The Narcoeconomy and Small-town, Rural Mexico
James H. McDonald
Little ethnographic research has been conducted on how the illegal drug trade has affected and transformed rural communities in Mexico and the rest of Mesoamerica. It is a topic that is difficult and potentially dangerous to explore, at least directly; thus it is not surprising that relatively few researchers have openly studied it. For those of us working on rural development problems, it means that our analyses are silent on a critical dimension of the local economy. This paper describes the effects of drug trafficking on a small, rural town in Mexico’s central highlands in which a highly interpenetrated legal-illegal economy has emerged. A series of ethnographic vignettes provide the entry point for exploring how the narcoeconomy manifested itself both materially and in the imaginations of local people. An ordinary town, in fact, had extraordinary inequalities: opulent houses; the subversion of traditional forms of leisure; a new urban-oriented consumer culture; and new farmer entrepreneurs. All were underwritten by narco-activities. The paper closes by considering the broader implications of the narcoeconomy by expanding on themes of globalization and poverty, migration, gender, and violence that run through the descriptive vignettes.
Key words: drug trafficking, narcoeconomy, globalization, inequality, culture change, Mexico
Children’s Perceptions of the Social Support of Neighborhood Institutions and Establishments
James C. Spilsbury
A study of children’s help-seeking behavior in 5 Cleveland, Ohio (USA) neighborhoods revealed the important role played by particular members of neighborhood institutions and establishments not commonly considered in research on children’s social networks: the school crossing guard, the librarian at the local public library branch, and the store owner/clerk at the neighborhood convenience store. These roles—above and beyond their “position descriptions”—ranged from provisioner of winter clothing in the case of crossing guards to mediator of child disputes in the case of public librarians. Moreover, crossing guards, librarians, and store owners/clerks were identified by some children as resources for dealing with bullies. The implications of these unrecognized supportive roles are discussed.
Key words: social support, children, help-seeking, neighborhoods
Social Impacts of La Crosse Encephalitis in North Carolina
J. Todd Utz, Charles S. Apperson, and E. Jacquelin Dietz
La Crosse (LAC) encephalitis, caused by a mosquito-transmitted virus, is endemic in the mountains of North Carolina and increasingly recognized in other areas of southern Appalachia. To obtain information on the social and familial impacts of LAC encephalitis in North Carolina, adult case patients (n = 2) and the parents/guardians of juvenile case patients (n = 23) were interviewed. Non-monetary quantitative and qualitative methods were used to estimate the burden of disease over the cumulative life years that elapsed from the onset of illness to the date of interviews. The largest portion of the psychological and social impact of LAC encephalitis was borne by case patients with lifelong neurological sequelae (the aftereffect of a disease or injury) (n = 5). Case patients (n = 16) manifesting transitory sequelae were impacted to a lesser extent, but significantly greater (P < 0.05) than patients (n = 4) who recovered completely from the illness. Prior to a family member contracting the illness, 80% of study participants were unaware of LAC encephalitis; consequently, they were not concerned about the health impacts of the disease. Lack of public awareness appears to result in part because LAC encephalitis is presently is under-reported and under-recognized by the medical community. The disease burden imposed by LAC encephalitis could be reduced if the public health community would develop disease prevention education and engage in active case surveillance coupled with case reporting and follow-up assistance to families. The La Crosse encephalitis prevention program should be community-based, but include organization of a mosquito abatement agency staffed with professional mosquito biologists. The social impacts of LAC encephalitis are representative of effects expected from other neuroinvasive arboviral diseases, such as West Nile encephalitis, for which there are relatively fewer case patients in long-term recovery.
Key words: La Crosse encephalitis, La Crosse virus, social impact
Counseling Contraception for Malian Migrants in Paris: Global, State, and Personal Politics
Carolyn Sargent
Malian migrants in Paris figure prominently in French public discourse surrounding immigration, the role of the state in regulating population, and the perceived burden of migrants from Sub-Saharan Africa on public health and social welfare systems. Political and biomedical critiques of Malian and other African women have linked high fertility to housing shortages, polygamy, and high unemployment. This research explores how French government policies, transnational migration, and the public health system shape reproductive strategies and relations in the Malian migrant population. State pronatalism, anti-immigrant sentiment, diverse Islamic interpretations of contraception, and marital tensions over childbearing have produced both coercive and empowering strategies among midwives, hospital interpreters, social workers, and migrants. Interviews with Malians in clinical community settings as well as observations in two public hospitals in Paris suggest that women assert agency in the face of formidable constraints by choosing to use contraception. However, evidence of potentially coercive birth control interventions raises challenging questions about how (and whether) midwives and other staff disseminate information on contraception to this population.
