Capstone Proposal



Capstone Proposal

Margaret Everett, Anthropology

Jack Corbett, Public Administration

Portland State University

SECTION I

General Description

Diabetes Awareness and Prevention among Mexico’s Transnational Migrant Population

The health of populations is shaped by both biological and social forces. In the southern state of Oaxaca, Mexico, migration, tourism, and emergency displacement, among other factors, shape an array of health challenges. Diabetes is one of the fastest growing and most significant of those health challenges. Students will travel to Oaxaca City to work with local organizations to assess the prevalence of diabetes and the associated risk factors involved, and will assist these organizations in developing strategies toward a coordinated awareness and prevention program.

Community Issue/Problem to be addressed:

In a world where international migration, tourism, emergency displacement, and other factors provoke the movement of populations across national boundaries these forces acquire the capacity to affect the health of large numbers of people in short order. To effectively manage, protect, and improve the health status of populations in movement it becomes necessary to understand circumstances in both sending and receiving regions as both shape status and needs. While our attention generally centers on crises and dramatic cases such as avian flu or AIDS this reality in practice has relevance for a wide array of health problems.

One emerging example of these complex realities is the growth of diabetes as a transnational health concern in Mexico and the United States. For example, the rural population from communities in the southern Mexican state of Oaxaca, a population with substantial representation among migrants and immigrants in Oregon, displays a high incidence of diabetes despite a nominally low-risk diet. The incidence of diabetes therefore challenges populations and health care providers on both sides of the border. To better understand this phenomenon students will travel to Oaxaca to work with local organizations to assess the prevalence of diabetes and the associated risk factors involved, will assist these organizations in developing strategies toward a coordinated awareness and prevention program, and prepare themselves to do similar work among the Mexican-origin population in Oregon.

According to the International Diabetes Federation (), diabetes is the fourth leading cause of death worldwide. Diabetes is growing worldwide, and Latin America is experiencing one of the fastest growth rates (IDF estimates that parts of Latin America will experience an 85% increase in diabetes prevalence by 2025). At least 50% of all people with diabetes are unaware of the condition, and this rate is higher in the developing world () . Complications from diabetes include blindness, cardiovascular disease, amputation, and kidney failure. Prevention and early detection are critical to lowering the human and economic costs of diabetes.

The exceptionally high rate of diabetes in Native American communities is well documented. Native Americans, in fact, have the highest prevalence of type 2 diabetes of any group, according to the Center for Disease Control. Less is known, however, about the rate of diabetes among indigenous Mexicans, although some studies and anecdotal evidence suggests that the problem is increasing with urbanization and migration, economic development, and changes in foodways and physical activity. In the United States, Mexican Americans are almost twice as likely to have diabetes as non-Hispanic whites of similar age, according to the Center for Disease Control. Scientists continue to debate the relative weight of social and biological (i.e. genetic predisposition) causes of diabetes. One of the founding assumptions of this course, however, is that diabetes is the result of a complex interaction of biological and social forces.

In Oaxaca, doctors in rural clinics report an especially high incidence of diabetes. Access to screening and prevention programs is lower in rural areas, and hindered by economic and language barriers. Many members of rural communities emigrate to the United States, especially to participate in seasonal agriculture. A large number of indigenous Oaxacans come to Oregon each year, especially to the Willamette Valley and the Woodburn area. Migration poses a number of health challenges in general, and makes the management and prevention of chronic conditions such as diabetes especially difficult. Additionally, many of those who stay behind in Oaxaca are elderly and may be more vulnerable as family members and others whom they can turn to for mutual aid leave the country. Although we initially plan to concentrate on work in Oaxaca itself, it is impossible to ignore the relationship of migration to health and we anticipate that this will be a significant focus of our project. We further see this as an exciting opportunity for students to explore the way their home region is connected to other countries and regions.

Learning Objectives:

For students to gain first hand experience with participant observation and immersion in an international setting.

For students to reflect on the complex ways health is impacted by social, economic, political and cultural forces.

For students to develop collaborative and problem-solving skills.

For students to gain practical experience working with community partners, using the model of participatory action research, in order to develop a meaningful action plan for diabetes awareness and prevention.

For students to develop understanding of transnational populations in Oregon and their ongoing connections to their home communities.

Academic Literature/ Reading List

NOTE: Articles in Spanish and public reports are for course development only and will not be required reading.

