Research that matters

Garcia’s ethnography on pastoral clinics and rural heroin addiction in New Mexico humanizes heroin addiction. She emphasizes the societal, familial, and systemic issues that contribute to pastoral clinics’ purported failure by measures self-discharge and relapse. Garcia’s quote in Chapter 5 where she talks about how the biggest problem with clinic life is life outside of it sums up her emphasis on societal factors. Heroin addiction is not an individual failing, as shown by her relationship with her subjects who have relapsed into heroin addiction. Rather, heroin addiction can be due to a multitude of factors outside of one’s control such as familial involvement in heroin trafficking and lack of long-term treatment programs that accommodate childcare needs.

Her methods bring up the question of research ethics. Garcia became part of the clinic because she was hired as a detoxification attendant. She took the job primarily because she wanted to get closer to her subjects and get them to trust her. My question is, did she disclose her motivations for taking the job to her subjects? If so, did she disclose her motivation before or after developing relationships with them? Working in the clinic obviously gave her insider status so that the clinics’ patients would be more likely to confide in her. However, I’m interested to hear others’ perspectives on the ethics of taking a job to get closer with one’s ethnographic subjects. 

Granted, Garcia does not center her work as a detoxification attendant. Rather, she centers the experiences the patients who cycled in and out of the clinic. If she hadn’t disclosed that she worked at the clinic, I would not have guessed that she did. However, knowing that she worked at the clinic, it makes sense why she faced little barriers to accessing the clinics’ patients and gaining their trust. I also wonder what information she might be omitting in her ethnography to protect the clinic and its patients because of her insider status. 

In regards to content, I enjoyed this reading as it reframes the issue of drug addiction, which is highly stigmatized in the United States. Garcia goes against norms and stereotypes of addicts to look at alternative factors in drug usage and relapse. She encourages the consideration of a multitude of factors from neoliberalism to historical issues that create the conditions for drug usage, addiction, and relapse.

One thing that I have noticed both from Professor Khan in her talk on campus as well as in Garcia’s writings that they both connected to broader philosophical thinking. In formation of her research question/focus, I am curious if Garcia had these broader philosophical thoughts (such as Levinas) which she narrowed or vice versa. Additionally, I loved how she was transparent with her shortcomings, for a lack of a better word. She acknowledged how broader happenings, particularly the suicide of a teenager at a faith-based rehabilitation program, resulted in certain groups being closed off and hesitant. I am curious at the different ways she tried to establish rapport in these difficult conditions, but it was nice to see a professional be honest about their shortcoming and subsequent adaptations/modifications to research.

In Chapter 5, Garcia does a great job of gathering diverse perspectives during her fieldwork. However, her choice to utilize anecdotes allows a personification of addicts that is normally stripped away in society, politics, media, etc. She seemingly approached these conversations in a nonjudgemental way allowing these addicts to confide in her. She utilizes these stories of individuals, such as Adela, to describe how neoliberalism has impacted medicine and her continue practice of “home detox.”

All in all, I think Garcia did a great job at establishing rapport and utilizing the stories of individuals to personify drug usage and illustrate how broader systems impact individuals and communities.

Garcia’s The Pastoral Clinic: Addiction and Dispossession along the Rio Grande provides a fascinating look into the lifestyle and challenges faced by people in New Mexico, tracing complicated histories of heroin addiction, detox resources, overdoses, and structural violence. Methodologically, the author describes her own experiences working as a detoxification attendant in a drug detoxification clinic in Española Valley. I found it interesting that she sought out this job to obtain an intimate relationships with her subjects, facing the harsh realities of this occupation for herself. Since other attendants only needed to pass an exam on prescription medications – without official training – there was a low barrier to access this way (2).

Later, when recalling her own experiences in this area, she says how she “would speak of New Mexico’s distinctive beauty, never of the deep suffering that I knew existed there” and eventually realizing how physical landscape and systematic addiction is inextricable – each with “its own processes of sedimentation” (6). This sentiment was particularly powerful to me, as I am currently in an Environmental Humanities class where we explore similar topics with regard to how ecological terrain can propagate narratives of “nature,” human destruction, and generational significance. 