Key words: reproduction, contraception, globalization, immigration, public health
Integrating Local and Biomedical Knowledge and Communication: Experiences from KINET Project in Southern Tanzania
Happiness Minja and Brigit Obrist
This study examines social and cultural dimensions of the Kilombero Treated Net (KINET) project, a large-scale social marketing program of insecticide treated nets for malaria control in two rural districts in Southern Tanzania from 1996 to 2000. Drawing on a model distinguishing between indigenous and exogenous components of knowledge and communication, it uses a range of ethnographic methods to investigate the flow of information between the project and the villagers. This approach facilitates a shift of perspective from a static to a dynamic view of knowledge and emphasizes the interface of indigenous and exogenous knowledge and communication. The findings document that extended ethnographic research throughout the project cycle taps the neglected potential of indigenous knowledge, provides rich information on the ways people communicate about and respond to the project, and thus helps the team of experts tailor the intervention to local needs and conditions. Operational research based on ethnographic fieldwork should be further refined and become an integral part of health and other interventions from the initial design to evaluation.
Key words: Tanzania, malaria prevention, mosquito nets, local knowledge
Rights and Wrongs: HIV/AIDS Research in Africa
Louise de la Gorgendière
This paper, which is based on a pilot study in Africa, raises a host of ethical issues in relation to ‘applying’ anthropology and collaborative HIV/AIDS research. The author identifies major issues related to the reproductive rights of women and the welfare of their infants in the context of HIV/AIDS research in Africa. The account considers the implications of apparently well-intentioned research that fails to safeguard the well being and dignity of the people involved. It exposes serious problems concerning the lack of informed consent in a medical research project on antenatal testing and mother-to-child-transmission of HIV. Furthermore, the study draws attention to the need for repeated screening for new ethical issues in ongoing medical (and other) research projects involving research participants whose rights might be overlooked in outdated ethics considerations. The paper cautions anthropologists (and other researchers) about being “co-opted” by those in authority, and serves as a reminder about the ‘do no harm’ dictum.
Key words: HIV/AIDS, ethics, informed consent, human rights, women’s reproductive rights, breastfeeding, Africa
Lessons from the Field: From Research to Application in the Fight Against AIDS among Injection Drug Users in Three New England Cities
Merrill Singer, Tom Stopka, Susan Shaw, Claudia Santelices, David Buchanan, Wei Teng, Kaveh Khooshnood, and Robert Heimer
Social and behavioral research has made significant contributions to AIDS prevention. These contributions are multiple and have helped to make prevention more effective. Still, interventionists commonly bemoan barriers that diminish timely access to AIDS research findings and recognition of the programmatic and advocacy implications of research findings. This paper responds to these concerns by presenting a set of intervention and policy lessons learned through the implementation of a study of syringe access, use, and discard among injection drug users in three moderate-sized New England cities. This multi-method study that united ethnographic, epidemiological and laboratory components and a multidisciplinary research team began and ended with a strong commitment to moving findings quickly from the field into the hands of program and advocacy workers. Six specific lessons for prevention and advocacy are presented along with a review of their implications both for the fine-tuning of AIDS prevention targeted to injection drug user and for advocating for policies that support effective HIV risk reduction in this population.
Key words: AIDS, prevention, advocacy, social and behavioral research
Type 2 Diabetes and Fetal Origins: The Promise of Prevention Programs Focusing on Prenatal Health in High Prevalence Native American Communities
Daniel C. Benyshek
Recent diabetes research is challenging the longstanding emphasis on the primary role genes play in the type 2 diabetes epidemic among Native American and other high prevalence populations. Increasingly, “thrifty genotype” models are being reevaluated and modified in order to accommodate experimental and epidemiological research that highlights the powerful effects of the prenatal environment in the development of the disorder. This body of research suggests that, especially in high-risk populations, diabetes may result initially from prenatal malnutrition followed by calorically adequate diets in adulthood, and then be propagated in subsequent generations via maternal hyperglycemia during pregnancy. The present paper highlights the recent research that is challenging the dominant genetic-predisposition model of diabetes, and then explores the promise of future community-based diabetes intervention strategies informed by this research. It suggests that prevention programs that focus on improved prenatal care have the best chance of significantly reducing the incidence and prevalence of diabetes in high risk Native American communities, and explains why such programs are likely to enjoy improved community support and participation.
Key words: diabetes, Native Americans, thrifty genotype, fetal origins, intervention
“Is Power-sharing Possible?” Using Empowerment Evaluation with Parents and Nurses in a Pediatric Hospital Transplantation Setting
Elizabeth Strober
This article describes the evaluation of an innovative empowerment project aimed at improving nurse-family communication in a pediatric transplantation setting. Empowerment and family-centered care models were employed to reduce barriers to communication and build partnerships. The goals of the project were to facilitate empowerment, power-sharing, and joint decision-making among nurses and families. Families gained insight into biomedical culture, culminating in the creation of a handbook for navigating biomedical culture, which they site as empowering. However, major barriers exist to achieving the remaining goals. Although nurses involved with the project value the principles of joint decision-making and power-sharing abstractly, they are reluctant to incorporate them into their practice. They describe them as at odds with tasks and roles they must accomplish. Foucault’s insights on clinical power assist in understanding why this project was successful in creating partnerships in some areas, but not accomplishing power-sharing at a structural and practical level.
Key words: Power-sharing, communication, biomedical culture, family-centered care