Books

Joe, Jennie, and Robert Young, eds. 1994. Diabetes As a Disease of Civilization: The Impact of Culture Change on Indigenous People. New York: Mouton de Gruyter.

Loustaunau, Martha, and Elisa Sobo. 1997. The Cultural Context of Health, Illness, and Medicine. Westport, CT: Bergin and Garvey.

Sacks, Oliver. 2002. Oaxaca Journal. Washington, D.C.: National Geographic.

Stephen, Lynn. Zapotec Women: Gender, Class, and Ethnicity in Globalized Oaxaca. Durham, NC: Duke University Press.

Articles/Chapters

Anguiano, M.E. 1993. “The Migration of Indigenous Mixtecans. Population Mobility and Preservation of Identities.” Demos 6: 16-7.

Carlson, B.A., D. Neal, G. Magwood, C. Jenkins, M.G. King, C.L. Hossler. 2006. “A Community-Based Participatory Health Information Needs Assessment to Help Eliminate Diabetes Information Disparities.” Health Promotion Practice 7(3, suppl): 213S-222S.

Castro-Sanchez, H. and J. Escobedo de la Peña. 1997. “La Prevalencia de la Diabetes Mellitus no Dependiente de Insulina y Factores de Riesgos Asociados, en Población Mazateca del Estado de Oaxaca, México.” [Prevalence of Non-Insulin Dependent Diabetes Mellitus and Associated Risk Factors in the Mazatec Population of the State of Oaxaca, Mexico] Gaceta Médica de México 133(6): 527-34.

Conway, D. and J.H. Cohen. 1998. “Consequences of Migration and Remittances for Mexican Transnational Communities.” Economic Geography 74(1): 26-44.

Farquhar, Stephanie, Yvonne Michael, and Noelle Wiggins. 2005. “Building on Leadership and Social Capital to Create Change in Two Urban Communities.” American Journal of Public Health 95(4): 596-601.

Greenwood, Davydd, and Morten Levin. 1998. Introduction to Action Research: Social Research for Social Change. London: Sage.

Guidi, M. 1993. “Es Realmente la Migración una Estrategia de Supervivencia?” [Is Migration Really a Survival Strategy? The Case of the Northern Oaxacan Mixteca] Review of International Sociology 5: 89-109.

McGuire, S. and J. Georges. 2003. “Undocumentedness and Liminality as Health Variables.” Advances in Nursing Science 26(3): 185-95.

Potvin, Louise, Sylvie Gendron, Angele Bilodeau, and Patrick Chabot. 2005. “Integrating Social Theory into Public Health Practice.” American Journal of Public Health. 95(4): 591-595.

Rubel, Arthur, and Carole Browner. 1999. “Antropología de la Salud en Oaxaca.” Alteridades 9(17):85-94.

Schulz, L.O. and R.C. Weidensee. 1995. “Glucose Tolerance and Physical Activity in a Mexican Indigenous Population.” Diabetes Care 18(9): 1274-6.

Sims, Brian and Jeffrey Bentley. 2002. “Partipatory Research: A Set of Tools but not the Key to the Universe.” Culture and Agriculture 24(1): 34-41.

Smith-Morris, Carolyn. 2004. “Reducing Diabetes in Indian Country: Lessons from the Three Domains Influencing Pima Diabetes.” Human Organization 63(1): 34-46.

Sunstein, Bonnie, and Elizabeth Chiseri-Strater. 2002. “Stepping In and Stepping Out: Understanding Cultures” IN Fieldworking: Reading and Writing Research. Boston: Bedford/St. Martins, pages 1-53.

Whiteford, Michael. 2006. “Homeopathic Medicine in the City of Oaxaca, Mexico: Patients’ Perspectives and Observations” IN Health and Healing in Comparative Perspective, Elizabeth Whitaker, ed. Upper Saddle River, NJ: Pearson, pages 53-60.

Ysunza-Ogazon A., Diez-Urdanivia-Coria S, Lopez-Nuñez L. 1993. “Programa de Investigación-acción comunitaria en migración y nutrición” [A Program of Community Action Research on Migration and Nutrition] Salud Pública de México 5(6): 569-75.

Reports

Oregon Department of Human Services. Oregon Diabetes Program. 2002. Oregon Population-Based Guidelines for Diabetes Mellitus: Measuring Quality of Care in Health Systems.

Oregon Diabetes Coalition. 2005. Oregon’s Action Plan for Diabetes: Improving the Health and Quality of Life of Oregonians Affected by Diabetes.

