Journal - Medical anthropology (England )

Abstract :

Data from this multiyear qualitative study of the effects of Hurricane Katrina and flooding in New Orleans suggest differences in how the elderly cope with disaster. At the time of the disaster, the elderly of New Orleans were at greater risk than other groups, and more elderly died than any other group during the storm and in the first year after. Those who did survive beyond the first year report coping with the long-term disaster aftermath better than the generation below them, experiencing heightened stresses, and feeling as if they are "aging" faster than they should. We offer insight on how we might define and characterize disasters, and illustrate that long-term catastrophes "age" in specific ways.

Journal - American ethnologist

Abstract :

Many New Orleans residents who were displaced in 2005 by Hurricanes Katrina and Rita and the subsequent levee failures and floods are still displaced. Living with long-term stress related to loss of family, community, jobs, and social security as well as the continuous struggle for a decent life in unsettled life circumstances, they manifest what we are calling "chronic disaster syndrome." The term refers not only to the physiological and psychological effects generated at the individual level by ongoing social disruption but also to the nexus of socioeconomic and political conditions that produce this situation as a long-term and intractable problem. Chronic disaster syndrome emerges from the convergence of three phenomena that create a nexus of displacement: long-term effects of personal trauma (including near loss of life and loss of family members, homes, jobs, community, financial security, and well-being); the social arrangements that enable the smooth functioning of what Naomi Klein calls "disaster capitalism," in which "disaster" is prolonged as a way of life; and the permanent displacement of the most vulnerable populations from the social landscape as a perceived remedy that actually exacerbates the syndrome.

Journal - Social science & medicine (1982) (England )

Abstract :

Recent shifts in the global health infrastructure warrant consideration of the value and effectiveness of national public health campaigns. These shifts include the globalization of pharmaceutical research, the rise of NGO-funded health interventions, and the rise of biosecurity models of international health. We argue that although these trends have arisen as worthwhile responses to actual health needs, it is important to remember the key role that public health campaigns can play in the promotion of national health, especially in developing nations. Focusing on an example set by China in response to a public health crisis surrounding the national need for a clean and adequate blood supply and the inadvertent spread of HIV by way of blood donation in the early 1990's, we argue that there is an important role for strong national public health programs. We also identify the key factors that enabled China's response to this burgeoning epidemic to be, in the end, largely successful.

Journal - Culture, medicine and psychiatry (Netherlands )

Abstract :

Procedures of Informed Consent are considered a high priority for international biomedical research. However, informed consent protocols are not necessarily transferable across cultural, national or ethnic groups. Recent debates identify the need for balancing ethical universals with practical and local conditions and paying attention to questions of cultural competence when it comes to the Informed Consent process for clinical biomedical research. This article reports on the results of a two-year effort to establish a culturally appropriate Informed Consent process for biomedical research in the Tibet Autonomous Region in the People's Republic of China. A team of Tibetan and American researchers, physicians, health professionals and medical anthropologists conducted the research. The Informed Consent was specifically for undertaking a triple-blind, double placebo-controlled randomized clinical trial of a Tibetan medicine compared with Misoprostol for reducing postpartum blood loss. The findings suggest greater need for flexibility and cooperation in establishing Informed Consent protocols across cultures and nations.

Journal - Medical anthropology (United States )

Abstract :

Social theorists have explored the ways in which quantification serves as an instrument of governance in the modern state, whether tied to concerns of population size and quality or to problems of social behavior. Biopolitics are as visible in the modern socialist states as they are in free-market democratic states, and they are perhaps nowhere more visible today than in the new global standards of "evidence-based medicine," wherein it is assumed that only quantifiable evidence can serve to establish policy, procedure, and outcome. When it comes to creating ways to "civilize" and organize their target citizenry through health development, Socialist China as relied on such technologies as much as have health development funding agencies from donor countries. In this article, I look at quantitative methods in relation to assumptions that morality can be severed from truth and that numbers are potentially morally neutral. This idea is tied not only to forms of modern subjectivity but also to the distinct ways in which certain linguistic and theoretical practices relate to provisional notions of "lying," "truth-telling," and ways of "believing." An exploration of the effects of attempts to quantify maternal behavior, morbidity, and morality in rural Tibet highlights the problem of morality within an environment in which numbers are never free-standing but, rather, are always presumed to carry moral messages, and in which domains that cannot be quantified serve as a primary basis for knowing truth. Through an exploration of rural Tibetan encounters with health development programs for safe motherhood, I provide a critique of quantification and return to questions about "belief" as a rubric that interrupts modern dichotomies of lies versus truths.

Journal - Medical anthropology quarterly (United States )

Abstract :

Efforts to conduct Western clinical research in non-Western medical settings with little or no familiarity with such methodologies are on the rise, but documented accounts of the ways that biomedical science requires negotiation and translation across cultures are not plentiful. This article adds to this literature through analysis of an NICHD-funded collaborative research effort in women's health carried out in the Tibetan Autonomous Region of the People's Republic of China. The research involved a feasibility study for an eventual clinical trial comparing Tibetan medicine with misoprostol for preventing postpartum hemorrhage in delivering women. It explores strategies of negotiation and translation in and around notions of the scientific method, informed consent procedures, randomization, blinding, placebo, and concepts of medical standardization.

