Peaks and Valleys of Building Community Rapport: Lessons Learned Through an Investigation of Adolescent Sexual Health

On my graduate school journey in medical anthropology at the University of Alabama, I became curious about HIV risk while conducting fieldwork in Mobile, Alabama. There, I worked on my thesis on intergenerational body image beliefs of working class African American mothers and daughters. Mothers in my study revealed that they could tell someone had HIV by looking at them. These insights solidified my interests in determining what African American adolescent girls in Alabama knew about HIV and how social ecological factors influence both knowledge and sexual health behaviors. Alabama is an abstinence only sex education state (Minimum Contents to be Included in Sex Education Program or Curriculum, Alabama State Code Section 16-40A-2). Sexual health education is focused on abstinence until marriage, and prevention of sexually transmitted infections, including HIV/AIDS, and teen pregnancy.

The Youth Risk Behavior Surveillance reports that while risky sexual activity is decreasing among adolescents, condom use among African American high school teens during last sexual intercourse declined from 70 percent in 1999 to 65 percent in 2011. Alabama is ranked lowest in rates of condom use among high school students (Eaton et al. 2012). African Americans represent 26 percent of the state’s population, but 64 percent of reported HIV infections are from this group. Adolescents in Alabama aged 13-24 comprise 5 percent of existing HIV infections, and 32 percent of new cases reported in 2014 (Alabama Department of Public Health, 2015).

When I embarked on my journey toward this project, I was driven by anthropological theory as a way to address a public health concern. Although I did not consider a strengths-based approach to lead my inquiry regarding sexual health, I understood and respected the importance of addressing community needs as a participant observer and researcher. I recognize that dismissing assets used to address sexual health concerns is problematic. However, given the taboo nature of what I wanted to explore, I believe acknowledging these assets pose additional challenges and would not have changed the peaks and valleys experienced in my community engagement and research. Following is a brief, partial list of lessons learned through my experiences working with an anonymous African American community in Alabama. It is my hope that the suggestions put forth will prove valuable to those committed to community engagement and scholarship.

  1. Find community members supportive about what you want to learn.

Two years prior to beginning my research, I met with many community members. Among them was a school board member who worked for many years as a nurse. She developed and implemented a health initiative program where I happened to volunteer one summer prior to meeting her. Because of this established rapport through familiarity of her program, she provided me with beneficial information about health issues, community life and how to effectively engage with other members. She recommended members and organizations, as she ended many of our conversations saying, “Tell them I sent you.” This type of advocacy was essential to discovering where my skills could be used in the community while simultaneously researching sexual health issues among teen girls.

  1. Understand that what scholars, governmental institutions, and non-profit organizations view as important, community members may not judge similarly.

When establishing rapport in the early stages of my research, a professor suggested I meet a pastor amenable to research. This pastor was extremely welcoming, although, early on in our conversation, he stated that his church members do not really talk about HIV or believe it is a major problem in the community. In addition, I attended a high school parent meeting provided by a local health organization discussing sexual health and sexually transmitted infections. Notably, only two school administrators and myself attended this meeting, even though parents were given advanced notice of the seminar.

I discovered early on that difficulty in trying to research a stigmatizing topic is the strong desire for community members to separate themselves from the issue through attempting to achieve mainstream social norms, values, and conduct. This also creates difficulty in using a strengths-based approach, since assets may not be used for the purpose of addressing a proscribed issue that community members approach in denial.

  1. Find a place where you fit in and build community relationships.

After explaining my project to numerous community members, I had a difficult time having people take me seriously, return my calls, or acknowledge me in public. Initially, I spoke with middle class community members to gain entrée into the community, establish where I could assist with community needs, and determine the best way to learn what young teenage girls knew about HIV risk. For example, I approached another pastor who was willing to assist, but was ultimately too busy to accommodate me in his church. This early acceptance and eventual rejection happened frequently. While this pastor was too occupied to assist me, he introduced me to the director of a neighborhood center centrally located in a working class community, and this introduction proved to be extremely valuable.

The neighborhood center resulted in collaboration with the director where I fulfilled both community engagement and research roles. The center provides residents with numerous services including computer classes, GED classes, a Chess Club, and after-school and summer programs for youth. Upon my introduction to the community, the director asked if I would be interested in teaching GED. classes. I jumped at the chance to serve this community that was welcoming to my presence and could utilize my academic skills. I taught math GED classes weekly for a fall and spring semester to men and women in the community.

The women I taught were extremely helpful to my understanding of community dynamics. Understanding community interactions was useful given that I took a social ecological perspective to HIV risk in my research. Women shared that conflict centered on arguing over men who were unfaithful in not only the local community where the center was centrally located, but also in an adjacent governmental housing area. Remarkably, one of the women revealed that higher sexual risk was associated with a woman’s male partner having a concurrent relationship with someone outside of the immediate neighborhood. If their boyfriend had a sexual relationship with a woman in the governmental housing neighborhood or beyond the immediate community, it was believed that sexual health risk increased greatly because the sexual partners that their boyfriend was concurrently dating was unfamiliar. Given that the women were aware of gossip regarding illnesses that other women in the local community held, it was viewed as a higher risk situation when information about the health of potential sex partners outside of the community was not readily available, whether this information is true or not.

After spending some time in the community, I interviewed younger girls in the neighborhood who shared various characteristics and behaviors associated with HIV risk which highlighted socio-ecological factors important to this topic. High risk was associated with lack of parental investment, hanging out in the neighborhood, running away from home, and transactional sex. In contrast, low risk was associated with parental investment, staying at home, interest in academic pursuits and future goals, and involvement in church.

  1. Do not take it personally when you run into a person or people who are unsupportive. Avoid flattery and move on to someone willing to assist.

A school administrator that worked closely with the students shared some of the experiences of the girls that attended the community high school where I observed. At the outset, she was forthcoming about issues faced by female students including domestic violence, sexual abuse, teenage pregnancy and abortions. Through this first conversation, this administrator mentioned that she mentored and advised two in-school programs for girls that experienced these concerns. I looked forward to observing these programs, hoping to get a sense of how these students understood sexual health through their lived experiences. Afterwards, the administrator noted that she would have to ask permission to allow me to gain access to these programs and observe students.