Websites

American Diabetes Association ()

International Diabetes Foundation ()

Federación Méxicana de Diabetes ()

Center for Disease Control, Diabetes Program (diabetes)

Description of the Final Product

In the first year of the project, students will:

1. Develop a needs assessment and action plan for the second year students to follow up on.

2. The assessment will contain all relevant findings about prevalence and distribution of diabetes in Oaxaca, especially among indigenous populations. The assessment will be based on first hand observations and visits to a number of key “stake-holders” including a rural clinic, a traditional village healer, the food bank of Oaxaca, the Center for Attention to the Migrant, the Center for Population, State of Oaxaca, the public health authorities.

3. This report will be produced in Spanish and English and distributed to interested parties in Oaxaca.

4. The report will conclude with suggestions for next steps, to be taken up by subsequent capstone classes.

5. A preliminary report to invited guests in Oaxaca, and a public presentation at PSU.

List of Majors

Anthropology – medical anthropology, fieldwork methods, transnationalism and migration

Sociology – medical sociology, research methods, social determinants of health

Health Studies – community health education, health promotion and disease prevention, community-based health interventions, social determinants of health

Economics – economics of health care, economics of ethnicity, Latin American political economy, labor migration

Political science – health policy, political economy of health

Urban Studies – social aspects of urbanization and migration

Philosophy – bioethics and social justice

Native American Studies (minor) – indigenous issues, health inequalities, cultural studies

Spanish – the course provides an opportunity for language immersion through home-stay and formal language instruction while in Oaxaca; Spanish majors and native Spanish speakers will be especially encouraged to join the capstone

International Studies – globalization, Latin American Studies

Chicano-Latino Studies (certificate) – migration and health, cultural studies, social issues

Academic Expertise/Professional Background

This course will be team-taught by an anthropologist and a political scientist.

Jack Corbett is Associate Professor of Public Administration in the College of Urban and Public Affairs and Executive Director of the Instituto Welte de Estudios Oaxaqueños, a research center in Oaxaca, Mexico. His research interests include international migration, community development, and resource management. He has managed over fifty short-term and semester-length programs in Oaxaca and has taught a graduate-level course titled Health and Society in Mexico there. Jack has worked extensively with public agencies, NGOs, and community governments in Oaxaca, and these contacts provide us with access to an array of partners.

Margaret Everett is Associate Professor of Anthropology at Portland State University, with a background in medical and urban anthropology. Dr. Everett’s past research includes fieldwork in Bogotá, Colombia on rural-urban migration and urban development, and more recently on health policy making and bioethics in the U.S. She teaches several courses in medical and applied anthropology, and has supervised graduate and undergraduate students in community-based projects for 10 years.

Development of Community Partnership

Jack Corbett has met with people in the health professions, migrant services, and NGOs in Oaxaca and found widespread interest in developing better diabetes awareness and prevention. From rural doctors to state agencies there is a clear sense that this is a critical health issue, one which has not been addressed because it lacks drama and has little immediate relevance to the traditional focus on children and mothers. Medical training and public health in Mexico has tended to focus on pediatrics and maternal/child health. The prevalence of Type II diabetes, which disproportionately affects adults and the elderly, may partly explain why this disease has not received more attention from health officials. Our discussions with health providers in Oaxaca, however, suggest that this has begun to change, and chronic diseases like diabetes are receiving more attention. A recent attempt to create a diabetes association, although backed by a handful of doctors concerned about long-term implications, foundered in large part because it could not command the high visibility of other health problems. Thus there is a sense of a need to help the general population and state officials appreciate the number of people at risk and the long-term implications of the spread of diabetes. This would be an important step in facilitating development of coordinated treatment and prevention programs. The capstone would be an important contribution to understanding diabetes prevalence, risk factors, and potential interventions.

There are a number of local government and non-governmental organizations with very specific interests in collaborating with this capstone. Cesar Magani, research director of the state´s General Population Council, and Lucia Cruz, research director of the Center for Attention to Migrants, are interested in diabetes incidence among the general rural population and the migrant population, respectively. Jack Corbett has worked with Lucia Cruz on other projects and is aware of her concern that migrants develop untreated, often undiagnosed, diabetes during their time in the US, then return to rural communities with serious health problems difficult to treat given problems of poverty and isolation. The Oaxaca Food Bank is sensitive to the fact that many of the donations from major food distributors are heavily laced with sugar and wants to develop informational materials helping its users to modify diets. The Oaxaca Association of General Medical Practitioners, and particularly its former president Dr. Javier Mendez, would like to make another attempt to create a state diabetes association. The Instituto Welte de Estudios Oaxaqueños and other research organizations have a continuing interest in fostering local and international studies which contribute to a better understanding of contemporary Oaxaca.