Garcia’s book describes a particular instance of “self-discharge” from clinics whereas some detox patients are unable to complete the process to eliminate drug dependence. She gives the example of John, who had apparently “gotten over the hardest stretch of heroin detox” and motivated himself toward progress with the threat of going to prison despite ultimately “self-discharging” and supposedly relapsing (4). The author asks “were there other, perhaps deeper dynamics of loss and longing during our walk that contributed to his relapse? How would I be able to begin to understand the motivations, force, and meaning of his “self-discharge”?” (4). The very presence of syringes in the natural environment poses a threat to getting and remaining sober because of the reminder it serves.

In the introduction, readers begin to learn about the presence of clandestine abortions in Senegal and the ways in which those performing post-abortion care have worked in conjunction with the carceral system in order to prosecute and investigate these abortions and those who are involved with its procurement. Suh also defines reproductive governance, the “mechanism through which different historical configurations of actors—such as state institutions, churches, donor agencies, and non-governmental organizations (NGOs)—use legislative controls, economic inducements, moral injunctions, direct coercion, and ethical incitements to produce, monitor, and control reproductive behaviors and practices” (3). Through this, I learned that the International Conference on Population and Development did not recommend legal abortion as part of its reproductive rights framework. Instead, for countries where abortion is illegal, they recommended post-abortion care as a strategy to reduce mortality caused by unsafe abortions and their complications. Though this harm reduction strategy can be helpful, to not push for access for abortions for all, marginalized people retain the most risk. As talked about in regards to Senegal, women who are low-income and single are more likely to suffer morbidities and fatalities because they don’t have access to safe and discreet abortion care services. The global political landscape has also been greatly influenced by policies in the U.S., including the Mexico City Policy, which threatens developing countries with restricted family planning aid if they choose to fund abortion services, advocacy, or research. In this way, I begin to see how Senegal’s reproductive justice landscape is shaped by not just local policy and social norms, but also the whims, desires, and objectives of global powers like the United States. Thinking about this, I begin to have many questions about how much the influence of colonialism and imperialism have impacted Senegal and the birth givers who reside there. Not only are their current law remnants of colonial ideas, but the current environment is continuing to be shaped by the influence of Western powers.

I thought that this ethnography was a perfect example of showing how ethnographic methods can provide information that we would not be able to get from another research method or style. Something from the introduction that particularly stood out to me was the difficulty of determining the statistical significance of PAC. Strict laws, indeterminacy, and underreporting cause abortion mortalities and abortion morbidities to be difficult and near impossible to determine (p. 8). This fact, in my opinion, absolutely highlights how much ethnography can give us on this topic that statistics cannot provide. Some individuals could argue against PAC because of the lack of statistical significance in favor of it without recognizing how important it is as a start to reproductive governance. A statistic that did stand out to me was that “up to 40% of women who experience complications do not receive care” (p. 6). While the numbers may not show a significant connection of PAC with decreasing abortion mortality rates, I think the fact that this piece shows and highlights the stories of those who might have been helped by it shows that even without these exact statistics, PAC can still help people. Unfortunately, Chapter 3 also highlights the imperfect application of PAC by showing the different stakeholders involved: healthcare workers, midwives, police, and the women potentially getting abortions. Specifically, I found it interesting that doctors rewrote the narratives in order to portray these women as “reproductive” bodies to help stifle the suspicion around whether they pursued an abortion. This leads to a huge amount of judgment enacted by these healthcare workers that can change depending on the state of a woman’s body, marital status, socioeconomic status, and more. Suh enlightens this through anecdotes and quotes from her informants. I am curious, from Suh’s perspective, how she was able to separate her emotions from studying this? Many of the stories of these women emotionally impacted me, and I wonder how speaking about them impact Suh.

Suh’s ethnography explores the racial, class, and gender-based components of post-abortion care (PAC) and reproductive health politics in Senegal. At first glance, I thought of the term PAC to be neutral. However, my impression of the term soon flipped to be negative after reading Suh’s analysis of how PAC perpetuates reproductive injustice through placing Senegalese women under increased scrutiny when they seek abortions. PAC treats abortions that have already occurred. Health care providers in states with restrictive abortion laws therefore are motivated to misclassify induced abortions as miscarriages. Underreporting the number of induced abortions increases stigma against women who seek out abortions and places them under elevated surveillance and legal consequences.

Suh’s methods include interviews with Senegalese patients, health care workers, and police. She also observes hospital activities and health care workers’ conduct within hospitals when treating patients seeking reproductive health services. I appreciate how Suh interviewed patients, health care workers, and police so she could get all perspectives of those involved in reproductive health politics. She contrasts patients’ reports about the scrutiny they faced in hospitals with the polices’ reports about their unchecked power to investigate women who they suspect of having abortions. These perspectives showcase the power differential between the patient and the provider and the patient and the legal system in Senegal. 

