Volume 56, No. 1, Spring 1997
The Quality Movement in U.S. Health Care: Implications for Anthropology
Irwin Press
Key words: Hospitals, TQM, consulting, quality improvement, organizational culture, US
A growing trend in U.S. health care may provide unprecedented opportunity for introducing many of anthropology's concerns and concepts within the clinical setting. Faced with increasing competition, plus demands from payers and accrediting entities that they prove their quality, hospitals are attempting to apply principles of Total Quality Management (TQM) to improve performance. TQM stresses the systemic (functionally integrated) nature of hospital organization, as well as the impact of organizational culture on the effectiveness of policies and processes. It is argued that these principles (coupled with hospital administrators' growing familiarity with the concept of "culture") fit neatly with anthropology's core paradigm. Several short term consulting examples reflect the susceptibility of hospital quality issues to anthropological insight. It is suggested that Anthropology is uniquely qualified to contribute to the evolving "quality movement." By so participating, we may be able to introduce and perhaps institutionalize our insights and values at the influential administrative level of health care.
A Native American-Based Cultural Model of Substance Dependency and Recovery
Linda K. Watts and Sara E. Gutierres
Key words: Native American alcoholism, cultural models, traditional healing methods, US, Arizona, Phoenix
The purpose of this study was to identify cultural themes associated with alcohol and drug dependency that may reflect fundamental traditional Native American beliefs and values. Qualitative interviews were conducted with 58 clients at three residential treatment facilities in Phoenix, Arizona. Discourse-based content analysis of the interview data reveals several highly shared conceptions regarding significant life event situations surrounding alcohol and drug dependency from the perspective of these Native American respondents. A folk-theoretic, cultural model of the development and successful recovery from substance dependency emerges from an interpretive analysis of the most salient themes evident in these interview data.
Impact of an Outbreak of Dengue Fever: A Case Study from Rural Puerto Rico
M. Idalí Torres
Key words: dengue fever, disease outbreak, medical anthropology, women, Puerto Rico
This study documents the impact of an outbreak of dengue fever for the people who experienced the disease in Lares, a rural municipality in Puerto Rico. Symptomatology presented by reported cases of the fever corresponds to the clinical picture of the mild form of the dengue virus. The study utilizes a combined quantitative/qualitative methodological approach. The findings indicate that social status is a significant factor in terms of who is affected by the dengue fever. The impact of the outbreak was greater for poor communities in the urban and semi-rural areas, particularly for women who described themselves as housewives and mothers, and their children. Social expectations and the family's demands for these women to fulfill the role of caretaker superseded their own sick role. In addition, they experienced the greatest loss of time as a consequence of the outbreak. The main effect of the outbreak on work activities not traditionally remunerated with money, such as housework, was the inability of adult females in the household to perform their routine activities to maintain family life. Moreover, the monetary costs of health care absorbed a significant percentage of the household weekly income. The impact on psychological well-being was related to the stress produced by the clinical, social, and economic consequences of the outbreak for women. Implications of salient results for dengue fever prevention and control, as well as for the field of applied medical anthropology are discussed.
Traditional Healing: The Epistemology of Systems
Russel Barsh
Key words: medicine, epistemology, ethnoscience, ethnomedicine, ethnopharmacology, methodology
The number of in vitro and clinical trials of traditional or "folk" remedies has been growing rapidly. Overall, the results indicate a high degree of efficacy for indigenous pharmacopoeia, although some individual remedies seem ineffective or toxic. Since comparatively little attention has been devoted to the prescription of traditional remedies, however, this efficacy has probably been underestimated. Current field research makes assumptions about the legal structure and pedagogy of traditional healing systems, furthermore, which invite significant errors. Traditional healing systems do not simply match drugs with diseases, but acknowledge the individuality of patients' physiologies, and employ complex models for combining remedies into individually-tailored compounds. The extent to which healers engage in innovation, experimentation, and exchange of experience must also be recognized.
Beyond the Sexual Monad: Combining Complementary Cognitions to Explain and Predict Unsafe Sex among Gay Men
John Vincke and Ralph Bolton
Key words: risky sex, HIV/AIDS prevention, sexual dyads, gay male sexuality, cluster analysis, Belgium
Successful HIV prevention depends on delivering messages appropriate for specific, targeted audiences. In this article we document the existence of three naturally-occurring clusters of Flemish gay men based on their patterns of participation in eight forms of sexual behavior. Manova and discriminant analysis indicate that the clusters differ significantly in the assessment of both the pleasures and dangers of unprotected penetrative sexual practices. The complementarity of group differences underscores the critical importance of the dyadic dynamics in the etiology of risk taking with respect to the potential transmission of HIV during a sexual encounter. This dyadic approach to understanding risky behavior is contrasted with the individualistic paradigms which currently dominate the field of AIDS prevention research. We find that most of the social and psychological variables used in previous models lose their explanatory power when they are analyzed using groups based on sexual style rather than on the etic dimension of riskiness. The implications of the findings for the design of HIV interventions are discussed.
Doing Gender, Doing Surgery: Women Surgeons in a Man's Profession
Joan Cassell
Key words: gender, professions, surgery, women, US
A central issue in the study of gender is whether women and men are fundamentally different or essentially the same. "Difference theorists" contend that women are, or tend to be, more nurturing, caring, and cooperative, as opposed to men, who are more independent, detached, and hierarchical. Inquiring whether women surgeons differ from their male colleagues, however, produced ambiguous and confusing data. More successful was an approach that examined process and interaction, rather than seeking binary oppositions and hypothesizing about deep structure. Concentrating on the processes of "doing" or "negotiating" gender made sense of otherwise confusing findings. In a profession where men (surgeons) traditionally "do dominance" while women (nurses) "do deference," female surgeons are sanctioned for displaying the dominant and agonistic behavior exhibited by their male colleagues.