Abstract :

DESCRIPTION (provided by applicant): The overall aim of this qualitative, anthropological research is to examine the process of disruption and life reorganization after a disaster, namely Hurricane Katrina, for people ages 50-80. Aims are to examine how age, race/ethnicity, socioeconomic status, health, and family relationships affects life reorganization after displacement, and how people adjust to unwanted, catastrophic change over time. The full range of this experience is addressed in a 48-month project by studying 180 African Americans and European Americans in two groups of 90 each who were living either below or slightly above the poverty line at the time of the disaster. Respondents will be interviewed longitudinally, with 3 interviews taking place over a one-year period. Qualitative analysis will be undertaken in a systematic progression of steps and will be supported by quantitative analysis of health measurement data, measures, and qualitatively-derived data. Relevance: The proposed study has potential for application of preventive strategies in future disasters, as well as in public health and clinical management of older people's health. Examining the process of unwanted change in later life can provide many insights about how people deal with change, the ways they adjust and accommodate it in daily life, and the effects of unwanted change on health and well-being.

Abstract :

DESCRIPTION (provided by applicant): The overall aim of this qualitative, anthropological research is to examine the process of disruption and life reorganization after a disaster, namely Hurricane Katrina, for people ages 50-80. Aims are to examine how age, race/ethnicity, socioeconomic status, health, and family relationships affects life reorganization after displacement, and how people adjust to unwanted, catastrophic change over time. The full range of this experience is addressed in a 48-month project by studying 180 African Americans and European Americans in two groups of 90 each who were living either below or slightly above the poverty line at the time of the disaster. Respondents will be interviewed longitudinally, with 3 interviews taking place over a one-year period. Qualitative analysis will be undertaken in a systematic progression of steps and will be supported by quantitative analysis of health measurement data, measures, and qualitatively-derived data. Relevance: The proposed study has potential for application of preventive strategies in future disasters, as well as in public health and clinical management of older people's health. Examining the process of unwanted change in later life can provide many insights about how people deal with change, the ways they adjust and accommodate it in daily life, and the effects of unwanted change on health and well-being.

Abstract :

DESCRIPTION (provided by applicant): This Exploratory Research Award (R-21) will identify the specific cultural, social and structural factors that underlie low rates of voluntary blood donation in China. It will contribute to public health programs that seek to increase voluntary donation for the purpose of preventing the transmission of HIV and other blood-borne viruses via the transfusion of contaminated blood from illegal paid donors. This study will also provide data necessary to determine the scope and feasibility of a larger R01 study. The research will occur under the auspices of the UCSF Center for AIDS Prevention, with the cooperation of the Shanghai Academy of Social Sciences. The PI, a medical anthropologist, has expertise in conducting long-term ethnographic research in urban China, and is fluent in Mandarin. Her training in HIV prevention research is complemented by the expertise of three Senior Advisors in blood banking and blood donor research in the US and China, and in the development of international HIV prevention research. Employing in-depth interviews, field observations at blood centers and clinics, family and social network discussions, and secondary quantitative data, the research will explore the salience of six hypothesized cultural, social, and structural factors for shaping blood donation in urban China. Reluctance to give blood may be related to 1) the meanings of a gift, and reciprocity as the basis for kin and social relations; 2) notions of blood as a life force in Chinese medicine; 3) the gendered symbolism of blood and nurturance; 4) public mistrust of clinical procedures and staff training; 5) lack of access and information; and 6) demographic factors. As exploratory research, the project may uncover additional important factors. The study's specific aims are to: 1) examine the relative importance of emic cultural beliefs that may shape blood donation; 2) examine the relative importance of social and structural factors that may facilitate or inhibit donation; 3) advance theoretical and practical public health knowledge of the processes by which motivations and intentions to voluntarily donate blood are formed among urban Chinese; 4) generate data necessary to determine the scope and feasibility of future research. Data collection will occur in Shanghai; overall project oversight and data analysis will occur in San Francisco, CA.

Abstract :

DESCRIPTION (provided by applicant): This Exploratory Research Award (R-21) will identify the specific cultural, social and structural factors that underlie low rates of voluntary blood donation in China. It will contribute to public health programs that seek to increase voluntary donation for the purpose of preventing the transmission of HIV and other blood-borne viruses via the transfusion of contaminated blood from illegal paid donors. This study will also provide data necessary to determine the scope and feasibility of a larger R01 study. The research will occur under the auspices of the UCSF Center for AIDS Prevention, with the cooperation of the Shanghai Academy of Social Sciences. The PI, a medical anthropologist, has expertise in conducting long-term ethnographic research in urban China, and is fluent in Mandarin. Her training in HIV prevention research is complemented by the expertise of three Senior Advisors in blood banking and blood donor research in the US and China, and in the development of international HIV prevention research. Employing in-depth interviews, field observations at blood centers and clinics, family and social network discussions, and secondary quantitative data, the research will explore the salience of six hypothesized cultural, social, and structural factors for shaping blood donation in urban China. Reluctance to give blood may be related to 1) the meanings of a gift, and reciprocity as the basis for kin and social relations; 2) notions of blood as a life force in Chinese medicine; 3) the gendered symbolism of blood and nurturance; 4) public mistrust of clinical procedures and staff training; 5) lack of access and information; and 6) demographic factors. As exploratory research, the project may uncover additional important factors. The study's specific aims are to: 1) examine the relative importance of emic cultural beliefs that may shape blood donation; 2) examine the relative importance of social and structural factors that may facilitate or inhibit donation; 3) advance theoretical and practical public health knowledge of the processes by which motivations and intentions to voluntarily donate blood are formed among urban Chinese; 4) generate data necessary to determine the scope and feasibility of future research. Data collection will occur in Shanghai; overall project oversight and data analysis will occur in San Francisco, CA.