After a great deal of effort to contact her in the days and weeks following our conversation, I emailed her to see if I would be more successful in contacting her in that manner. This approach worked, with a brief email returned almost immediately. Unfortunately, the administrator noted that aside from the Principal of the school, she also answered to another supervisor at the department of education. Her supervisor advised that she was not under any responsibility to assist me in understanding issues related to sexual health, and wished me the best in my endeavors.

I was not surprised by the eventual demise of our communication, although the situation was extremely discouraging. After the dust settled, I asked some colleagues in anthropology and the school board member (see lesson #1 above) for advice on the situation. My colleagues thought I should try to establish rapport with her by finding out what she liked and buying it for her. This was not bad advice from anthropologists since we are trained that participant observation “involves getting close to people and making them feel comfortable enough with your presence so that you can observe and record information about their lives. […] Only by confronting the truth about participant observation—that it involves deception and impression management—can we hope to conduct ourselves ethically in fieldwork“ (Bernard 2006:342). With this training, it makes sense that fellow anthropologists would advise me to build rapport using this method.

In contrast, when I met with the school board member over lunch one afternoon, she stated that there would always be someone who does not approve of the work being done in the community, and that people would stand in the way. She advised that I should simply go around the school administrator and find someone able to help with what I need—a suggestion that really spoke to who I am personally. I could not imagine having a disingenuous relationship with this woman who is extremely busy with her own responsibilities. Eventually, I became grateful for the little time where we sat together and she shared valuable information about the girls that she serves through her employment at the school. Fortunately, I did bypass this school administrator and found allies with amazing teachers and other administrators who supported my observation in the school.

To conclude, this journey to understand sexual health concerns and risks among African-American teenagers taught me a great deal. I learned the value of community engagement on a level of incorporating my skills to meet the needs of those who valued my presence, even though they may have thought I was strange for asking about community dynamics or why some girls were viewed as high or low risk of HIV. One of the most valuable things I learned is that if there is sincerity in your desire to assist in what the community deems important, community members will value that goodwill and add to your scholarship by revealing more about their lives than initially hoped.


Tina Thomas (PhD, University at Alabama, 2016) is a Postdoctoral Fellow in Anthropology at Juniata College. She studies the intersection of culture, social ecology, and health in the U.S.

Replacing the Lone Stranger with Evidence-Based Theory: Collaborative Fieldwork in Anthropology

Drs. Michaela Howells and Christopher Lynn (author) in traditional business attire to meet with officials outside Samoan Affairs, Tutuila, in American Samoa.

Drs. Michaela Howells and Christopher Lynn (author) in traditional business attire to meet with officials outside Samoan Affairs, Tutuila, American Samoa.

An abridged version of this post first appeared in our column in Anthropology News: http://www.anthropology-news.org/index.php/2016/12/19/replacing-the-lone-stranger-with-evidence-based-theory/

At the 115th Annual Meeting of the American Anthropological Association this year in Minneapolis, MN, I was recruiting a graduate student whose former adviser was denied a promotion and who then told the student she should leave academia because she would never get hired or tenure at an R1 institution. There are several layers of things wrong with this scenario, but my pitch in gaining her interest in our program (as she has no intention of leaving academia) was that I absolutely refuse to send students into the field alone unless they essentially demand it, have already set up the field site, and have a proven track record of mature and independent work. There are several reasons for this. One, fieldworkers learn more from each other as part of a team. Two, there is emotional support when working with trained collaborators. Three, fieldwork teams conduct better science and collect more thorough data. Four, in theory, team fieldwork should be safer, provided the team makes safety a conscious priority and is ethically vetted. And, five, team fieldwork is a joyous, fun experience.

In the most recent issue of Annals of Anthropological Practice (an all-around great special issue called “‘Involve Me and I Learn’: Teaching and Applying Anthropology” edited by Toni Copeland and Francois Dengah), Max Stein and other students in my research group outline several advantages of this collaborative approach (2016). We draw on Philip Salzman (1989, 1994), who has written previously on problems with the implicit anthropological myth of the anthropologist as “lone stranger,” that of doing fieldwork alone in a remote location. As Salzman points out, we tend to be relatively uncritical of this model, which owes more to the heritage of our discipline and the predecessors we look up to than any value added to research. Similarly, Philippe Bourgois and Jeffrey Schonberg (2009) clearly articulate how the elicitation of “deep meaning” during data collection and analyses is improved through anthropological collaboration.

American Samoa is simultaneously a U.S. territory, a tropical paradise, and a developing country. WWII pillboxes remain all over Tutuila, the main island, such as this one near the village of Alega, 7/20/16.

American Samoa is simultaneously a U.S. territory, a tropical paradise, and a developing country. WWII pillboxes remain all over Tutuila, the main island, such as this one near the village of Alega, 7/20/16.

As we were preparing the AAP article and I was teaching with Bourgois and Schonberg’s book in my Anthropology of Drug Use course, I was invited by my friend and fellow biocultural anthropologist Michaela Howells (UNCW) to tag along as her research assistant for a trip to American Samoa to assess the influence of the Zika outbreak there on prenatal care access and utilization. Michaela and I have collaborated for the past several years on our Family and the Field Study, but we had never worked together in the field. This trip to American Samoa gave us an opportunity to test out this collaborative fieldwork model firsthand. I was recruited because, as a male with relatively high rank in the U.S. (as a tenured associate professor), I would be able to interview males in this traditional, hierarchical cultural system, where it is not appropriate for females to interview males, especially high status males, and vice versa. 

American Samoa is a small group of islands in the South Pacific and the southernmost territory of the U.S. It is characterized as the most traditional of the Pacific cultures, with village-based authority dominated by mostly male chiefs (Shore 1982). It is also strongly evangelical Christian and influenced by neoliberal identity politics. Women have been the primary resources for studies of prenatal care utilization, but in the American Samoan cultural system, resources are redistributed in the villages, with preferences given to elite members or relatives of chiefs (Howells 2013). Michaela and I spent several weeks making arrangements to interview males in the village of Fagasa, even buying ritual goods to give for the planned sua, a ceremonial gift-giving ceremony when interacting with matai or chiefs. However, the arrangements ultimately fell through; we collected survey data from 172 participants in the Department of Health clinics, but we failed to conduct any firsthand interviews. This situation could have been really frustrating, given the resources Michaela used to get me to American Samoa. Instead, it was the best, most productive field season I have ever experienced, primarily because we established and developed our team.

