policy evolution and a literature review that notes problems in the equitable implementation of the original policy. An update in information is added based on original material collected in 1979 and 1981, providing a current picture of efforts to implement the new professional focus. While BFDs everywhere are taking the certification examinations, there are almost no signs of other features of the new policy.
The Barefoot Doctor policy of the Peoples Republic of China has recently been changed. Rather than remaining a permanent corp of paraprofessionals, Barefoot Doctors (BDF) are to be upgraded, certified, and paid wages for full time medical work in a process of slow professionalization. This article includes a brief historical description of BFD policy evolution and a literature review that notes problems in the equitable implementation of the original policy. An update in information is added based on original material collected in 1979 and 1981, providing a current picture of efforts to implement the new professional focus. While BFDs everywhere are taking the certification examinations, there are almost no signs of other features of the new policy which include: new standards with increased emphasis on medical work; a 2 level system of examinations (competency test and advanced certifying examination for "country or village doctor"); reserved places for the most promising BFDs in medical schools; work as full time practitioners; salaries instead of workpoints. Tables include information on the distribution of BFDs and specific training programs.
One class of traditional Dinka healers is a practical surgeon-bonesetter-obstetrician who practices (all but obstetrics) on both people and animals. His anatomical, physiological, and pathological knowledge and surmises, derived almost entirely from observations on cattle, are in some respects remarkable, especially those on the function of the kidney and nature of the circulatory system. He shares with ancient Egyptian healers the belief that sperm originate in the spinal cord and brain and performs a unique surgical operation on the horns of bulls that has been known in the Nile valley since the Egyptian 5th dynasty. With minimum training he might function effectively within the governmental health and veterinary services of the southern Sudan, an area populated mostly by transhumant cattle-culture peoples not easily reached through conventional health services.
Virtually all migration research examines international migration or urbanization. Yet understudied rural migrants are of critical concern for environmental conservation and rural sustainable development. Despite the fact that a relatively small number of all migrants settle remote rural frontiers, these are the agents responsible for perhaps most of the tropical deforestation on the planet. Further, rural migrants are among the most destitute people worldwide in terms of economic and human development. While a host of research has investigated deforestation resulting from frontier migration, and a modest literature has emerged on frontier development, this article explores the necessary antecedent to tropical deforestation and poverty along agricultural frontiers: out-migration from origin areas. The data come from a 2000 survey with community leaders and key informants in 16 municipios of migrant origin to the Maya Biosphere Reserve (MBR), Petén, Guatemala. A common denominator among communities of migration origin to the Petén frontier was unequal resource access, usually land. Nevertheless, the factors driving resource scarcity were widely variable. Land degradation, land consolidation, and population growth prevailed in some communities but not in others. Despite similar exposure to community and regional level push factors, most people in the sampled communities did not out-migrate, suggesting that any one or combination of factors is not necessarily sufficient for out-migration.
This report profiles the woman at highest risk of a low birthweight delivery and infant death, in a generally disadvantaged, Black population in a major northeastern city which maintains one of the highest infant mortality rates in the nation. It discusses the existence of a very high risk subpopulation which contributes disproportionately and repeatedly to the infant and perinatal death statistics. If adequately identified, these women can be subject to intervention programs. Results show that within an inner-city Black population, where educational levels are relatively low and much of the reproductive segment is young and unmarried, the standard identification criteria of age, education, and marital status do not vary with poor pregnancy outcome. Furthermore, certain factors associated stereotypically with inner city lifestyle, such as drug abuse and venereal disease, also fail to distinguish women having normal and very low birthweight infants. Instead, alcoholism, smoking, low maternal weight at delivery, hypertension history, migrant status, ineffective contraception, prenatal care, violence, and relatively poor psychological adjustments and social support systems distinguish the study samples.