Doctoral Dissertation Research: Between Community and Clinic: Households, Intermediaries, and Bureaucracy

斯坦福大学博士生安娜·韦斯特将在詹姆斯·弗格森博士的指导下，对公民身份、政治主体性和国家在家庭健康促进背景下的发展进行人种学研究，这种做法在世界各地都有，但在发展中国家特别普遍。这项研究将在马拉维进行，马拉维是一个撒哈拉以南的非洲国家，面临着医生和护士严重短缺的问题，因此必须依靠社区卫生工作者来执行国家和全球卫生指令。马拉维的社区卫生工作者(CHW)被称为健康监测助理，他们是中学毕业生，接受过提供健康教育、提供基本治疗护理和在农村家庭进行疾病监测的培训。CHW与农村家庭中的男女的常规互动构成了与国家的持续亲密接触，否则这在许多偏远社区是不存在的。研究人员将研究这些家庭层面的健康促进活动如何塑造马拉维农村人的家庭和家庭实践、政治主观性以及在国家健康和发展的广泛意识形态项目中的公民经历。调查者将进行为期18个月的实地工作，结合马拉维中部地区的社区卫生工作者和农村家庭的基于村庄的民族志，以及关于社区卫生工作者在马拉维卫生系统中的作用的机构民族志和档案研究。她将探讨卫生工作者与家庭接触的三个方面：(1)卫生工作者如何在日常对话中代表生物医学价值和健康概念；(2)他们如何定位卫生责任；以及(3)他们如何参与疾病监测和例行官僚文书工作，以生成影响卫生政策和干预设计的村卫生和农村家庭的肖像。数据将通过参与者观察、半结构化深度访谈、口述历史访谈和卫生政策文件的内容分析来收集。这项研究很重要，因为通过关注中间人和外展工作者在卫生和发展项目中的作用，它将阐明将大规模全球倡议转化为常规服务提供的当地动态和后果。这些发现还将有助于社会科学文献中关于健康促进、家庭生活和政治主观性之间的相互作用。支持这项研究也有助于培养一名社会科学家。

Stanford University doctoral student Anna West, with the guidance of Dr. James Ferguson, will conduct ethnographic research on citizenship, political subjectivity, and the state as it develops in the context of household-based health promotion, a practice found throughout the world but is especially prevalent in developing countries. The research will be conducted in Malawi, a sub-Saharan African country that is faced with a severe shortage of physicians and nurses and so must rely on community health workers to implement national and global health directives. Malawi's community health workers (CHWs), known as Health Surveillance Assistants, are secondary school graduates trained to deliver health education, provide basic curative care, and conduct disease surveillance in rural homes. The CHWs' routine interactions with women and men in rural households constitute an ongoing intimate encounter with the state, which is otherwise absent in many remote communities. The researcher will examine how these household-level health promotion encounters shape rural Malawians' homes and domestic practices, political subjectivities, and experiences of citizenship within broad ideological projects of national health and development.The investigator will conduct eighteen months of fieldwork combining village-based ethnography with community health workers and rural households in Malawi's Central Region, and institutional ethnography and archival research on the role of community health workers in Malawi's health system. She will explore three aspects of the health workers' encounters with households: (1) how the CHWs represent biomedical values and concepts of health in routine conversations; (2) how they position health responsibility; and (3) how they engage in disease surveillance and routine bureaucratic paperwork to generate a portrait of village health and rural homes that influences health policy and intervention design. Data will be collected through participant observation, semi-structured in-depth interviews, oral history interviews, and content analysis of health policy documents.The research is important because by focusing on the role of intermediaries and outreach workers in health and development projects, it will shed light on the local dynamics and consequences of translating large-scale global initiatives into routine service delivery. Findings also will contribute to social science literature on the interaction between health promotion, domesticity, and political subjectivities. Supporting this research also contributes to the education of a social scientist.