Doctoral Dissertation Improvement Grant: Medical Rumors and Humanitarian Relief Clinic Closures in Ethiopia

在人道主义危机之后，许多人从国际人道主义救济诊所提供的抗生素疗法中受益。然而，当紧急资金耗尽时，许多这样的诊所就会关闭，让贫困人口得不到可靠的药物来源。由马克·尼克特博士指导的研究生劳伦·卡鲁斯在埃塞俄比亚东部农村进行的初步研究表明，在救济诊所关闭后，对违禁抗生素的需求增加了，而矛盾的是，关于劣质药物的传言比比皆是。尽管非处方抗生素的消费很常见，但人们可能一次只服用几种抗生素，因为他们担心当地的药品供应含有有毒的假药。作为缩短疗程的结果，即使药物是真正的，它们很可能被不适当和无效地服用。这篇论文项目进一步提出：救济诊所关闭如何影响当地的抗生素实践和非正式的卫生经济？以及，医疗风险和医疗谣言在社区、市场、诊所和国际人道主义救援组织中是如何表达和作用的？这项研究将在埃塞俄比亚偏远的Shinile地区进行，那里是跨国违禁品贸易、不断发生的人道主义危机和反复的救援行动的中心。将通过参与性测绘、深度访谈、结构化观察和参与者观察，在希尼勒区的多个地点收集数据。这项研究对于改进关于救灾的长期但有时隐藏的后果的社会科学理论具有重要意义。不受监管的制药做法和非正规卫生经济是埃塞俄比亚医疗保健的核心，但仍然没有出现在人道主义干预、医疗系统或灾难的研究中。通过影响医疗行为，对劣质药物和诊所关闭的恐惧可能会对当地流行病学、传染病微生物的进化和表现、未来对药品的反应以及未来的卫生干预措施产生重要影响。最紧迫的是，通过不适当地使用抗生素药片来管理不良药物风险的地方战略，可能会为对唯一可用的药物产生抗药性的疾病的发展提供一个理想的环境。这项研究还将有助于社会科学家的教育。

In the aftermath of humanitarian crises, numerous people have benefited from antibiotic therapies supplied by international humanitarian relief clinics. Yet when emergency funding dissipates, many of these clinics close, leaving impoverished populations without trusted sources of medication. Preliminary research in rural eastern Ethiopia by Lauren Carruth, a graduate student supervised by Dr. Mark Nichter, suggests that in the wake of relief clinic closures, demand for contraband antibiotics increases, while paradoxically, rumors of bad medicine abound. Although the consumption of non-prescribed antibiotics is common, people may take only a few antibiotics at a time because they fear the local drug supply contains poisonous counterfeit pills. As a result of shortened regimens, even if the medications are genuine, they are likely to be taken inappropriately and ineffectively. This dissertation project asks further: how do relief clinic closures shape local antibiotic practices and informal health economies? And, how are medical risks and medical rumors articulated and acted on within communities, markets, clinics, and international humanitarian relief organizations? The research will be carried out in the remote Shinile Zone of Ethiopia, a locus of transnational contraband trade, recurrent humanitarian crises, and repeated relief operations. Data will be gathered at multiple sites in the Shinile Zone through participatory mapping, in-depth interviews, structured observations, and participant observation. This research is important for its potential to improve social science theory regarding the long-term but sometimes hidden consequences of disaster relief. Unregulated pharmaceutical practices and informal health economies are central to healthcare in Ethiopia, but remain absent from studies of humanitarian intervention, medical systems, or disaster. By affecting medical behaviors, fears of bad medicine and clinic closures may importantly shape local epidemiology, the evolution and manifestations of infectious microbes, future responses to pharmaceutical products, and future health interventions. Most urgently, local strategies of managing the risks of bad medicine by inappropriately consuming antibiotic pills may provide an ideal environment for the development of diseases resistant to the only medications available. The research also will contribute to the education of a social scientist.