Doctoral Dissertation Research: Social Contexts of Treatment and Care: Patients and their Families in a Tuberculosis Epidemic

加州大学洛杉矶分校的博士候选人汉娜·赖斯将在琳达·加罗博士的指导下，探索日常生活中疾病的社会背景，这些患者接受了一个旨在满足生物医学护理普遍标准的治疗方案。为什么一种已经得到有效治疗的疾病仍然有如此高的发病率？促进或阻碍成功治疗的疾病和护理的社会背景是什么？为了解决这些问题，Reiss将在塔吉克斯坦开展工作，该国是世界上结核病发病率最高的国家之一，治疗失败、违约和死亡的频率也很高。她的研究将探索促进或阻碍治疗的社会力量、实践和理解，因为患者和他们的家人应对结核病和治疗。她的研究结合了：1)纵向设计，在整个治疗过程中跟踪患者；2)双重关注临床和社会互动；3)重视组织来自家庭和社区的社会支持。Reiss将通过与家属的参与观察、与患者、其亲属和临床医生的访谈、疾病叙述和临床遭遇的观察来收集数据。本项目将探索疾病经历作为一种复杂的社会现象，通过以下方式为人类学理论做出贡献：1)在传染病研究中纳入经验、纵向和相关方法，以扩展当前的概念框架；2)增加了将健康定位为家庭、网络和社区关注的文献；3)解决结核病患者护理的社会结构和社会支持在成功完成治疗中的作用。该项目在提供保健服务方面具有更广泛的适用性。在更好地了解当地疾病现实的情况下，开展基层卫生行动至关重要。塔吉克斯坦是结核病流行对全球健康构成广泛威胁的生动例子。

University of California, Los Angeles doctoral candidate Hannah Reiss, supervised by Dr. Linda Garro, will explore the social contexts of illness in the day-to-day lives patients accepted into a treatment program designed to meet prevailing standards of biomedical care. Why does an illness with effective treatment continue to persist with such high incidence rates? What are the social contexts of illness and care that promote or impede successful treatment? To address these questions, Reiss will work in Tajikistan, which has one of the highest incidence rates of tuberculosis in the world and high frequencies of treatment failure, default and death. Her research will explore the social forces, practices, and understandings that promote or impede treatment as patients and their families navigate tuberculosis illness and therapy. Her study combines: 1) a longitudinal design to follow patients throughout treatment; 2) a dual focus on clinical and social interaction; and 3) attention to the organization of social support from families and the community. Reiss will collect data through participant observation with families, interviews with patients, their relatives and clinicians, illness narratives, and observations of clinical encounters. This project will explore the illness experience as a complex social phenomenon, contributing to anthropological theory by 1) incorporating experiential, longitudinal and relational approaches in the examination of infectious disease to expand current conceptual frameworks; 2) adding to the growing body of literature that positions health as a family, network and community concern; and 3) addressing the social structures of care for tuberculosis patients and the role of social support in successful completion of treatment. This project has wider applicability for health care delivery. It is critical to ground health initiatives in a better understanding of local realities of illness. Tajikistan is a vivid example of the tuberculosis epidemic's broad threat to global health.