EASA, 2006: EASA06: Europe and the world
Bristol, UK, 18/09/2006 – 21/09/2006
Transferring anthropological methods, theory and experience to applied health research
Location Chem LT1
Date and Start Time 21 Sep, 2006 at 11:30
This workshop will explore the dynamic between conventional anthropology and applied health research. Papers will examine shifts in method and theory that occur when anthropologists relocate to conduct applied research.
The workshop will explore the relationship between conventional anthropological methods and theory and those used by anthropologists working in applied health research in both Europe and globally. Applied health research will be defined in its broadest sense to include work on health, illness, medicine, healing, well-being, advocacy, health policy, etc. Questions addressing methodological issues might include the following: How do anthropologists in applied settings draw on previous fieldwork experiences that were often in significantly different environments and circumstances? How do anthropologists trained to conduct ethnographic research based on a sole-fieldworker model then work within multidisciplinary or international teams? Is it possible to implement flexible and fluid research designs in applied settings? To what extent do applied anthropologists adapt ethnographic methods to use strategies such as interviews and focused observation, and how does this influence the conduct of the research and its theoretical content? Anthropology has a long tradition of privileging the interests and concerns of informants – does this assist in addressing the current drive to include participants in conducting health research? Focusing on theoretical concerns, papers in this workshop might address how and to what extent applied health anthropologists use, represent and contribute to anthropological theory. More generally, papers might address the interface between anthropological theories and those of other disciplines that also have a strong, or possibly stronger, presence in this area. These are some of the potential themes that might be explored. We hope that this workshop will generate innovative and constructive suggestions for the future of applied anthropology in health. The workshop welcomes submissions from those with a diverse range of experiences, including submissions from colleagues working in either applied or academic settings both within and outside Europe.
Chair: Rachael Gooberman-Hill
Discussant: Isabel de Salis
When does collaboration become undue influence? Ethical dilemmas in an ethnographic study of health policy-makers
Co-author: Dr. Andrew Russell, Durham University
In April 2006, a team based at Durham University began a detailed ethnographic study of the first regional tobacco control office of its kind in the U.K. This office was established with the goal of reducing smoking prevalence in the North East of England, focusing on the de-normalization of tobacco with emphasis on second hand smoking and regional infrastructure. The aims of the study, which is funded by the National Prevention Research Initiative (the largest consortium of research council and charitable bodies ever assembled in the U.K. to fund a research programme), are to evaluate the effectiveness of the TCO in the U.K. setting, and record and analyse good practice that could be adopted in other regions. The lead researchers have experience in collaborative research in other parts of the world and brought this experience to bear in this project. The ideal of collaboration is fully realizable in this setting, where the participants are both eager and qualified to contribute meaningfully to the project. However, the fulfilment of such an ideal poses its own problems. For example, the educational level of participants means they can fully engage with the theoretical framework to the extent that they could, if allowed, rewrite manuscripts. Other issues are more subtle, such as how to establish appropriate boundaries between the researcher and the TCO staff and their perspectives. This paper will highlight these and other emerging issues related to collaborating with health policy-makers in this setting and some of the ways in which the research team is working to resolve them.
Ethnological research of (traditional) medicine in South-Eastern Europe
Ethnomedicine, medical anthropology and folk medicine are some of the disciplines which deal with different topics related to traditional medicine and the cross-cultural concepts of health and illness. Both ethnomedicine and medical anthropology were established as disciplines during the 1960-ies and 1970-ies, when the majority of the medical projects offered to non-Western societies and Third World countries have failed. It became obvious that medical concepts have to be treated as cultural concepts and as parts of a single culture.
Today the two disciplines deal with current ethnomedical problems in both Western and non-Western societies, among rural and urban population alike, and their findings are increasingly recognized as vital not only for cultural research, but also as the solutions to many practical, urgent and current problems of health care and prevention of disease.
The research on the traditional concepts of health and illness in the region of South Eastern Europe was structured around the term 'folk medicine', which has been presented as a 'manifestation of cosmology'. The majority of research dealt with the beliefs and customs connected to traditional healing and with their mythological background. Publications on these topics were descriptive ethnographies, which aimed only at the collection of data about the 'exotic' healing rituals in rural areas, and, lacking any severe analysis, completely neglected the biological aspects of healing techniques.
This paper aims at showing, using the history, development and current trends of traditional medicine in Croatian ethnology as a case study, the need to 'infest' the decriptive ethnographies on health and ilness with medical anthropological theories, thus moving away from magico-ritual concepts and including pragmatical research on 'how medical anthropology can alleviate human suffering (Joralemon:1999)'.
