TY - JOUR
T1 - An ethnography of nonadherence
T2 - Culture, poverty, and tuberculosis in urban Bolivia
AU - Greene, Jeremy A.
N1 - Funding Information:
Research for this paper was supported by grants and structural support from the David Rockefeller Center for Latin American Studies and the Department of Social Medicine at Harvard Medical School. In addition, this study would not have been possible without the generosity of many individuals, most notably the informants, who were gracious enough to open their homes and lives to the author. The active collaboration of the Fundacion San Gabriel, in particular Dr. Lieselotte Barragán, Dr. Marcel Loayza, Dr. Carmen Berrios, Dr. Edgar Calderón, and the district community health workers, was crucial to the execution of the research project. Dolores Charlay, an Aymara ethnographer based in El Alto, provided invaluable assistance with fieldwork in La Paz. Project conception and design was aided greatly by the collaboration of Dr. Guillermo Herrera, Dr. Paul Farmer, and Dr. Arthur Kleinman at Harvard Medical School. Thanks also to Dr. Joyce Millen, Elizabeth Dorosh Greene, Kate McGurn, Jeremy Mumford, and the two anonymous reviewers for Culture Medicine and Psychiatry for their helpful comments and suggestions throughout.
PY - 2004/9
Y1 - 2004/9
N2 - The author conducted a focused descriptive ethnographic study of nonadherence with tuberculosis (TB) therapy among Aymara-speaking residents of the city of La Paz, Bolivia. A cohort of patient-informants was identified from the District III TB Control Registry of La Paz as having been nonadherent with their TB medication protocol. From June to August 1998, ethnographic material was collected through participant-observation and repeated interviews and visits in homes, workplaces, clinics, and the community. Ethnographic analysis revealed structural barriers to be more important than cultural differences in the production of nonadherence. Though informants maintained a variety of beliefs and practices related to Aymara medicine, the majority of patients were comfortable with a biomedical model of tuberculosis and maintained belief in the efficacy of antituberculosis chemotherapy and desire to finish treatment. Patients overwhelmingly cited hidden costs of treatments, poor access to care, ethnic discrimination, and prior maltreatment by the health system as reasons for abandoning treatment. These data suggest that overemphasis of cultural difference without exploration of other social dimensions of health care delivery can obscure a more practical understanding of nonadherence in marginalized populations.
AB - The author conducted a focused descriptive ethnographic study of nonadherence with tuberculosis (TB) therapy among Aymara-speaking residents of the city of La Paz, Bolivia. A cohort of patient-informants was identified from the District III TB Control Registry of La Paz as having been nonadherent with their TB medication protocol. From June to August 1998, ethnographic material was collected through participant-observation and repeated interviews and visits in homes, workplaces, clinics, and the community. Ethnographic analysis revealed structural barriers to be more important than cultural differences in the production of nonadherence. Though informants maintained a variety of beliefs and practices related to Aymara medicine, the majority of patients were comfortable with a biomedical model of tuberculosis and maintained belief in the efficacy of antituberculosis chemotherapy and desire to finish treatment. Patients overwhelmingly cited hidden costs of treatments, poor access to care, ethnic discrimination, and prior maltreatment by the health system as reasons for abandoning treatment. These data suggest that overemphasis of cultural difference without exploration of other social dimensions of health care delivery can obscure a more practical understanding of nonadherence in marginalized populations.
KW - Anthropology
KW - Aymara
KW - Bolivia
KW - Ethnography
KW - Patient nonadherence
KW - Tuberculosis
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U2 - 10.1023/B:MEDI.0000046429.55801.c8
DO - 10.1023/B:MEDI.0000046429.55801.c8
M3 - Review article
C2 - 15600119
AN - SCOPUS:10344247948
SN - 0165-005X
VL - 28
SP - 401
EP - 425
JO - Culture, Medicine and Psychiatry
JF - Culture, Medicine and Psychiatry
IS - 3
ER -