Category Archives: Methods

Prior Planning Prevents Piss Poor Performance, Probably

When I began my career as a wilderness guide, for the first time in my life I encountered people who were constantly seeking the newest piece of gear, anything from a titanium drinking cup to a sleeping bag which had arms and legs. Being an unschooled vagabond living in my truck and prostituting my wilderness skills out to the highest bidders throughout Idaho, Montana, and Colorado, I made do with the simplest and minimalist accoutrements. I’ve always looked at my gear as sacred; I easily signed over the title of my 1994 Ford Explorer to my friend John, but you could only wrench my MSR backpacker stove out of my cold dead hands. While I was working as a logistics coordinator for the Trailhead Wilderness School, I was often called the “Road Worrier” due to the mental effort I put into packing for a trip. I have protected and cherished my gear throughout the years. For the next year I will be living in a small village without most modern day amenities. Tomorrow everything is going in storage, today I need to pack my gear for Costa Rica.WP_20150715_003

The journey to Yorkín, the Bribrí village in the Talamancan Mountains along the border with Panama where I would be working with a locally conceived ecotourism project called Estibrawpa and conducting my research, begins in Puerto Viejo, a surfer/alternative lifestyle/international small town on the coast which was first settled by black Caribbeans. You catch a bus early in the morning to the town of Bribrí, the main town in the Talamancan Indigenous Reserve. From there you take an old yellow school bus to Bambu, which is nothing but a small general store and a few houses. There you meet one of the Yorkín boat captains who pilots a dugout canoe with an outboard motor up the Yorkín River to the village. From there it is a half hour slog along muddy trails to the Estibrawpa headquarters. Obviously, you cannot simply arrive at your living quarters in a car or bus and unload your belongings. I knew from my experience of the previous summer that I would have to be able to carry all of my personal belongings on my person.

In order to be able to carry all of my belongings, I decided on a large backpack (a Kelty 75th anniversary hybrid 7000 in.³, which I had purchased eleven years prior as a 40th birthday present to myself) instead of a full size dry bag with shoulder straps. In addition, I would bring two daypacks which I could carry one in each hand, and a soft briefcase which I could sling over my shoulder. I had considered bringing the full size dry bag because of its ability to keep moisture away from some of my other gear. However, the dry bag does not have as much internal space and is not as comfortable to carry over long distances as the Kelty pack. After some deliberation, I concluded that I would rather have the Kelty pack and purchase 5 gallon buckets or something similar on my first excursion out of the village either to Bambu, Bribrí, or Puerto Viejo, depending on where I could procure something useful in keeping pests and moisture out of my food and belongings.

When I first began guiding, there was an older more experienced guide (he made his own clothing, something I was always impressed with) who told me, “Take care of your feet first, they are your most important tool.” I took this advice to heart, and own leather boots with vibram soles for travel over terrain, military style bunny boots for the winter, a solid pair of Chaco sandals with the hiking sole for on rafts or kayaks and crossing rivers, and a pair of mukluks for lounging around camp at night. For this trip I knew I would need a pair of what are known in western Colorado as irrigation boots. These are just-below-knee-high rubber boots with good tread, good for mucking livestock stalls and irrigating fields in Colorado or keeping your feet dry and offering (hopefully) protection from a variety of venomous plants, insects, amphibians and reptiles (Costa Rica is home to the fer-de-lance, a snake feared for its aggressiveness and deadly venom) while in the rain forest. On my previous visit to Yorkín, I purchased a pair of boots, and knee-high socks, from a hardware store outside of Puerto Viejo. As I was leaving the village after my stay, I gave those boots to Julio Morales, in whose wife’s house I resided during my visit and with whom I spent my days while he served as guide for the visitors to the village. While still in Tuscaloosa, I perused websites and finally decided on buying a pair of Servus boots from the Campmor catalogue. I knew these would be slightly different boots from those worn by the villagers (green not black for example) and I accepted the fact that these boots would set me apart, reinforcing the fact that I was an outsider, from somewhere else, and somewhat different. These boots would mark me; people would see my boots on the stair steps leading up to a house, and think, “Gregorio esta aqui.”WP_20150715_004

