Doctoral Dissertation Research: Cultural Negotiations of Medical Care Among the Lancaster Amish

博士生玛莎·金（北卡罗来纳大学教堂山分校）将在多萝西·霍兰德博士的指导下，调查一个非营利性的基因治疗/研究机构，特殊儿童诊所（CSC）和它在宾夕法尼亚州兰开斯特周围服务的阿米什定居点之间发展起来的合作方式和类型。该研究将探讨如何协商和提供生物医学护理服务给对身体和医学有不同文化信仰的群体这一广泛问题。这项研究的动机是两个广泛的兴趣：兰开斯特阿米什人如何在围绕定居点的更大文化背景下继续塑造他们对技术的使用，以及CSC如何设法创造一个生物医学环境，使这种文化谈判能够发生？该项目旨在了解诊所从业人员和阿米什患者家庭之间的互动如何导致阿米什和生物医学文化的适应和/或修改。这两个群体在接受检查时，对疾病、医学和技术的理解往往存在根本的差异。例如，阿米什文化认同的共同线索包括为了社区的利益放弃自我意志，因为阿米什人积极地避开个人主义，并将身体视为扎根于社区的精神家园。相比之下，他们正在导航的卫生系统是以生物医学方法为前提的，认为个人身体是自主的；从业人员经常处理个别病人作为离散的单位。研究人员将通过住在旧秩序阿米什教堂区并定期在临床环境中观察来进行参与性观察。对阿米什人参与者、临床工作人员和研究人员的深入访谈将进行分析，以发现这种保守宗教传统的观念和实践，因为他们正在谈判高科技、个性化的医疗模式。本研究利用这些以人种学为重点的方法，为医学人类学和阿米什研究增加了一个至关重要的丰富领域。此外，它为阐明新的遗传理解的社会影响和后果，以及在小规模医疗实践中可能发生的挑战和成功提供了一个极好的案例，在小规模医疗实践中，跨核心信念的翻译是必要的。

Doctoral student Martha King (University of North Carolina at Chapel Hill), under the guidance of Dr. Dorothy Holland, will investigate the manner and types of cooperation that have been developed between a non-profit, genetic treatment/research facility, the Clinic for Special Children (CSC), and the Amish settlement it serves around Lancaster, PA. The research will address the broad issues of how the negotiation and delivery of biomedical care services to groups with different cultural beliefs about the body and medicine is accomplished.This research is motivated by two broad interests: how do the Lancaster Amish populations continue to shape their use of technology in light of the larger culture surrounding the settlement and how does CSC manage to create a biomedical environment where this kind of cultural negotiation can occur? This project seeks to understand how interactions between clinic practitioners and Amish patient families result in accommodations and/or modifications of both Amish and biomedical cultures. These two groups often arrive at the examination table with fundamentally different understandings of illness, medicine, and technology. For example, common threads of Amish cultural identity involve relinquishing of self-will for the benefit of the community as Amish actively eschew individualism and view the body as a spiritual home rooted in community. In contrast, the health system they are navigating is premised on a biomedical approach to the individual body as autonomous; practitioners frequently deal with individual patients as discrete units. The researcher will perform participant observation by living in an Old Order Amish church district and observing regularly in the clinical setting. In-depth interviews with Amish participants, clinical staff, and research staff will be analyzed to discover the perceptions and practices of this conservative religious tradition as they negotiate highly technological, individualized medical models. This research utilizes these ethnographically-focused methods to add an area of vital richness to medical anthropology and Amish studies. Further, it provides an excellent case for elucidating the social implications and consequences of new genetic understanding, as well as the challenges and successes that can occur in small-scale medical practice where translation across core beliefs is necessary.