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

博士论文改进补助金：埃塞俄比亚的医疗谣言和人道主义救济诊所关闭

• 批准号: 0818325
• 负责人: Mark Nichter
• 金额: $ 1.5万
• 依托单位: University of Arizona
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2009-08-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=0818325&HistoricalAwards=false
• 关键词: Doctoral; Dissertation; Improvement; Grant; Medical

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.

人道主义危机发生后，许多人受益于国际人道主义救援诊所提供的抗生素疗法。 然而，当紧急资金耗尽时，许多诊所就会关闭，导致贫困人口无法获得可靠的药物来源。马克·尼希特 (Mark Nichter) 博士指导的研究生劳伦·卡鲁斯 (Lauren Carruth) 在埃塞俄比亚东部农村地区进行的初步研究表明，在救援诊所关闭后，对违禁抗生素的需求增加，而矛盾的是，劣药的谣言却比比皆是。 尽管服用非处方抗生素很常见，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。由于疗程缩短，即使药物是正品，也可能服用不当且无效。本论文项目进一步提出问题：救济诊所的关闭如何影响当地的抗生素实践和非正式卫生经济？ 而且，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采取行动的？这项研究将在埃塞俄比亚偏远的希尼勒地区进行，这里是跨国走私贸易、人道主义危机频发和救援行动频繁发生的地区。将通过参与式绘图、深度访谈、结构化观察和参与式观察，在 Shinile 区域的多个地点收集数据。 这项研究很重要，因为它有可能改进关于救灾的长期但有时是隐藏后果的社会科学理论。不受监管的制药实践和非正式卫生经济是埃塞俄比亚医疗保健的核心，但在人道主义干预、医疗系统或灾难的研究中仍然缺席。 通过影响医疗行为，对不良药物和诊所关闭的恐惧可能会严重影响当地的流行病学、传染性微生物的演变和表现、未来对药品的反应以及未来的健康干预措施。 最紧迫的是，通过不恰当地服用抗生素药丸来管理不良药物风险的当地策略可能为对现有药物产生耐药性的疾病的发展提供理想的环境。该研究还将有助于社会科学家的教育。