Working on the survey back translation with R.N. Tele Hill at the American Samoan Department of Health. (Photo by Michaela Howells).

Working on the survey back translation with R.N. Tele Hill at the American Samoan Department of Health. (Photo by Michaela Howells).

One of the best parts of this experience was watching each other work and learning how to communicate nonverbally with a good team member. One of the things I learned from Michaela is how easy it is to give a compliment to someone and how far that can go toward forging a relationship. Like many cultures of the world, one of the most important ethnographic skills to develop in Samoa is learning to hang out and shoot the shit. When you’re meeting someone, bring food to share, sit down with them (i.e., don’t hover over them, suggesting you’re in a rush and preparing to leave), and look for something to compliment. Michaela admired a lot of puletasi (traditional Samoan two-piece formal garment, worn by Samoan women to church or other formal events) while we were there. In turn, I learned to comment on the tatau (tattoos) I was noticing. I have brought this new skill home with me—I love good facial bling, colored contacts, tattoos, hairstyles, and clothes. People go to the trouble to deck themselves out, and it turns out they enjoy it when people do them the courtesy of noticing. The necessity of making small talk before getting down to business is common cross-culturally, but it’s not a norm in the U.S. and requires learning, especially for academic types, who are not necessarily known for their skills in verbal social grooming.

We talked with high school students in a health professions summer program through American Samoa Community College at LBJ Tropical Medical Center. Michaela and I intuitively traded off telling stories about medical anthropology to broaden these students' awareness of possible careers related to health.

Michaela talking with high school students in a health professions summer program through American Samoa Community College at LBJ Tropical Medical Center. Michaela and I intuitively traded off telling stories about medical anthropology to broaden these students’ awareness of possible careers related to health.

To figure out how to talk with people in Samoa, I watched Michaela and quickly learned how to show deference and when and how to reinforce what she was saying. But she also pointed out things I wouldn’t have noticed, such as that I am a resonant talker and tend to dominate a room. Ordinarily, and as a teacher, this works to my benefit; but in working with Samoans, I needed to tone it down, speak quieter, and literally lower my body so my head would be below that of the person I was speaking with. This behavior shows respect in a status-conscious, traditional society. This type of context is where our non-verbal communication came into play. As a feminist male, I defer to Michaela’s ethnographic expertise in American Samoa but am conscious to explicitly give her credit where it is due because others may assume that, as a male, I am in charge and that she is my student (or something else). I pointed out, for instance, that she developed the project and field site and that I was there as her research assistant.

I learned a lot about myself as well. I have never been observed by a colleague or superior in the field, though anthropology is not my first career or where I learned to teach or interview. However, aside from being hired for teaching jobs after demonstrating my approach, reading my teaching evaluations, or listening to my interviews and reading the transcripts, this was the first time I have ever received feedback on the job I was doing while doing it. For instance, I always try to maintain eye contact and to talk with people, not at them. Michaela noted that my eye contact seems to bring my interlocutors to life, like they are being seen, and my skill at turn-taking opens them up so that they feel like they are being heard. This was extremely validating and something I had developed on purpose but without realizing its effect. Our feedback to each other, thereby, reinforces our strengths and tweaks our skills while they are in use in the field.

Michaela working with Director of Nursing Margaret Sesepasara on the survey translation, 7/11/16.

Michaela working with Director of Nursing Margaret Sesepasara on the survey translation, 7/11/16.

One of the misnomers of fieldwork is that it is always a dream come true while it is happening. In fact, most anecdotal evidence and a significant accumulation of literature supports a different model. Conducting fieldwork alone, especially as an inexperienced student, is scary and can even be traumatizing. I often tell students about the first time I went into a Pentecostal church service, when I was beginning my dissertation fieldwork. I was in New Paltz, which I affectionately term “Portlandia East” (or the liberal vortex of the east coast). Despite feeling very comfortable in this, my hometown at the time, I was so nervous about walking into the “other” that I sat in my car until the service was half over. The result was that the only seat left was right up front, and I drew more attention to myself by arriving late than if I’d gone straight in. Most of us are nervous about fieldwork and lack anyone to talk to about these experiences. My wife does clinical work, part of which includes processing emotions and “transference” with a clinical supervisor or adviser. Anthropologists only get this if they have empathetic advisers and colleagues, which is certainly not guaranteed and, in my discussions with colleagues, may be relatively rare. Even as a professional, when I began setting up a second field site in Costa Rica, a veritable tropical paradise, I often felt alone and exposed and did not particularly enjoy it. By contrast, setting up a new field site in American Samoa (mind you, one that had really been set up in advance by Michaela) was truly pleasurable. I enjoyed every moment of it specifically because we gave each other emotional support while problems were occurring. Because Michaela and I share similar training, the support we could gave was qualified and credible. For instance, when we could not get the interviews in the short time we were there, we were able to remind each other that we were learning actual realistic things about navigating culture and that our process was as or more important for the long term project as was the survey data we were collecting for the short term project. Our sympathetic support of each other meant that we rolled with the frustrations of the field and took things in stride, without reacting in potentially negative ways.

Tuna, crackers, water, and beer we bought for the sua, for the interviews arranged in fagasa.

Tuna, crackers, water, and beer we bought for the sua, for the interviews arranged in Fagasa.

Team research is better research, whether for scientific or humanistic data collection and interpretation. We do both in Samoa. For instance, together Michaela and I constructed a better (though always imperfect nevertheless) survey in a rapid amount of time, complete with translations into Samoan and back-translations to ensure accuracy. It is always difficult to find a balance in survey questions when one is also soliciting native input, as emic and etic biases pull you in different directions. Michaela and I were able to continually confer with each other to ensure that the questions we asked addressed our research questions first and foremost, while remaining sensitive to cultural perspectives. This was particularly important and difficult when asking about condom use, the discussion of which is basically verboten in the Samoas. Furthermore, we were able to discuss the greater vision of our project. Is this 10-year plan that we envision practical? Can we do this? What are our resources? What should we include? Are we on the right track? Regardless of the expertise of one trained individual, two or more trained team members can observe more, have greater vision, and plan better. And, frankly, while we share training, Michaela and I have complementary but slightly different temperaments that enhance our abilities to connect with a variety of people. Finally, it is no coincidence that we follow in the footsteps of Margaret Mead in American Samoa. Mead realized immediately after her first field experience in Ta’o, the island we plan to return to, that fieldwork in the Pacific—and probably everywhere—is better conducted by a team of trained researchers that includes females and males (Shankman 2009).

