I was just reading a post from development economist Ed Carr’s blog, where he reflects on a book he wrote almost five years ago. Reflection is a pretty depressing excercise for any academic, but Carr seems to remain positive about his book.
He sums it up in three points:
“1. Most of the time, we have no idea what the global poor are doing or why they are doing it.
2. Because of this, most of our projects are designed for what we think is going on, which rarely aligns with reality
3. This is why so many development projects fail, and if we keep doing this, the consequences will get dire”
Well, yeah. This is a huge problem. In academics, we filter the experiences of the poor through a lens of academic frameworks, which we haphazardly impose with often no consultation with our subjects. Granted, this is likely inevtiable, but when designing public health interventions, it helps to have some idea of what the poorest of the poor do and why or our efforts are doomed to fail.
I remember a set of arguments a few years back on bed nets. Development and public health people were all upset because people were seen using nets for fishing. The reaction, particularly from in country workers was that poor people are stupid and will shoot themselves in the foot at any opportunity.
I couldn’t really understand the condescension and was rather fascinated that people were taking a new product and adapting it to their own needs. Business would see this as an opportunity and would seek to figure out why people were using nets for things other than malaria prevention and attempt to develop some new strategy to satisfy both needs (fishing and malaria prevention) at once. Academics simply weren’t interested.
To work with the poor, we have to understand them and understanding them requires that we respect their agency. If we don’t do this, we risk alienating the people we seek to help.
Called “hearsay ethnography,” it makes ethnographers out of non-professional folks who are already embedded within the community. To date, it has been used in understanding the cultural understanding of HIV in Malawi.
We are turning local young people into anthropologists.
Through this technique, we can minimize the observer effect, i.e. the problem of influencing the data collection environment by being the odd, linguistically challenged white people of ambiguous intent. The writers have to write in English, in a manner assumed to be understood by educated folks, which presents problems of its own, but it’s a somewhat more flexible methodology.
It’s a valuable tool for medical anthropology. Through this study, we hope to begin to understand how people in this area conceptualize malaria, malaria treatment and health delivery.
I hired these guys last May, the money ran out, and I thought that the project was just a bust. To my surprise and delight, the data collectors are still writing in their journals and I was finally able to see the results.
Here’s a sample:
I attended the funeral of a child below five years old at Kamyeri. There were so many people who attended irrespective of their age or gender. The discussion about malaria broke out when the child’s father was narrating the cause of her death. He said that many people may think that his daughter had been bewitched but according to him, her death was as a result of his wife’s negligence.
He went on saying that he wasn’t at home when he received the news about her daughter’s illness. He told his wife to take the child to the hospital. However, he arrived home after two days to find out that the child had not been taken to hospital and have not received any kind of medication. He rushed her to the hospital but it was too late because the child died dew hours after the doctor had confirmed that she had serious malaria.
He went on saying if she would have diagnosed early enough, maybe she could have not died.
He added that before someone make or jump to any conclusions about the cause of any illness, he/she should go to the hospital and get tested in order to know the real cause of a disease he/she must be suffering from.
Then an old woman who was just in front of me said that she had informed the child’s mother to take to her the child so that she could treat her through “frito” and “suro.” ”Frito” means a method in which powder traditional herbs are administered to a patient through snifting, while “suro” means a method in which herbs in a powdered form is put on small cuts made using a knife. However, the woman did not turn up instead she went to a preacher to seek divine healing.
The old woman continued saying that the shivering and headache could have been treated using traditional herbs.
Just discovered that this got included in a special supplement of Malaria Journal commemorating the recent “Challenges in Malaria Research” conference in Basel, Switzerland. It was just a poster presentation, but is openly available to all. Thanks to my co-authors. Great work!
Now give me a job.
Knowledge and practices of malaria prevention with ITNs in post-and near-elimination areas of Vanuatu
Peter S Larson1*, Akira Kaneko2, Koji Lum3, Noriko Watanabe4 and Takeo Tanihata5
Insecticide Treated Nets (ITNs) remain an important tool for sustained malaria control and play an integral part in malaria elimination strategies. As malaria incidence decreases in holodemic areas, however, proactive and regular use of ITNs may simultaneously decline if risk perception diminishes.
In Summer 2012, we conducted a cross-sectional survey of three communities in Vanuatu: i) where malaria has been locally eliminated (Aneityum), ii) where malaria remains present but with rapidly declining incidence (Ambae), and iii) an urban area where malaria transmission may or may not occur (Efate). Respondents were asked a battery of questions regarding knowledge of malaria, ITN possession and use, and compliance with other anti-malaria interventions. Information on basic demographics, education levels, dietary habits and household economic activities were also recorded.
Residents of Aneityum (malaria eliminated) reported near universal use of ITNs, but uneven knowledge of malaria, particularly in younger individuals born around the time of malaria elimination. Residents in the other communities reported less consistent, though high levels of ITN use despite past individual malaria diagnoses.
Results indicate that achieving sustained high levels of ITN use in near- and post-elimination contexts is possible, but that maintaining awareness could present a long-term challenge to prevent reintroduction and recrudensence. Sustained local community cooperation will be essential to maintaining elimination efforts worldwide.