Cancer, the bogeyman and me: reflexivity and emotion in 'end of life' research
This paper draws on a study which explored research methods and approaches applicable to end-of-life research. We conducted a systematic review, 31 semi-structured interviews with researchers and 4 focus groups with people affected by cancer. In this paper, however, rather than privilege taped interviews or focus group material, I demonstrate how my own experience and subjectivity became an integral part of the analysis.
This paper provides an ethnographic account of a piece of research that aimed to explore research methods and methodological challenges of cancer research. Rather than present the study and 'results', as is the norm in biomedical research, I discuss how anthropological training shaped both a broader understanding of the meanings of cancer and contributed to a greater analytical depth. During this research, my first visit to a hospice elicited feelings that connected with memories of caring for a person with terminal cancer. However, revisiting this past experience through the lens of the present offered a window into understanding the impact of cultural constructions of health and illness that eventually illuminated the final analysis in significant ways.
Exploring the challenges of conducting research in this field requires a reflexive engagement with socio-cultural constructions of cancer. This reveals that for many, cancer is a 'Bogeyman' that must be laid to rest before we can truly do sensitive research in this area. Only then can researchers go beyond constructions of 'the patient' and seek to engage with the person and their experience. By connecting reflexivity, emotion and a wider notion of what constitutes 'research' or perhaps 'research evidence' I learned that while persons with cancer may raise their voices above and beyond 'the disease', it appears that often researchers do not.
Blurred boundaries: conventional and applied research
In this presentation I will examine methodological and theoretical approaches in conventional vs. applied health research in anthropology. I will draw from my own fieldwork experiences, in particular from the research project Abnormal Birth: Ethical Questions and Practical Life conducted in Iceland. In the research I aim to examine ethical questions concerning treatment and eventual end-of-life decisions for infants with birth weight of 1000 g or less and the implications on the daily life for the families involved. Methodological approaches include fieldwork in a neonatal intensive care unit and visits to the infants' homes, their day-care centres and ambulatory treatment facilities. In-depth interviews were taken with parents, family members and professionals.
Despite existing differences, conventional research and applied health research (not only within medical anthropology) have increasingly become influenced by each other's methodological, and to some extent theoretical, approaches. Within medical anthropology the boundaries are often blurred between these two fields. However for research to become truly applied, anthropologists have to publish their findings in relevant forum and present results in an appropriate language.
From Jacob Sarmento to William Withering: Enlightenment theories in the folk narratives of water spa healing in contemporary Portugal
Folk views regarding health, sickness and healing are often permeated by concepts borrowed from medical theories and re-assembled in original systems or narratives. We will substantiate this statement with a study of folk narratives regarding the healing powers of mineral waters. Narratives were collected in contemporary Portugal among users of all kinds of water sources regarded as potentially curative. Those narratives make use of a number of concepts that were developed in the context of the Enlightment era medical research, as illustrated by the medical works of the Jacob Sarmento and William Whitering. Both travelled between Portugal and England for different reasons: Sarmento in order to escape inquisition in his native Portugal, and Scottish born Whitering in order to study Southern Iberia natural elements. Both developed reflections and models in order to account for the mineral properties of waters. Some of those elements area precisely kept frozen, though re-worked, in the folk tradition up to our days.
'Going native' in anthropological health research… Is it that wrong?
The paper is based on the methodological, ethical and theoretical dilemmas experienced during a doctoral research project on the theme of adolescent girls and sexual health in Tanzania. During one year of anthropological fieldwork, several methods were combined, such as participant observation, focus-group and in-depth interviews, role-plays etc, as well as a survey. Training courses and seminars were attended, as well as a youth-friendly clinic was initiated. Participatory, collaborative research implying a "dialogic epistemology" was pursued to engage young people and health workers in the issue of sexual health promotion and HIV prevention.
The combination of various, unconventional methods provided a rich source of data. The approach allowed for entering the various formal and informal arenas where young people and health professionals operate in respectively seeking- and providing for health services. It allowed for capturing the tension, at various levels, between structure and agency, and, giving voice to different people helped uncovering the embodiment of inequality and poverty in times of AIDS.
Yet, this integration of various methods was also based on previous experience as a health worker in the locality. Anthropological fieldwork was thus facilitated by accumulated "native" knowledge in the health sector, and by an ambiguous status as a researcher and a former colleague. On the other hand, various informants had different and often contradicting concerns, and including health professionals in the research process implied several ethical dilemmas, such as when studying the practice of abortion in an illegal context. At the same time, such close, long-term involvement in a deadly epidemic created some feeling of personal and political impotence. Finally, the fact of defining oneself as an anthropologist engaged in health promotion seems to bring about a scholarly scepticism suggesting the anthropological "impurity" of the data produced.