Michaela meets the First Lady of American Samoa at the Nursing Association Centennial, 7/30/16.

Michaela meets Cynthia Malala Moliga, the First Lady of American Samoa, at the Nurses Association Centennial, 7/30/16.

As I said, Michaela and I  planned to interview men and get their perspectives. We went so far as to buy goods for ritual gift-giving for the sua and Samoan business attire for the occasion. (Michaela had puletasi already, but I needed Hawaiian shirts, which I borrowed from David Herdrich, an ie faitaga [male sewn lavalava in neutral colors, with pockets], and a kukui nut necklace.) However, our trip coincided with the planning and celebration of the American Samoa Nurses Association Centennial, which took place over the last several days we were there and dominated everyone’s time and attention, including ours. Since there were two of us, Michaela focused on refining our social networks to develop leads for later or the next field season, as well as collecting data for a project with Nicky Hawley and Micah van der Ryn on gestational diabetes, while I collected survey data from visitors to the Department of Health Physical Exam, Prenatal Care, and Well Baby Clinics.

In that short time, we made two significant observations. The first is that public health initiatives need medical anthropologists on their teams from the design stage through implementation. This is by no means a novel finding, but it is the first observation specifically with regard to the Zika outbreak. We have written a short commentary on this that is currently in review, but journalist Jessica Carew Kraft recently published an NBC News piece about our work on Zika and the role of culture in American Samoa. Second, according to our data, there is a general consensus among Samoans that prenatal care is more urgent for married mothers than for unmarried mothers, despite believing that all pregnant women should get prenatal care and be screened for Zika. Such attitudes place an additional burden on lower status women and their babies, reinforce social inequities, and play a role in the “biosocial inheritance” of health disparities trans-generationally (see Schell 1992 and 1997 for how risk is focused across multiple generations like this and Hoke and McDade 2014 for a thorough integration of risk-focusing and related models under the theoretical paradigm of “biosocial inheritance”).

Gaualofa Msipili, ??, Michaela Howells, Sivai Miki Kupu, and Chris Lynn at the American Samoa Nurses Association Centennial Celebration, 7/30/16.

With friends at the American Samoa Nurses Association Centennial Celebration, 7/30/16.

Conducting fieldwork with partners with the same professional status does not guarantee safety, but I would like to think it reduces the chances of sexual harassment. There are few ways to guarantee that sexual harassment and assault won’t happen, but there are ways to minimize their potential and it is important to be explicit in addressing them with students. Safety in the field is discussed in most graduate programs but generally with respect to human subject protections and the stability of the site. Less discussed until recent publications by the SAFE team (e.g., Clancy et al 2014) and others is safety with regard to sexual harassment by peers, supervisors, and advisers in the field. While I hoped we were entering a new era of increasing scrutiny within our disciplines of microaggressions that lead to sexual harassment, the U.S. public’s willingness to be represented by President Pussy-Grabber leads me to believe that people really do think there is a problem with so-called “political correctness.” In reality, the backlash against being politically correct is a frustration by those in positions of privilege at the inconvenience of having to consider the feelings of those previously invisible to them. Such microaggressions start with professors or supervisors feeling they can put their arms around undergraduate student shoulders without permission and get worse from there. And it’s not restricted to aggressions by males toward females. When I was an undergrad on a study abroad program in Ecuador, a male professor plied me with whisky and began kissing me. The difference is that I felt brave and protected enough as a white male to tell the program administrators, and they were probably homophobic enough that they fired him immediately with absolutely no process to confirm or check my story (maybe he’d been reported before—I don’t know—but I still feel guilty about this 15 years later).

Fieldwork environments and experiences like the one Michaela and I created become, as a consequence, downright joyous and fun. Working this past summer in American Samoa with a friend and partner with the same training was more exciting than any field experience I’ve had before. Therefore, the work we did was enormously satisfying WHILE we were doing it. This was the type of experience that we tell our students about that inspires them to become anthropologists and the kind we have that validates our own career choice and keep us going. My goal going forward is to purposively create such experiences for my students by being explicit and concrete about how to design research, where to conduct it, how to get support, and how it should feel while doing it. There are no theoretical or methodological reasons to send out any more lone strangers. 


Christopher Lynn (PhD, University at Albany) is an Associate Professor in the Biocultural Medical program and director of the Evolutionary Studies program. He studies the cognitive science of religion, human behavioral ecology, and health in the U.S., Costa Rica, and American Samoa.

Biocultural Systematics is written by members of the University of Alabama Biocultural Medical Anthropology program.

“Making a Bill” in Search of Health

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CC 4.0 by TravelingOtter

The Poorest, Sickest State

Mississippi is the U.S.’s poorest state and has the lowest rates of insurance coverage. Mississippi also has very poor health outcomes including the highest or second highest rates of cardiovascular disease, diabetes, and age-adjusted death rate due to cancer (Mississippi State Department of Health 2014). These rates are nothing new and Mississippi has a history of health disparities that stretch back to the Depression and beyond. In spite of this, the Affordable Care Act has had little impact on the nation’s poorest, sickest state. Mississippi opted out of the Medicaid expansion, which left 138,000 Mississippians, most of whom are African American, without any insurance options (Kaiser Health News 2014). Refusing the federal subsidies has increased the burden on rural hospitals, forcing some to close entire departments and lay off staff.

During the course of my thesis research on health seeking behaviors of the working poor, I defined a cultural model that primarily included the usage of safety net providers, delaying treatment, or “making a bill,” which I will discuss more in a moment. Participants were particularly open about the competing demands for resources that have to be weighed before they decide to seek health care, like whether to pay for groceries or a doctor bill. Some participants were very frank about having to go without in order to go a doctor. One participant talked about sacrificing food so they could go see a dentist, in her words, “One thing has to take the place of the other.” When seeking health care requires making such sacrifices… it’s not really fair to characterize it as a choice, but, for lack of a better word, I will now discuss the “choice” between delaying treatment or making a bill, something that the working poor frequently brought up during interviews.

