A method of health culture research in an African country.

Abstract

Public health programming in a foreign culture requires attention to two main facets of the problem: (1) introduction of good practices of modern, decentralized, preventive medicine; and (2) study of the ecological conditions that exist prior to the planned change. The latter involves determination of epidemiology, human geography, pre-scientific attitudes and practices relating to health and sickness, ethno-cultural factors in the aspirations of the various population groups. The first facet can be solved by techniques developed in the field of p u b 1 i c health: allocation of funds; recruitment of instructors, administrators and equipment; and substitution of para-medical trainees in regions where the availability of fully-qualified physicians, nurses, and sanitary engineers for rural needs is a decade away. The solution to the second facet requires teamwork among several disciplines because of the interlacing of biological and cultural dimensions. This paper will outline a recent enterprise which was in part modelled on Dodd's controlled experiment on rural hygiene thirty years ago,4 but which required adaptation from the problems of Syria a generation ago to those of Ethiopia today. In both regions, experimental and controlled communities were selected, and arbitrary scores assigned to hygiene-related practices and attitudes. This paper describes the "before" part of the enterprise. The Ethiopian Context: The concept of decentralization of the introduction of modern health center facilities immediately directs the attention to the rural region where the majority of people live, in "developing" countries.5 Unlike Syria, Ethiopian rural folk live in series of hamlets rather than villages, but group around market centers. The latter take the aspects of little towns and vary in population from 1,000 to 4,500 residents. Since the introduction of health facilities requires accessability at least most of the year, the little towns constituted the most logical universe from which sample "study" and "control" communities were to be selected in such a manner as to represent the major ethnic and ecological dimensions of the country. Ethiopia was considered a good location for such a study because true baselines exist due to the long isolation of the country and poor communications among many of the communities.