A question I am left with is how did Suh navigate interviews with medical providers who mistreated women or police? She disagrees with both of these groups’ methods. How did she conduct those interviews and make them feel comfortable disclosing information while avoiding hostility?

A sentiment that stood out to me was that “Ethnographic data is fleeting, and the ethnographer’s job is to record it before it disappears or dissipates,” meaning one must be prepared in advance of their interviews to efficiently document minutiae that cannot be captured on a recorder. The book warns us about trying to describe what we remember after experiences and observations are first made, as “human memory is a tricky and complicated phenomenon, and it can complicate the record unnecessarily” (70). It is also important that ethnographers properly read the situation around them so that they do not make themselves stand out more than they need to, potentially threatening the degree of honest information they receive. On the other hand, it is likely unrealistic to think that an ethnographer can completely blend into the space around them while taking reliable notes, so one may decide to always have a notebook with them so others eventually accept it as normal (71). In terms of my own research project, I wonder how I might be able to reliably document my peers’ insight without suddenly changing my personality or introducing a new form of methods to record their thoughts. I might opt to take notes on my phone if I am observing a larger group of people so as not to stand out.

As covered in chapter six, when it comes to participant-observation, one must decide to what extent they want to engage with their field site. In this way, once the degree of participation and event recording is decided, the ethnographer must remember to obtain as many different versions of the story as possible to verify their data. For example, the book recommends attending “multiple versions of similar events” to compare social roles and behaviors as variables change (89). This discussion is relevant to my TikTok research project because I conducted ethnographic research at a TikTok Debate Event on campus, but it would be useful to experience more of that type of event to better understand what type of person participates and how these people think. A single event gave me a reference point but I cannot quite consider that as illuminating as developing a long-term bond with a specific informant.

I found Suh’s work to be very insightful. The placement of PAC, which is an attempt to protect mothers, in the category of obstetric violence was really profound. The way that the PAC statistics are manipulated to show success and prevent abortion law reform shows how this policy has many benefits but also detriments. Similarly, Suh places PAC in larger systems (i.e., legal, political, social, economic, etc.), and in Chapter 3, we see this carried out. Whether that be through gendered expectations in determining whether an abortion was induced or the divide between medicine and law, Suh places PAC in these various systems. For example, it is interesting how the norms, situations, and societal expectations of women lead to assumptions of miscarriage or induced abortion. All in all, I found this reading to be very insightful regarding the benefits and detriments of PAC for a woman and women, more broadly.

In regard to methodology, I found her introduction to be quite lengthy. It seemingly included an extensive background, utilizing past research, an acknowledgment of her potential biases as a feminist, and an outline of what is to come. While I thought the background to be lengthy yet insightful, I generally liked the structure of her introduction. In regards to Chapter 3, I thought the use of the quote from the nurse was very clever. I am curious how she got consent for an interview when the stakes of the interview include potential legal consequences. How did she get honest interviews when this is the case? I also think the use of anecdotes adds a human-element that is often missing from data and research.

Author Siri Suh presents an interesting dynamic that healthcare providers face in her work Dying to Count. Her ethnography focuses on Senegal, a country of Islamic majority with relatively strict abortion laws. These laws coincide with cultural expectations of restraining from sexual relations until marriage and of desired pregnancies. Suh writes that, in Senegal, “the concept of an ‘unwanted’ pregnancy within marriage falls beyond the boundaries of appropriate femininity, in which motherhood is a natural, desirable, and inevitable outcome of sexuality.” (86) To uphold this culture, authorities place pressure on healthcare workers to disclose induced abortions so that legal action can be taken against the mother. However, healthcare workers in Senegal “distinguish their role in managing abortion complications from that of law enforcement officials.” (88) One midwife who Suh interviewed stated that “even if the patient had an induced abortion… it’s not my problem. The obligation of a midwife is to care for the patient.” (88)

These dual pressures put healthcare providers in a bind. On one hand, they can follow legal expectancies and tip off authorities about suspected illegal abortions which they encounter. On the other hand, they face ethical and moral obligations to provide care for the patient, whether the abortion was induced or a miscarriage. To balance these pressures, healthcare workers in Senegal tend to alert authorities only when there is concrete evidence that a patient received an induced abortion: one head gynecologist stated that he is “not obligated to send if there’s suspicion, but not evidence.” (92) In the large majority of cases without evidence, healthcare providers chart the patient as having a miscarriage so that they can provide adequate PAC. Suh demonstrates how countries like Senegal attempt to balance legal repercussions regarding abortion and the provision of best care, when the end goal is to limit maternal mortality.