Delaying treatment or “Making a Bill”

With few good options for affordable health care the working poor openly discussed delaying treatment so they could avoid “making a bill.” By making a bill, what participants were literally referring to was the creation of a new monthly bill. For the working poor, seeking health care outside of the free clinics is almost synonymous with the creation of a new long-term payment commitment. Participants discussed waiting until it was unavoidable to go to the doctor’s office or the ER/ED and “make a bill.” While they were speaking literally, this language also indexes to others their place in society and the tough decisions that the poor are faced with every day including those concerning their health and those of their family members. money-256312_960_720“Making a bill” indexes a position in society that is deemed unworthy of access to affordable health care. During the entire course of fieldwork and interviewing, not one participant said that a doctor’s visit would mean emptying their savings or bank account. A few participants mentioned borrowing money from family or friends, but “making a bill” was the more likely outcome. When asked if some people without insurance don’t seek health care when they are sick, one participant said:

Yeah, cause they can’t afford it. Sometimes before you can be seen they need money and you don’t have it cause you need it for groceries or to pay a bill. They pray to get well. They try to do a home remedy, try to get better on they own. Get on their knees and pray to God to get better.

This was not an uncommon response. When another participant was asked what he did for health care, he said:

If I ain’t got no money, if it’s an emergency, then I just have to charge up a bill and make a payment. […] I do anything to not get sick. That’s one thing about being a small business owner, no insurance. […] I primarily use the free clinic. I have medical bills right now. I try to pay them off. I’m a small business owner. I want a good credit rating.

This participant ran a small food cart and needed a good credit rating so he might expand his business in the future. He was one of a handful of participants who brought up credit ratings. The very real possibility of not being able to make consistent payments was yet another consideration for the working poor when deciding whether to seek medical care. Treating even relatively minor acute illness episodes could turn into years of monthly payments making it increasingly difficult for the working poor to make ends meet and to afford future health care costs.

This intersection of culture and biology finds the working poor making decisions based on financial needs in the moment that have repercussions for their long term health. The participants and providers I worked with indicated that outside of the free clinics, health care for the working poor came at cost they were ill able to afford out of pocket. When delaying treatment became unavoidable, they reported that “making a bill” was the only option. A circumstance which has become so normalized in this community that there is an effective shorthand for simultaneously conveying the situation they found themselves in and the outcome of seeking care.

It is important to note that the link between delaying treatment and poor health outcomes was not lost on patients or providers, but no one knew how to break the cycle within the current health care system. Medical and non-medical participants alike discussed changing the system. They were frustrated with a system that seems to be working against the working poor at every level of health care. One doctor told me that the hardest part of his job was getting people the care they need but can’t afford. Affordable health care for the poor seems to be continually out of reach.


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Biocultural Systematics is written by members of the University of Alabama Biocultural Medical Anthropology program.

Avery McNeece is a doctoral student in the department who has conducted research in northeast Mississippi.

A World Famous African-American Scientist Puts the Presidential Election in Perspective: “I Am Not Surprised At All”

On Wednesday, the day after our 2017 presidential election, I dreaded having to put on my host face to go out to dinner with Dr. Joseph Graves, our ALLELE speaker for Thursday. I couldn’t really stand the thought of talking to anyone. His talk on “Biological determinism in the age of genomics” was supposed to have been anti-climactic after Hillary’s easy sweep. We see how well that went.

Joseph Graves is the first African-American to ever earn a Ph.D. in evolutionary biology and go on to become an evolutionary biologist. Before he came here this week though, I remember wondering if, in the age of Obama, it is important to have any one scientist speak about the race concept over another scientist simply because the one speaking is black (i.e., Jim Bindon, a white male anthropologist who has spent over 30 years teaching about the fallacy of the race concept, does a great job explaining it to me, another white guy; and I, in turn, am therefore fairly at explaining it to other middle class, privileged white people).

But then Tuesday the election happened, and on Wednesday, I picked up Joe Graves for dinner, and he told me how much of a battle his whole career has been merely because he is African-American. He said that, until grad school, he thought his middle name was “Nigger” because he was addressed as such so much. And he said that the results of the presidential election actually didn’t surprise him at all because he sees every day how much 8 years of Obama has made racist America angry.

This left me stupefied. I literally could not talk about any of this at dinner. Instead, I did my best to keep up by talking about the genetics of longevity and senescence and how one goes about studying these using bacteria and nanoparticles. In essence, the daily lived experience of Joe as an African-American scientist was too painful for me because it is now directly affecting me (though that is why I had invited him), so I stuck to talking to him about sports, music, and the minutiae of his day job.

But I was the host for this ALLELE lecture, which meant that I would be introducing Joe to an audience of 200-500 people. It would be a disservice to everyone if I just phoned this one in with my usual blah blah evolutionary studies, blah blah blah thanks to your generous donations, blah blah blah follow us on Twitter. So I wrote the following intro, which I have modified for this blog, because I hope it had more resonance, was worth saying to our audience, and thus is also worth sharing here.

2016-2017 ALLELE series

FIG 1. Alabama Lectures on Life’s Evolution series schedule at the University of Alabama.

“The ALLELE series is in it 11th year. The goal of the ALLELE series is to promote evolution research, education, and outreach in our community.

evolution education fund

FIG. 2. To donate or get involved, please contact Kathy Yarbrough, me, or follow us via our website, Facebook page, or Twitter.

“On the one hand, I’m heartened that our mission is supported by an ever growing community, including several new sponsors that I’ve bolded in red in FIG. 2. But I’m going to save a little time that I’ll spend in another way—instead of telling you all about us, I’m directing you to our website, Facebook page, and Twitter account to learn more.

“On the other hand, we are not a political organization and I don’t purposely talk about politics. I am especially loathe to do so at the moment, but evolution is controversial. And in Alabama, evolution is associated with the “liberal agenda,” making it a political hot potato.

elephants

FIG. 3. The Crimson Tide elephant rolls over our rivals. What will the other elephant in the room do to us?

“So, instead of that usual introduction, I want to start by addressing the elephant in the room (FIG. 3). No, not the Crimson elephant that will roll over Mississippi State this weekend (Roll Tide?) but the one that permeates my consciousness today and likely many of yours.

onion headline

FIG. 4. From The Onion, November 9, 2016 (Vol. 52, Issue 44).

“This is me today (FIG. 4). This week, I find myself historically wrong for the first time in my life. I am devastated by our presidential election. At the cost of sounding melodramatic, it’s pretty close to the feeling that someone close to me who I didn’t expect to lose just died. And I had that experience a few years ago, so I know my reaction hasn’t been quite that extreme, but I think you get my meaning.

