Doctoral Dissertation Research: Knowledge, Practice, and Clinical Experiences of Oncology

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As chronic diseases, such as cancer, begin to dominate the landscape of threats to global health and development targets, it is of vital importance to improve our understanding of how to implement biomedical programs in non-Western, low resource environments. Research from within anthropology has repeatedly shown medical treatments are rarely implemented in a new context unchanged, and that biomedical systems adapt to local conditions and beliefs. Through a careful examination of implementation of oncology practice, this project explores the ways that care for cancer is shaped by differences in technology, infrastructure, economics, development, medical practice, and cultural beliefs. By gaining a better understanding of the ways that these forces impact care for cancer, this project has the potential to yield insights for improvement in biomedical and development practice in oncology. Further, the lessons learned from this specific case study may be fruitfully extended to improve biomedical and development practice more broadly, including use in other cases of implementation of systems of care for non-infectious diseases. Thus, as the global health community begins to pivot towards the problems of chronic illness, this project has the potential to yield concrete, actionable recommendations for improving biomedical practice, training, and the development of sustainable infrastructure in this context.Rebecca Henderson, under the supervision of Dr. Adrienne Strong of the University of Florida, will investigate how knowledge, technology, and treatment protocols of cancer are created an enacted in clinical settings, with the aim of understanding how biomedicine is transformed as it travels. This research will be conducted in several of the key cancer research centers in Haiti in the capital city of Port-au-Prince, as well as those in more rural areas. Using a qualitative approach, this project will capture the perspectives of clinicians, patients, and families as they encounter oncology. It will employ participant observation in order to document activities in hospitals and health centers, as well as centers of diagnosis such as laboratories and imaging centers. It will also employ semi-structured interviews with patients, their families, and the clinicians engaged in their care in order to capture local understandings of cancer, cancer treatment, and disease course. Oral histories will allow for an improved understanding of the development of cancer care over the last decade. All interviews and fieldnotes will be thematically coded using an iterative, inductive methodology based on grounded-theory. Finally, a review of medical records will be conducted at clinical centers in order to more fully describe changes in oncological care over time, as well as to better understand the effect of these factors on patient outcomes.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.