From the start, I found Dixon’s approach to her ethnography to be incredibly interesting and rather well-rounded considering the intended goals of her work. When used correctly, ethnography can do exactly what we have discussed in class: unveil the non-obvious. And Dixon appears to do just that through this piece, actually deciding to call it a “story,” rather than merely research, with the intent of divulging how “midwives are strategically navigating the changing global discourse around women’s health to both strengthen their professional authority and improve health outcomes for their patients and communities” (Dixon, 2020: 7). She even notes how the ethnographic method is quite useful in these circumstances given its ability to “allow us to see how individual experiences, desires, and outcomes in health are related to conversations and interventions at local, national, and global levels,” though this regard for ethnography causes me to consider a recent reading that I have done that actually notes some of the drawbacks of the research method (2020: 11). DeGenova in his own book Working Boundaries: Race, Space, and Illegality in
Mexican Chicago actually makes note of the colonialist foundation of the practice, especially since his interlocutors were especially distrusting of him due to his scholastic status. Within the first chapter, he asserts that he “had a responsibility not to transpose my research into the kind of dehumanizing study by which a white social scientist… presumes to make authoritative pronouncements about ‘the Mexicans’ and some ossified thing called ‘their culture'” while presenting the research in this book, an acknowledgement that Dixon does not appear to blatantly state in her own work (DeGenova, 2005: 18). Though she acknowledges the systematic structures inherently involved in the basis of her research, she does not appear to grapple with the inevitability of similar oppressive structures within the practice of ethnography itself. This, however, has a possibility of being omitted depending on how her work represents the studied demographic, but it may be difficult at times to neglect the oppressive foundation of the practice as a whole in relation to the demographic that was, at one point, affected by that same oppression. My question now is how necessary such an acknowledgement is in works like these that call attention to movement throughout ironclad political and institutional structures, and how effective this awareness can be in diminishing the strength of these powers.

In chapter three, Dixon describes what she calls maternal conditioning, which refers to the process by which “women become conditioned to behav[e] in a certain way and… [expect] certain things and to the material conditions that women find themselves in once they act as they are told” (94). The structural inequalities that produce the inequities faced by women in Mexico and the effects of this are related to this. This chapter also heavily focuses on “patient-provider interactions” and it is through this analysis that Dixon illuminates what many anthropologists term illness experiences and life world meaning. The patient’s experience in the context of their world, in this case, the structures that result in low-income women and women who live in rural areas, to die in childbirth or have various morbidities during pregnancy and birth, informs their experience and their interactions with health professionals. Structural inequities like poor road conditions and limited access and knowledge are then framed by the ways midwives address structural violence through a “humanization of the health-care system” (95). It is this that I believe gets to the root of how midwifery in Mexico is able to bridge the gap between patients and providers. Because they build trust with their patients and are able to address their needs in a way other health providers are unable to, midwives in Mexico are able to reduce morbidity rates and give women care that they are likely unable to receive elsewhere.

Dixon writes her ethnography in a way that directly acknowledges the subversion of expectations. For example, on the very first page of the Introduction, she discusses how pharmaceuticals and syringes are not something that you might expect when you think of “midwifery.” I believe that this is, in part, to show the amount of inherent bias and misunderstanding towards “non-mainstream” medical care. However, despite the misunderstanding and the Mexican government’s attempts to undermine the practice of midwifery, the practice still evolves and prevails. I also thought it was incredibly interesting how Dixon addresses she needed extensive ethnographic fieldwork in order to understand the historical context of midwifery in Mexico. Typically, I feel like medical care and treatment are both things that are well documented. However, because of the systematic attempts to devalue the practice, the ethnographic fieldwork seemed fundamental and instrumental in researching this. I also really liked her acknowledgment that healthcare, in an attempt to globalize it and make it universal, does not address alternative forms of health care and also the underlying structural problems and needs of different countries (p. 9). This ethnography, in general, made me think about our class activity where we discussed remedies for the common cold and saw how many different remedies we considered just within the class. Furthermore, what remedies are considered atypical or not mainstream, as Dixon writes, are seen with far more vitriol than what is deemed as a remedy by the dominant healthcare system. Following this reading, I am curious about how midwifery is viewed in other countries. In the United States, I know that there are “natural births” and “doulas” that can have medical degrees and training and Dixon also talks about the ever-evolving field in Mexico, but I am curious about this practice cross-culturally.