“This sense of devastation may surprise those who know me as the child of lower-middle class white liberals from rural Indiana. I grew up accustomed to being on the losing side through many presidential elections and keeping my mouth shut about things like the blatant racism of my classmates and neighbors. But then I fled to liberal New York, where I lived for nearly 20 years before moving to Alabama. But I moved to Alabama to take a decidedly upper-middle class job as a tenure-track professor and start, of all things, an evolutionary studies program.

starting an evos program

FIG. 5. My first blog post for the EvoS Consortium was about the non-event of starting an EvoS program in a conservative start that was obviously not threatened whatsoever.

“People back in New York and Indiana were shocked and awed at the audacity that I would start an evolution program in the Deep South. But, frankly, we encountered almost no impediments. The only rancor to starting our program came from within. There was some political resistance from the natural sciences that a social science department, Anthropology, would house the EvoS program. The only other flare-up worth note, incidentally, was over the topic of tonight’s lecture.

coyne_marks

FIG. 6. Jerry Coyne and Jonathan Marks gave back to back ALLELE lectures my first semester at UA.

“My first semester here, we hosted back-to-back lectures by evolutionary biologist Jerry Coyne and evolutionary anthropologist Jonathan Marks. I liked the Coyne lecture. It was full of information and relatively uncontroversial for those of us who have drunk deeply of the evolution Kool-Aid.

coyne

FIG. 7. Jerry Coyne is essentially a eugenicist, though a revised version.

“But in his blog (FIG. 7), Coyne comes across very differently. Coyne, Rissler, and others support a revised eugenics model which holds the biology of race as comparable to a subspecies.

marks

FIG. 8. Marks gets the genetics right, but he is equally aggressive in his tactics.

“Marks, on the other hand, I sadly missed because of a funeral. However, he got into an argument with the previous EVOWOG chair over eugenics. Marks decidedly does not support that there is any genetic basis to the race concept (FIG. 8) and—paraphrasing—said he would put his foot up the ass of anyone who does.

state science standards

FIG. 10. In 2009, Mead and Mates published a study that scored Alabama as the worst state in the nation at teaching K-12 evolution.

“Outside of this kerfuffle, no one seemed to blink an eye that the flagship state research institution in the state with the anti-evolution disclaimer on texts and the worst K-12 record in the nation for teaching evolution had started a minor in evolutionary studies. This worried me and suggested that we are essentially a non-threat. The results of Tuesday’s presidential election support that, as do Dr. Graves’ comments to me last night at dinner that he is in the minority of people who are not at all surprised by the election results.

rissler paper

FIG. 11. Former EVOWOG chair Leslie Rissler and students surveyed 2999 UA undergrads and found that most had made up their minds about evolution by the time they got here.

“A few years ago, Rissler and colleagues conducted a study here at UA among a sample of nearly 3000 undergrads and found that attitudes about science and evolution are largely set by the time students arrive as freshmen. As you can imagine, this is pretty disconcerting. Two of my goals as an anthropology and an evolution professor are (1), as Jello Biafra so prosaically articulated, to “blow minds for a living” (FIG. 12) and (2) to blow the race concept out of the water. However, the students who enroll in the majority of my courses have largely already decided what they believe and can choose many of their courses accordingly, including whether to take even a single course in anthropology or evolutionary studies.

FIG. 12. I saw Jello Biafra speak at Indiana University when I was a college freshman, and he quite literally blew my mind.

FIG. 12. I saw Jello Biafra speak at Indiana University when I was a college freshman, and he quite literally blew my mind.

“How do we “fix” a system from on high if the slim majority in the influential states (i.e., the big electoral college states) don’t believe it’s broken or don’t believe it’s broken in the same way?

krauss

FIG. 13. Physicist Lawrence Krauss talking to my “Evolution for Everyone” students about how social problems resolve themselves when previous generations die off.

“A few years ago, physicist Lawrence Krauss sat in my class talking to students and answered this same question about fixing society and changing the world. He said, you teach young people and wait for them to grow up, vote, and change the world through a demographic shift (actually, he said, you wait for the previous generation to die).

“I thought that was happening. I still think it’s happening, though I am a privileged white liberal male with a myopic, rose-tinted view of the world. That is clear. But it’s still the only direction I can think of to move in.

family & field

FIG. 14. We are studying the structure of our own discipline and—surprise surprise—we are an economically privileged lot.

“My colleague Michaela Howells and I have been studying our own discipline of anthropology and the dynamics of having a family or not while trying to be or to become a field anthropologist. Our preliminary assessment is that, if you’re born upper-middle class, regardless of race, you are more likely to be successful in your goal of going into anthropology and either postponing having kids or being able to find the resources to get them care while you work. Poor people simply have much less hope or opportunity to go to college, to get an advanced degree, and have a thriving family life.

“So how do we change that?

evo in al

FIG. 15. Our book targets K-16 educators and students with cultural backstory, the demystification of rhetoric, and resources that can be used in the classroom.

“We change that for one by starting at the bottom and educating all kids to be more aware of the possibilities in life and consider their importance. We provide more resources for teachers to teach science correctly and without the inherent anti-scientific bias of disclaimer stickers. FIG. 15 is the table of contents to a book coming out next year based initially on this series that targets K-16 teachers and students. Authors in bold are those who have spoken at UA or are our students or faculty.

race in frats

FIG. 16. Over the past few years, our students have made the national news 2-3 times for the racism of our sorority system. Our fraternity system is no better and is a hot mess of rape culture. And both were implicated in voter fraud that disenfranchised multiple respected school board members in favor of white males whose sole objective is to preserve the status quo.

“As happy and pleased with myself as I am to have invited Dr. Graves here to speak to you tonight, I think whatever we can do to support our K-12 teachers and kids are the most important things we can be doing to improve our world.

“Because this. What does it say to our kids here in Tuscaloosa that we make national news for our racist sorority system or the rape culture of our fraternity system, then go back to business as usual? How do these events seem to make so little impact?

“To improve our culture and our community, we need to start in elementary schools by creating role models and showing kids actual paths they can take to better lives.

graves flyer

FIG. 18. Flyer for Graves’ talk.

