Health care allocation and selective neglect in rural Peru

This study of health care allocation to children in northern Puno, Peru, utilizes quantitative and qualitative data to explore differential resource allocation to children in rural Andean households. As part of a broader ethnographic study of health in two communities, quantitative data on reported health status, symptoms, and treatments (both lay and specialist) were collected for 23 children under the age of 7 over a one year period. Additional data were collected from local health post records. Data were analyzed by gender, and by three age groups (birth to 1 year, 1-3 years, and 4-6 years) to determine if differences existed in the allocation of health care. The data suggest a pattern of discrimination against females and younger children, especially infants under age one, despite the fact that these groups were reported to be sicker. Differences were especially significant in the allocation of biomedical treatments, the most costly in terms of parental time, effort, and money. Ethnographic data on child illness, gender, and developmental concepts help to explain why children of different genders and ages may be treated differently in the rural Andes. They provide a context in which to interpret health care allocation data, and, in the absence of a population-based study, reinforce findings based on the limited study sample. Female children are valued less because of their future social and economic potential. Females are also regarded to be less vulnerable to illness than male children, meaning that less elaborate measures are necessary to protect their health. Young children are thought to have a loose body-soul connection, making them more vulnerable to illness, and are thought to be less human than older individuals. The folk illnesses uraña (fright) and larpa explain child deaths in culturally acceptable ways, and the types of funerals given to children of different ages indicate that the death of young children is not considered unusual. Health care allocation and ethnographic data suggest that selective neglect (passive infanticide) may be occurring in rural Peru, possibly as a means of regulating family size and sex ratio. It is important to go beyond placing blame on individual parents or on culture, however, to address the underlying causes of differential health care allocation, such as poor socieconomic conditions, lack of access to contraceptives, and female subordination.intra-household resource allocation ethnomedicine selective neglect Andes

Environment, vulnerability, and gender in Andean ethnomedicine

In Cuyo Cuyo, in the southern Peruvian highlands, ethnomedicine is rife with images of human vulnerability to a hostile and unpredictable environment. This is represented in the ethnomedical system by a focus on wayras, air- or wind-borne illnesses that enter through vulnerable body openings such as the head, orifices, lower back, and feet. Women are viewed to be more vulnerable, or débil, than men to illness because they have an extra orifice, the vagina, they lose copious amounts of blood, which is thought to be irreplaceable, during childbirth, and because they suffer more negative emotions, which are thought to attract wayras and other illnesses to the body. The relationship of ethnomedical beliefs to the Andean physical and political economic environment is explored within the context of social and economic change. Negative beliefs about women's bodies have negative effects on women's roles and position vis-a`-vis men in present day Cuyo Cuyo. Ethnomedical beliefs reflect and reinforce gender inequalities in present day Peru and are part of a cultural ideology that in general devalues women. This case study demonstrates that power is a key dimension in the cultural construction of medical knowledge, whether in non-Western or Western societies.ethnomedicine gender Andes economic transformation

Staying Well on the Margins of the Formal Economy: Exploring Occupational Health and Treatment among Peruvian Vendors in the Urban Marketplace

With a growing percentage of the world's population living in urban areas, many people in cities are increasingly participating in economic activities on the margins of the formal economy. Many such workers generate income by vending goods on a small-scale level in and around traditional open-aired marketplaces. As a setting for health, marketplaces have been studied largely in the interest of consumer safety but less in terms of occupational health. This study explores the health of market vendors with a health promotion lens. It assumes health to be a holistic concept that considers the physical and psychosocial affects that vendors experience as a result of their work. Situated in the Andes, I describe how traditional concepts of health and well-being related to social reciprocity and ritual payments to the natural surroundings inform vendors' everyday health practices in a market located in the city of Arequipa, in the southern Andes of Peru. Data interpreted through socio- economic frameworks describes how one's social status, inside and outside the market, as well as social networks, affect health and rationale of treatment choices, largely in terms of biomedical and traditional methods. It was found that the nature of vendor's work represents a challenge to maintaining health in relation to both biomedical and traditional health practices. Findings suggest that treatment decisions may be motivated by demands of work, but also made as a means to re-enforce social relationships that go on to support one's economic well-being

Contrasting Patient and Practitioner Perspectives in Type 2 Diabetes Management

Studies of self-care behaviors in the management of type 2 diabetes of ten focus on patient knowledge and montivation, without considering the role of practitioner orientations. Using an exploratory descriptive design, we conducted open-ended interviews with 51 type 2 diabetes patients and 35 practitionersfrom clinics in San Antonio and Laredo, Texas. We found critical differences between patient andpractitioner goals, evaluations, and strategies in diabetes management, especially regarding such key concepts as "control" and "taking care of self:" Practitioners' perspectives are rooted in a clinical context, emphasizing technical considerations, whereas patients'perspectives exist within a life-world context andforeground practical and experiential considerations. These result in very different approaches to treatment. Practitioners, presuming failed treatment indicates uncooperativeness, try to inform and motivate patients. The patients we interviewed, however, understood and were committed to type 2 diabetes selfcare, but lackedfull access to behavioral options due to theirpoverty and limited social power.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69023/2/10.1177_019394599802000602.pd