Imen-Delphi: A Delphi Variant Procedure for Emergence
David Passig
Key words: Delphi variant, Imen-Delphi (ID), change, emergence, Jewish education, teenagers, forecasting methodology, USA.
Since its introduction in the early 1950s, the Delphi technique has experienced ever-increasing utilization, variants, praise, and criticism. The purpose of this article is to propose an evolutionary variant called Imen-Delphi for futures research. This article suggests that an Imen-Delphi procedure may be appropriate as a research technique to improve the efficiency of a group of panelists to invent change. This article describes the Imen-Delphi's design and procedure, alongside details of a real world example of its use in engaging a group of participants to redefine a relevant future-mission for their educational institute.
Some Methodological Issues in Counting Communities and Households
Richard Wilk and Stephen Miller
Key words: census, community, household, methodology, Belize
In this article we discuss some of the limitations of conventional census techniques that assign all individuals to a single household in a single community. In areas with high rates of mobility and where people may belong to several households, traditional census methods can lead to very deceptive results that are poor guides for policy making and the delivery of services. The article suggests some ways census methods could be improved, so they can yield more informative and useful results.
Mapping Conflict Cultures: Interpersonal Disputing in a South African Black Township
George J. McCall, Jacquie Ngeva, and Mpumie Mbebe
Key words: culture, domain, ethnosemantic, dispute resolution, South Africa, Johannesburg, Alexandra
Even in socially diverse communities, who fights about what, and how different sorts of disputes get handled, are culturally patterned features of social living. Cognitive anthropologists have devised techniques for systematically mapping cultural domains, and this article applies one such technique (ethnosemantic domain definition) to mapping community beliefs about disputes and dispute handling. That application is illustrated through a cultural-informant study, conducted in 1992, of such beliefs within a highly diverse black township adjoining Johannesburg, South Africa.
Limitation of Human Rights, Land Exclusion, and Tribal Extinction: The Agta Negritos of the Philippines
Thomas N. Headland and Janet D. Headland
Key words: Human rights, Negritos, Agta, competitive exclusion principle, community development, ethnocide, Philippines
Southeast Asia's many Negrito groups have suffered formidable human rights violations during the past century. This article documents some of the abuses that have occurred in one particular Negrito society in the Philippines, the economic and demographic effect these abuses have had on that society, and how the members of that society are today responding (or failing to respond) to what is happening to them. The authors apply the competitive exclusion principle as a heuristic device for exploring why this social injustice is found worldwide whenever small-scale ethnic peoples are outnumbered by more powerful societies.
The Epistemology of Sustainable Resource Use: Managing Forest Products, Swiddens, and High-Yielding Variety Crops
Michael R. Dove and Daniel M. Kammen
Key words: sustainable resource use, exchange, swidden agriculture, HYV/green revolution agriculture, Borneo, Java, Indonesia
This study examines the moral ecology of resource use through a comparison of the ideological bases of three systems of resource use in Southeast Asia: gathering forest products (viz., forest fruit), swidden agriculture, and the cultivation of high-yielding variety, green revolution crops. A trade-off between the magnitude of return and the frequency of return is accepted in the first two systems, but this is denied in the third system in which there is, instead, insistence on the possibility of continuous, high-magnitude returns. In the fruit- gathering and swidden cultivation systems there is recognition of linkages to the wider temporal and spatial processes in which they are embedded, but in the green revolution system there is only a very narrow view of these linkages. Whereas the necessity of reciprocal exchange with their wider social and natural environments is accepted in the first two systems, such exchanges are minimized in the green revolution system. This study contributes to current debates about sustainable resource use, the conception of nature and culture, and the epistemology of science and the contemporary role of anthropology.
Institutions, Inequalities, and the Impact of Agrarian Reform on Rural Mexican Communities
Pete Brown
Key words: agrarian reform, community, ejido, Mexico
In 1992, Mexico revised its agrarian code ending the redistribution of land and allowing the privatization of Mexico's ejidos. This article examines the potential impacts of these changes through a comparison of two communities, one ejido, the other private property - a comparison that mirrors the changes introduced in the new agrarian reform. I document how the communities' foundation under these two different institutions profoundly shaped the historical and contemporary structure of landholdings and community relations. The ejido community was characterized by greater equality and community solidarity, and fewer social problems. The private property community had extreme inequalities, community relations divided by class interests, and newly-developed social problems. These differences, I argue, presage impending changes in agrarian communities throughout rural Mexico.
Development: Reflections from Bolivia
James C. Jones
Key words: development, Latin America, Bolivia.
The results of development are now widely thought to have betrayed expectations. Using illustrations from Bolivia, this essay argues that these dispiriting results often owe to distortions that render development something other than what it pretends to be, or is usually understood to be. The distortions derive from the use of inappropriate mental constructs, from links to foreign policy, from "expert" ignorance, and from weak sensitivity by development agencies to how their interventions are construed by local economic and power elites. While these agencies have formal mechanisms to correct some of the distortions, the mechanisms too often fail to work. Correcting these distortions is a daunting task, rooted as they are deep in national institutions and conceptions of national interest. The end of the Cold War nonetheless affords an auspicious moment for doing so. Indeed, not to is to risk turmoil in regions like Latin America. Yet international capitalist powers and local elites are not seizing the moment; exulting victory, they continue down old paths. Further alarming is the anti-aid sentiment in the United States and Europe, with consequent political advocacy ranging from abolishment to varying degrees of reform under large budget cuts.
Commentary: Cultural Anthropology Research Support at the National Science Foundation, 1991-95
Margaret Mastriana and Stuart Plattner
