Читать книгу A Companion to Medical Anthropology - Группа авторов - Страница 55

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.