In this reading, Carwill Bjork-James talks about the Bolivian social movement, focusing on discussing the strategies used by activists. I found the term “Sovereign Street” pretty interesting, especially in how it highlighted how urban protesters built their base of supporters by protesting in public spaces. I enjoyed this premise because it is not often that social movements where people try to take control of their fates in third-party countries are successful.
I really enjoyed this reading because it gave me a deeper understanding of what kinds of obstacles social movements such as the one in Bolivia face. I know that grassroots movements require a lot of mass mobility and cohesiveness. However, I do not know how governmental opposition, general discontinuity, and political intervention could play a role in fragmenting social movements. I also enjoyed how the leaders of these social movements were portrayed in interviews. Normally, these leaders would be seen as just that, leaders. However, in the interviews, it was seen that they were portraying themselves as simply the face of the people who are their main focus.
Overall, I enjoyed this reading as it gave me a unique perspective on an issue I rarely encounter. One question I would ask myself is, “how is this grassroots movement different from others/what differences lead this movement to continue to be cohesive in the face of governmental pushback whereas other grassroots movements fail?”

This reading was an interesting examination of the role of midwifery in reproductive care in Mexico. Since reproductive health is a topic I was passionate about, I took greater care reading this. Dixon’s work was done using fieldwork in rural areas of Mexico. She specifically focuses on the role of midwives in reproductive care within indigenous communities. She learned that midwives are extremely important in settings with limited hospital care through her on-site work. As discussed in Dr. SBJ’s Reproductive Health course, midwives are frequently painted as unnecessary and non-medical. However, they are extremely important ways for families to gain emotional and social support throughout their pregnancy and the birthing process.
I enjoyed how Dixon was able to emphasize creating the cultural and historical context of midwives in Mexico, going back to colonial periods to set the stage for the emergence of midwifery. This reading truly broadened my perspective of what current initiatives meant to help these communities still need to be included. They need an appreciation for what already works for the communities and need to integrate cultural practices that involve the community in the population’s health, typically defaulting to more Eurocentric standards of care. One question I found myself asking was, “Why do the women go to overstaffed hospitals over midwives and how can we tip the balance back in favor of midwives so that more equitable care is available?”

In Deborah Thomas’s essay, she examines violence concerning Jamaican citizenship. Violence is typically the last resort of Jamaican people being denied citizenship wrongfully. She also looks at various other forces pushing Jamaicans towards violence, such as international forces and global media depictions of Jamaican governments.
Some methods I gathered from her work were participant observation, interviews, research of existing historical documents, and analysis of visual mediums such as news footage. Analysis of her methods gives me a good understanding of how on-site ethnographic research methods could look. Most notably, her time spent in Jamaica taking notes during church services, political rallies, and other events gave me insight into how she could gain a deeper understanding of Jamaica’s political and cultural struggles.
The main question I gathered from her reading was, “How did she break cultural barriers in her interviews to get her participants to open up about aspects of their experience she would not know to ask about?”

In the introduction, Tsing talks about a concept called “savage capitalism,” which is the process by which companies try to create capital and product out of their waste products. From the get-go, this rhetoric of savageness in the capitalist system shows Tsing’s distaste for modern economic practices.
In Chapter 1, Tsing delves into a specific case study of the matsutake mushroom market in Japan. Matsutake is an important ingredient in Japanese food, and its procurement is an example of sustainable trade. In this chapter, Tsing follows the pipeline of harvesting the mushrooms to importing them to Japanese markets. This chapter emphasizes that this trading system does not follow normal capitalist practices, which lends itself to being more sustainable.
The introduction of her methods provided a global scope of how she conducted her research in this essay. How she described the Matsuke trade provided a human insight into how community-building and meaning attached to trade items could improve equitability in economic systems to benefit workers equally instead of concentrating profits with the leadership team.

One question I would be interested in learning more about is, “How did the trade of the Matsuke mushroom isolate itself from traditional capitalist practices for so long?”