“Dr. Graves is the kind of role model we need a lot more of. He is Associate Dean for Research and Professor of Biological Sciences at the Joint School of Nanosciences and Nanoengineering of North Carolina A&T State University and UNC Greensboro. To cherry pick liberally from his NIH biosketch, Dr. Graves is a pioneering African-American evolutionary biologist with over 25 years mentoring underrepresented minority students in biomedical related research at majority and minority-serving institutions.

“His research involves three areas: (1) the genetics/genomics of adaptation, especially with regard to aging in metazoans and anti-microbial resistance to metals in bacteria, (2) the biological impact of engineered nanomaterials in bacteria, and (3) evolutionary medicine, especially as relevant to health disparities and biological conceptions of race in humans. He has published over 80 papers and book chapters and appeared in seven documentary films and numerous television programs on these topics.

books

FIG. 19. Joseph Graves has written two books and numerous articles on the race concept.

“His books on the biology of race are entitled The Emperor’s New Clothes: Biological Theories of Race at the Millennium and The Race Myth: Why We Pretend Race Exists in America, both of which are on sale here tonight. A summary of Dr. Grave’s research career can be found on Wikipedia, and he is also featured in the ABC-CLIO volume on Outstanding African-American scientists. And the list very much goes on.

sin article

FIG. 20. Published in Annals of the American Academy of Political and Social Science (Vol. 661, No. 1).

“As I’m sure you’ve gathered, the title of tonight’s talk is “Great is Their Sin: Biological Determinism in the Age of Genomics,” which is based on this paper (FIG. 20) he published last year in Annals of the American Academy of Political and Social Science.

“And so, without any further ado, I present to you, Dr. Joseph L. Graves, Jr.”

This post originally appeared on the “Trancing, Tattoos, Religion, and Sex: Cheap Thrills through Evolution” blog at EvoS Studies.

Building professional social networks through the American Anthropological Association annual meeting

A few years ago, I’d all but decided I wasn’t going to go to the American Anthropological Association main conference anymore. This was the year it was in San Francisco (111th Annual Meeting, 2012). Ironically, that was a memorable conference. I had several good meals in the Vietnamese neighborhood nearby (it was hosted in the Tenderloin—mm, bahn mis), was part of a great neuroanthropology session convened by Daniel Lende and Greg Downey (and out of which, ultimately, a publication about my lab’s teaching model came out in Anthropology Now), met Sonya Pritzker, who we ultimately wooed to Alabama to become a faculty member in my department, and spent at least two whole days walking around and exploring San Francisco with Max Stein and my best friend from graduate school, Courtney Kurlanska (Courtney likes to remind me about how it appeared that I was courteously pulling her out of the rain when in fact I was pulling her into a spot where I could see the a football game across a street through a sports bar window in which a bizarre set of losses actually led to Alabama getting back into the BCS Championship game to beat LSU).

Among the joys of anthropology, traveling, & conferencing is food, natch. Dinner at The Bachelor Farmer, Mpls, MN. Photo by Michaela Howells.

Among the joys of anthropology, traveling, & conferencing is food, natch. Dinner at The Bachelor Farmer, Mpls, MN. Photo by Michaela Howells.

My main complaint was that there were not enough biocultural anthropology talks or sessions or things where I obviously felt like I fit in. What I failed to recognize was that I was already doing the things these conferences are really for—building my network. But then the next year in Chicago, there were several big biocultural sessions that I felt spoke to me, and Katie MacKinnon, Julienne Rutherford, Robin Nelson, and others reached out to me as a fellow Tweeter and blogger and made me feel welcome. I realized I’d found my people, and things clicked. I’m now going the other direction and trying to get MORE involved in the organization to promote the need for the AAA to better represent four-fieldness, and I feel like part of a cohort of others doing the same.

AAA 2016 Roomies: Marc Kissel, Michaela Howells, Chris Lynn. Photo by Michaela Howells.

AAA 2016 Roomies: Marc Kissel, Michaela Howells, Chris Lynn. Photo by Michaela Howells.

This year, the meeting was held in Minneapolis, MN, and I attended Wednesday, 11/16 through Sunday, 11/20. I shared a room with Michaela Howells and Marc Kissel, who are on the executive committee for the Biological Anthropology Section (BAS) of the AAA. So I tagged along with them to as many events as possible and tried to insinuate myself. Agustin Fuentes has been chosen as chair of next year’s AAA meeting and determined the theme to be “Anthropology Matters” and hosted a get-together in his suite to gather ideas. I think anthropologists have often felt embattled, but for the past 8 years, we have had a U.S. president whose mother was an anthropologist (I shared a bit on this a few weeks ago). I felt the anthropological perspective was implicit in Obama’s worldview and approach to politics and leadership. However, that has changed dramatically (and painfully), and there is urgency to explicitly demonstrate our relevance. The world does need us, and we need to articulate why.

In the Anthropology Dept at the University of Alabama, Lynn Funkhouser and I have developed a fantastic elementary (and middle) school outreach program at Alabama that conveys why anthropology matters. The opportunity to convey an anthropological perspective and influence humans to think about and appreciate diversity is most salient when they are young, before they self-select (in part) for their post-secondary lives. We rarely reach these kids, so most anthropological perspective is taught to largely upper middle-class white kids who go to college and chose to take anthropology courses (and the same is true of evolution courses, since this blog is about evolution—though evolution is one of the foundational theories of anthropology, so when I talk about anthropology, I imply evolution as well). Lynn and I and our students and colleagues have developed a model for teaching anthropology to elementary school students that we administer through a service-learning course to a few local schools, which we’ve received Wenner Gren funding to expand and just published an article about in Annals of Anthropological Practice.

BASAA executive committee dinner that I was allowed to tag along to (thanks, Michaela!). Clockwise from left: Marc Kissel (not pictured---sorry, I couldn't back up enough & clipped you), Rachel Caspari, Milford Wolfpoff, Cathy Willermet, Sang-Hee Lee, Jim McKenna, Andrea Eller, Jim's wife (sorry! name escapes), Melanie Beasley, Karen Rosenberg, Agustin Fuentes, Michaela Howells. Dinner at 102 Eatery.

BASAA executive committee dinner that I was allowed to tag along to (thanks, Michaela!). Clockwise from left: Marc Kissel (not pictured—sorry, I couldn’t back up enough & clipped you), Rachel Caspari, Milford Wolfpoff, Cathy Willermet, Sang-Hee Lee, Jim McKenna, Andrea Eller, Joanne Mack, Melanie Beasley, Karen Rosenberg, Agustin Fuentes, Michaela Howells. Dinner at 102 Eatery.

