A Companion to Medical Anthropology. Группа авторов
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programs and need for programs that serves populations with disabilities; (11) compare the relative importance of different types of disabling conditions in different cultures; and (12) create a general description of the place and meaning of disabilities and disability programs in local cultures. The practical aspects of the design required conducting the research at a number of different centers around the world that have varying levels of experience with qualitative and quantitative research methods. The methods had to be easy to use, inexpensive, comprehensive, and capable of producing defensible results. The ICIDH CAR model was designed to address a consistent issue for multisite cross-cultural applied research. The research requires a standardized sampling framework that does not place an extreme burden on the various centers. We used qualitative sampling procedures for the bulk of the CAR study, except in those cases where statistical power needs dictated a quantitative sampling approach. The ethnographic sampling framework was comprised of selected individuals who were especially knowledgeable about their culture, rather than randomly selected individuals who might not be able to contribute substantively to the study (cf. Johnson 1990a,b; Schensul et al. 1999). The process appropriately differs from probabilistic (forms of random) sampling due to the goals of the study, especially the need to interview individuals who are cultural experts and who have substantive knowledge in the area of disablement. The final results of the study and application was a consensual, multi-national, revision of the old disabilities classification system into a new system for assessing functioning in cultural context, which is a significant paradigm shift for both WHO and the disabilities communities. (Ustun et al. 2001).
Rapid Assessment as a Methodological Framework: Combining Emergent Theory, Midrange Theory, and Systematic Ethnographic Design
One of the highest impact methodological innovations in applied medical anthropology is the development of systematic rapid ethnographic methods and techniques targeted at emerging public health problems. This approach has been used to respond to problems such as malaria, diarrheal disease, dengue, breast and bottle feeding, and now drug abuse, AIDS and disaster relief. Rapid assessment was first formally described in the mid-1980s (Bentley et al. 1988; Schrimshaw et al.1987 ; Schrimshaw et al. 1991) along with other rapid assessment and evaluation models developed about the same time. Rapid ethnographic assessment fits into the general model of rapid assessment paradigms, including those used for rapid environmental appraisal (Oliver and Beattie 1996; Stohlgren et al. 1997), rapid epidemiology (Anker 1991; Smith 1989), rapid disaster assessment (Malilay et al. 1997), and rapid assessment of biomedical conditions (Lee and Price 1995). Rapid ethnographic assessment has a well-documented history of success in both international and domestic contexts (e.g., Dale et al. 1996; Vlassoff and Tanner 1992). It has been used in developing countries as a substitute for survey and other quantitative data-collection processes and as a compliment to existing data sets and surveillance systems. Examples include research about malaria in the Philippines (Miguel et al. 1999), HIV among young people in Cambodia (Tarr and Aggleton 1999), family planning in Burkina Faso (Askew et al. 1993), preschool children exposed to pesticides in Mexico (Guillette et al. 1998), sexually transmitted disease and HIV prevention in Turkey (Aral and Fransen 1995), and injection drug use in Vietnam (Power 1996). Rapid assessment is also used as a complimentary data collection process in developed countries. In this role, it is seen as valuable in targeting conditions and contexts that are more highly concentrated than those identified by normal surveillance and epidemiological efforts. It provides information for spotting emerging conditions that are not yet visible in other data sets and allows for the development of interventions successfully configured for local contexts, especially where local cultural conditions and values differ from the dominant cultural system. Examples of these types of rapid assessment projects include information on the health problems of homeless youth in Baltimore (Ensign and Gittelsohn 1998), identification of priority health issues for health care management policy review in France (Lerer 1999), assessment of home-based care for people with AIDS in the United States (McDonnell et al. 1994), and the Rapid Assessment Response and Evaluation (RARE) project (Trotter et al. 1999) which provides an integrated framework to help assure that rapid assessment will be conducted within the context of strong scientific methodological standards within a community controlled context. The RARE program includes the creation of a guide for community leaders and advisory committees, a methods work book, the use of existing data sets (epidemiology, surveillance, and research), oversight by individuals with experience in the method, methodological training for local field teams, direct involvement of community leaders and health providers, accommodation of the methodological concerns raised in various critiques of the process, and an evaluation component to assess intervention implementation. This has led to a sustained use of the RARE based approach in the areas of intervention development and intervention evaluation (Needle et al. 2008; Trotter and Singer 2005). In addition, there has been an continuing technological transfer of the rapid assessment approach within applied medical anthropology to encompass evaluation research targeted at both institutional reform and program improvement (Rugg et al. 2004; Sobo 2008; Stimson 2005), disaster relief and ancillary health issues (Low et al. 2005), and current health disparities research within a participatory action framework in public health (Hernandez et al. 2008). And the COVID-19 pandemic has revitalized some of the key policy investigation elements of the RARE approach (Eaves et al. 2020). This broad diffusion of innovation demonstrates that scientifically sound rapid assessment contains an important set of tools (ethnographic theory, methods, and community orientation) that are of significant use to applied medical anthropologists.
ETHICS3 AND APPLIED MEDICAL ANTHROPOLOGY: A COMFORTABLE FIT
Applied medical anthropology has (and needs) a strong ethics core that anchors medical anthropological praxis to appropriate standards of conduct. The complexities of ethnic and cultural nationalism, combined with the excesses and outright abuses of power during both colonial and post-colonial globalization periods have had a powerful impact on anthropologists’ ability to do applied medical anthropology.
Applied medical anthropologists face two complex, interwoven, yet frequently dichotomized ethical challenges that must be negotiated, addressed, and jointly accommodated. These two challenges are the ethics of professional praxis and the ethics of conducting cross-cultural research on health, healing, and medicine within a global multicultural context. The first challenge is to construct and conduct research in an ethical manner by successfully anticipating, addressing, and appropriately applying the numerous, often vague (sometimes culture bound), contradictory, and challenging disciplinary, national, and international ethical rules, guidelines, and treaty obligations surrounding the conduct of science and research. The history of human research is unfortunately littered with the cultural debris of harmful actions on the part of the researchers and their sponsors. Following the principles, guidelines, and laws that protect people from unethical research is a critical requirement for protecting humans from harm at the hands of researchers. An equally important complementary ethical challenge for anthropologists is to conduct their professional activities (teaching, applied practice, and knowledge dissemination) ethically within and across competing social and cultural boundaries. Anthropologists must be particularly ethically vigilant when they are using anthropological theory, knowledge, or praxis that might be a direct (and sometimes even indirect) cause of harm for vulnerable people. People’s lives can be impacted by what anthropologists say and what anthropologists do in their personal and professional capacity.
Anthropologists have been intimately involved in the public debates and explorations of the ethics of research ever since the emergence of the disciple in the late 1800s, when much of the ethical elements of the debate revolved around the meaning of evolution, the relationship of science to theology, and the nature of “civilization” to other forms of social complexity, as opposed to other cultural conditions. Since that time, the discussion of ethics in anthropology has consistently paralleled the concerns, explorations, and debates focused on science in general, on the impact of changing technology and globalization for all cultures around the world, on war and conflict, and on the emerging ethical concerns in the other social sciences (such as deception or sociobiology). One of the first public explorations of ethics in anthropological research is the American Anthropological Association’s participation in the drafting of the Universal Declaration of Human Rights