13
Jul
12

Trabajo de Campo

Today was one of several days I’ve spent doing fieldwork in rural communities in the interior of Puebla state. This picture was taken in Xochitepec, about a 4 hour drive from Puebla City, and a community of about 1,000 residents whose livelihoods depend on local agricultural production and many of whom speak their indigenous Nahuatl language. Men and women work long, hard days in the fields– planting, tending, and harvesting corn, rice, beans, squash, and other crops mainly used for local consumption and some of which are sold on the market. The women pictured in this photo are medical students and a psychiatry resident at the BUAP who are engaged in a study of diabetes – knowledge, treatment, and associated risk factors – in these communities. While the questionnaire we used to conduct interviews was frustrating for me – given that it had merely translated concepts such as “lifestyle” into Spanish with no real thought for local context or culture – I still found the fieldwork fascinating. I used my interviews with people to go off topic, and asked a good deal of questions about people’s locally-held explanatory models of diabetes. I found several themes emerge, among others: that many view diabetes onset as a result of “un espanto” or “un susto” – such as a spouse’s death or a child’s accident – and that many also treat diabetes with “remedios caseros” (home remedies), such as sávila (aloe), té de  hierba amarga (bitter herb tea), or mezcal. Even though I’m aware of the biomedical view of diabetes — as associated with a failure in insulin production/utilization likely due to a combination of diet, heredity, and other individual-level risk factors — talking with people in these communities about their experiences with diabetes leaves me thinking that their local explanations for the disease need to be taken much more seriously. From my perspective, even after a few days in these communities, I can’t help but think about how limited the concept of “lifestyle” (“estilo de vida”) is when taken as an individual-level construct. For men and women in their 50s and 60s who develop diabetes after decades of working long, arduous days in the fields; who labor under the hot sun without adequate rest or drinking water; whose poverty limits their dietary choices to the staple corn tortilla, rice, and beans; and who walk over fields and mountains to and from “la milpa” (the fields); “lifestyle” must be thought of in broader social/cultural/historical/economic terms than merely as a variable assessing whether an individual maintains the “right diet” and engages in “adequate exercise”. Indeed, I found the questionnaire’s items asking about exercise so far from people’s reality that they were both unintelligible for respondents and almost insulting for me to pose. If you walk an hour to your job in “el campo” and work 8 hours laboring in the fields, then walk home – is this not “exercise”?! There was no response choice in the questionnaire for this type of physical activity, since the question items were designed based on studies conducted with U.S. and other populations where “exercise” means going to the gym and standing on a machine for 30 minutes 5 times a week. I have many more thoughts about this, but for now I’ll sign off with a word a Nahuatl-speaking woman taught me today in Xochitepec: “Yanilla” (“ya me voy” / “I’m going now”).

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