Graduation Year

2014

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Department

Anthropology

Degree Granting Department

Applied Anthropology

Major Professor

Roberta Baer, Ph.D.

Committee Member

Aurora Sanchez-Anguiano, M.D., Ph.D.

Committee Member

Ricardo Izurieta, M.D., Ph.D., MPH

Committee Member

Daniel Lende, Ph.D.

Committee Member

Elizabeth Miller, Ph.D.

Committee Member

Rebecca Zarger, Ph.D.

Keywords

Chagas disease, cultural consensus, ethnomedicine, explanatory models, Santa Cruz

Abstract

This project describes and analyzes explanatory models of Chagas disease among people in a highly endemic area of eastern Bolivia, and examines the role that cultural and structural factors play in shaping explanatory models of this disease. Dressler (2001) characterizes medical anthropology as divided between two poles; the constructivist, which focuses on the "meaning and significance that events have for people," and the structuralist, which emphasizes the relationships between the components of a given society. This project endeavors to synthesize structuralist and constructivist perspectives by understanding the interaction between structural processes and explanatory models of Chagas disease.

The research took place in the spring of 2013, in collaboration with the Centro Medico Humberto Parra, a non-profit clinic servicing low income populations in Palacios, Bolivia and surrounding communities. Semistructured interviews (n=68) and consensus analysis questionnaires (n=48) were administered to people dealing with Chagas disease, and free lists of possible treatments were collected.

Overall, participants largely accepted the biomedical model, but also emphasized the emotional and social aspects of Chagas disease. The consensus analysis procedure indicated a clear shared model of Chagas disease, with coherent social, vector, symptoms, and ethnomedical domains. Furthermore, the model differed between groups based on ethnicity, gender, income and occupation. Significant differences were found in cultural knowledge of the disease based on community of residence and occupation status, two clear markers of how people are tied into the global economy. In the interviews, participants associate their Chagas disease with structural factors including poverty, rural living and traditional housing. They describe substantial barriers to getting biomedical care for their disease despite the existence of a free treatment program in Bolivia. However, participants reported numerous ethnomedical treatments; the study identified 39 ethnomedical treatments for Chagas disease and 66 for its cardiac symptoms.

In sum, explanatory models include structural processes that shape disease, and are in turn influenced by these processes. In Bolivia, although structural constraints limit the scope of biomedical treatment, ethnomedical approaches to the disease are in a process of dynamic growth. The methods used here for assessing the structural component of the explanatory model of Chagas disease can be replicated in future research on explanatory models or political economy of health.

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