In addition the Graduate School of Public Health at San Diego State University, in San Diego, California, has taken a special interest in the proposed capstone as it currently is working on a community-focused project on diabetes prevention and treatment among Oaxacan migrants to San Diego County. Professor Karen Coleman of San Diego State has offered to share their Spanish-language outreach materials and would like Portland State students to think in terms of collaborative exchange with San Diego State students, thereby increase the significance of both projects. There should be no problem obtaining letters of support or interest from organizations such as the Oaxaca Food Bank, the Center for Attention to Migrants, the Instituto Welte de Estudios Oaxaqueños, Oaxacan doctors, and others whose contact with vulnerable populations makes them aware of the serious health problem this project will address.

SECTION II

1. Inquiry and Critical Thinking

Before traveling to Oaxaca, students will meet with faculty for three class sessions in order to learn about the region, its people and culture, and to discuss introductory readings about health, migration, and diabetes. Students will participate in self-assessment and group discussions throughout the capstone experience. Like all cultural immersion experiences, we anticipate that students will be challenged to examine their own cultural backgrounds and worldviews. Because we will be focusing on health, students will have the opportunity to critically examine the differences between “biomedical” and “folk” understandings of disease. Drawing on their own disciplines, students will discover some of the ways that health and illness are shaped by the physical and social environment.

2. Communication

Students will have many opportunities to develop communication skills through this experience. Working in teams, students will need to bridge disciplinary boundaries and interact with community members in respectful and collaborative ways. Working in a foreign country, and in Spanish, students will need to be resourceful and creative. After returning to Portland, the class will meet on campus to prepare a final report, and will give a public presentation during the fall quarter. In their final report and public presentation, students will learn to communicate in a professional and accessible fashion, with sensitivity to a variety of stake-holders.

3. Variety of Human Experience (Diversity)

Through home-stay and participant observation, students will experience a place and culture that is likely quite different from their own prior experiences. While we encourage students to approach their international experience with an open and tolerant mind, we also encourage them to reflect honestly on their impressions and reactions to what they encounter. Students will learn, through preparatory reading as well as first-hand experience, about class and racial hierarchies in Mexico, as well as about the reasons why many Oaxacans seek work in the United States. Students will also have the chance to experience the rich heritage and vibrant culture of Oaxaca. Through journal writing and a series of free writing exercises, students will explore their experience.

4. Ethical and Social Responsibility

Ethical and social responsibility is at the heart of this capstone experience. What responsibility do wealthy nations have regarding the health and well-being of poorer nations? What is the impact of corporate marketing, international migration, and other forces of globalization on the health of populations? These questions will form the basis of group discussions and free writes.

Additionally, we will consider how to introduce intervention programs aimed at health promotion and illness prevention. What cultural, political, and economic factors will need to be considered in order to develop such intervention strategies? The model of Participatory Action Research will provide a basis for these discussions. Briefly, participatory approaches attempt to create sustainable positive change through community involvement at all stages of a project, from identification of “the problem,” program design and implementation, and assessment. Such approaches have become increasingly popular in development schemes and public health promotion. Participatory Action Research seeks to avoid paternalistic relationships between “experts” and laypersons. Consulting and partnering with a number of organizations in Oaxaca, for example, is essential. We encourage students to consider community members as the experts, and to seek their perspectives and priorities whenever possible. Distributing our findings and seeking feedback will also be important for contributing to ethical and effective social change.

McTaggart describes Participatory Action Research as an “overlapping spiral of steps,” including planning, acting, observing, and evaluating. Students will participate in all of these steps to some extent. McTaggart explains, “One good way to begin a participatory action research project is to collect some initial data in an area of general interest (a reconnaissance), then to reflect, and then to make a plan for changed action.” The first year of the capstone will likely be focused on the first steps -- reconnaissance and reflection through self-assessment exercises and the final report. Subsequent capstones will build on the work of previous groups, developing project strategies, consulting local partners, and implementing diabetes prevention and awareness activities.

Respectfully submitted.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download