I was pleased to be able to share our ideas for next year’s conference and to have them so well received. The next day, these ideas came up at an executive lunch and then again at the business meeting, which was open to all members. Agustin, Michaela, and Marc urged me to share our programs ideas in more detail with the entire BAS membership in attendance, which, again, was well received (and also includes the upcoming Kids Evolutionary Perspectives Society pre-conference!). I talked to BAS president Rachel Caspari and BAS web manager Andrea Eller about it in more detail during the reception and to others about coordinating an executive session (contact us if you’re interested or have ideas!). Afterward, I was lucky to be invited to join the executive committee for dinner afterward and discuss these things further, as well as catch up on shared interests and hear several fantastic war stories from Milford Wolfpoff, Jim McKenna, Karen Rosenberg, Agustin, Michaela, and others (Sang-Hee Lee took several good photos that she posted to the BASAA Facebook group, which I encourage y’all to join).

On Wednesday, between these events, was a humbling interjection by keynote Melissa Harris Perry. She is not an anthropologist, but I think that’s good, as we needed some outside voice to give us a shake, I think. Or me. I needed a shake. The message I took away was, ‘White liberals, stop acting so surprised about the election. If anyone had bothered to do a cross-tabulation of female voters in the U.S., you would know that white women vote Republican. Why would the revelation that Trump is a pussy-grabber cause them to change their minds? The only surprise was that Trump got caught on camera saying it. The reality is that almost every woman in the world has had her pussy grabbed and had to deal with it because it’s behavior we all ignore or perpetrate. Many women are married or related to pussy-grabbing men and protect them and apologize for or defend their behavior on a daily basis. We’ve probably all grabbed a pussy, ass, or boob without permission. What does our culture imply about this? That it’s OK. It’s not, but we’re all reacting instead of acting.’ Oof. But yeah.

On Thursday, I was supposed to have lunch with Sidney Greenfield, whose wonderful book Spirits with Scalpels is one of the best sources out there related to the neuroanthropological work I do. Unfortunately, he wasn’t feeling well and couldn’t attend the meetings at all, but he asked me to chair a session, show two short films, and read a paper for him for the Society for Senior Anthropologists. The session was on the work of Phil Singer and Greenfield and their efforts to document the process and thoughts of anthropologists who are over 80 years old about their impending death. Although it sounds rather heavy and macabre, it wasn’t. The overarching theme was that people don’t necessarily become preoccupied with thinking about or preparing for their own deaths—most of them seem to continue thinking about work and anthropology all the way till the end. Though a few of the interviewees had recently died, including Phil Singer, which added a sobering element to the session, the message overall was very validating and hopeful. I was glad I could be part of it.

There were several other highlights of the conference that I’ll highlight with Tweets and photos, but I will also summarize them here. I met a few prospective graduate students, which is exciting, as I need to replace the amazing work Max Stein has been doing in my lab. Max is the lead author on another AAP paper that just came out about how we do things (in an excellent special issue compiled by Toni Copeland and Francois Dengah), and he has been instrumental as lab and project manager this year. But he should soon have his PhD in hand and be ‘out there,’ as it were, hopefully with a job in hand (or you should be contacting him if you have a biocultural position opening, because he is awesome).

A row of excellent mustaches and shoes. Photo courtesy Michaela Howells.

A row of excellent mustaches and shoes . Photo courtesy Michaela Howells.

Courtney and I had our annual date (though I missed last year because my grandmother died and I was at her funeral), but we forgot to get a selfie together! We hung with some other UAlbany alumni, braved the yucky Mpls. snow (OK, it melted in a half hour, but I was only wearing canvas shoes) to go have dinner at a local Vietnamese place (with, apparently, everyone else attending the conference), then met up with Francois Dengah and Max Stein for a bit more hanging before calling it an evening. In the process, I realized what The Replacements song “Skyway” was about, after walking through it for several days. Perhaps two other people in attendance appreciated my revelation.

Over the course of Friday and Saturday there were three excellent biocultural sessions convened by Morgan Hoke, including one in which Michaela presented on our work this past summer in American Samoa. In the middle of that, Sonya and I convened a session on biocultural anthropology and linguistics with us, Daniel Lende, Avery McNeece, Mandy Guitar and Sabina Perrino with Jim Wilce and Carol Worthman as discussants.

I thought it went great. Sonya says the editor of Ethos is interested in a special issue about the session. I met a few people with further interest in the work, including Josh Brahinsky, a postdoc in Tanya Luhrmann’s group. We talked after about future collaboration possibilities, which I find exciting. Then there was a BAS-sponsored networking workshop for students organized by Michaela (great photos of that event here) that I was supposed to participate in, but I went to the Zika Interest Group and Roundtables instead, to make sure Michaela and I could get involved with that for our work in American Samoa. Those were VERY helpful.

I also met with several publishers while there to pitch the book I’ll be writing while on sabbatical next semester. It was disheartening but not surprising to hear how much marketing considerations want us to narrow our focus and put us in boxes, while in the biocultural sessions there was explicit commentary on breaking down disciplinary boundaries. After working in music distribution and schlepping music to stores by appeal to genres, this is an obvious intersection of idealism and logistic practicality. However, I do feel that if the AAA wants to represent itself as four-field, the book editors’ narrow focus on cultural anthropology is a BIG problem.

Despite the issue with editors, I got some good books in the book room on the premise that I might someday teach a course that might someday use this or that book. On the other hand, Michaela got this excellent bib, modeled here by her anthro dog extraordinaire Uli, which she sent me when I asked her for relevant photos.

Despite the issue with editors, I got some good books in the book room on the premise that I might someday teach a course that might someday use this or that book. On the other hand, Michaela got this excellent bib, modeled here by her anthro dog extraordinaire Uli, which she sent me when I asked her for relevant photos.

For us, the conference wrapped up with an unfortunately unpublicized and, thus, underattended talk by Frans de Waal. It was mostly the same talk I’ve seen previously, but he’s still one of the best ALLELE lectures we’ve ever had and does a great job articulating a clear message to educated lay audiences and selling a compelling idea about human empathy.

This post originally appeared at on the EvoS Studies blog: Cheap Thrills through Evolution.