In addition to the boots I decided to also pack a pair of Chaco sandals and a pair of Skechers tennis shoes. The tennis shoes I would wear while traveling through airports and on buses, the Chaco’s can be worn around the house, and the boots would be my main footwear worn while walking around the village and assisting the guides of Estibrawpa while they led visitors throughout the village. While I was studying tracking with Tom Brown in the Pine Barrens of New Jersey, he told me how his grandfather, an Apache shaman, had taught him that there were four sacred priorities: Shelter, water, fire, and food. He told me that the first and most important form of shelter is your clothing. Along with my footwear, I chose to bring two pairs of cotton socks, one pair of wool socks, and one pair of knee high socks. The knee-high socks are important to wear with the knee-high rubber boots to avoid chafing. I only owned one pair of knee high socks, so I decided I would simply buy two or three more pairs once I got to Puerto Viejo. For pants I chose to bring three pairs of nylon travel pants with the zip-off legs, a pair of shorts, and a lightweight pair of Carhart’s. I decided to bring the Carhart’s because it was quite likely that I would be lending a hand for various construction projects, and nothing is better than a pair of Carhart’s for construction work. I also brought three button up nylon shirts, one with long sleeves, as well as a T-shirt and two tank tops. I packed a pair of fleece bottoms, a fleece hoodie, and a flannel button-up; because I was going to be spending two months in the mountains of New Mexico before flying from Albuquerque to Costa Rica, I knew I would need some warm clothing. I also figured I would need some warm clothing if I ever chose to leave Costa Rica during my fieldwork to visit the United States, which most likely would be in one of the mountain states where it would be cold. I also packed a rain jacket and my U.S. Army rubber poncho, which can be used as a shelter, a bivouac bag, or simply as a poncho. To round out my clothing I brought a sun hat, a beanie, two bandanas, and my sarong.

In addition to my clothing, I had to decide which gear to bring and what could remain in storage. In keeping with the sacred priorities I brought only two cotton sheets to go along with my army poncho as shelter material. I knew that I would either be staying in my own little bungalow or with a family while in Yorkín. A roof over my head, a bed, and mosquito netting would be provided. So the next order of business would have to do with the procurement and storage of water. I packed one, 32 ounce Nalgene which were serve as my main water bottle. In addition to iodine tablets which I placed in my first aid kit, I also packed my Pur backpacker’s water filter. Even though while I was in Yorkín the previous summer I drank the water straight out of the taps with no ill effects, I could not be certain that everywhere I would be would have safe drinking water. In addition to my tools for water purification, I also brought my “water chicken.” a 2 gallon nylon bag with a pour spout, for water storage.

After feeling confident that I had safe drinking water storage and procurement taking care of, I next focused on fire. I decided to box up my MSR International Backpacker Stove (which can run off of pretty much any type of liquid fuel) along with six lighters and mail them to Puerto Viejo. On a trip to Baja California in January 2012, just a few months after 9/11, I had a backpacking stove removed for my luggage by TSA, and didn’t want to run that risk again. I decided to throw in several Bic lighters because you can’t take them on the plane and I’ve found the lighters throughout Latin America are not as dependable as a Bic.

Now that I had shelter, water, and fire taking care of, I could think about food. I would be purchasing food in Puerto Viejo and carrying it in my packs to Yorkín. I brought a small saucepan with a lid and handle for cooking, a Tupperware bowl with a lid, a thermal coffee cup, and a spoon. On my previous trip to Yorkín I noticed several good-sized trout swimming in the stream that forms the northern border of the village. At that moment I decided I would definitely bring my fishing gear along with me next time I came down. I packed my spin rod, an Ugly Stick pole that breaks down into four pieces and fits into my pack nicely, several lures, some swivels, and a little extra line.

Now that I had the four sacred priorities taking care of I could focus on personal items and first aid. I bought a single blade safety razor along with 50 extra blades for the trip. Along with three bars of Kirk’s Castile biodegradable soap and a toothbrush, this would make up my toiletries. For my first aid kit I packed a roll of athletic tape, Band-Aids, a large bottle of aspirin, a large quantity of bismuth, a nail clipper, baking soda (which has many uses- tooth cleanser, antacid, etc.) and a box of Emergen-C packets to use for oral rehydration. I also packed a bunch of AA and AAA batteries, my compass, GPS, sunglasses, and my Swiss Army knife. These items completed my gear inventory (I planned to buy a hammock and a machete in Puerto Viejo) and all I had left to think about were school supplies.

I decided to bring both my laptop and tablet, so I could have a backup in case one of them went down. These will mostly be used for typing up fieldnotes and data analysis. My plan was to leave the village once a month and get a room in Puerto Viejo where I could access Internet. I decided to bring my phone, even though I would be shutting my service off. I was unsure at the time whether or not the camera function, along with some other functions, would still work even though I turned my service off. I planned on mostly using the phone camera because in my opinion it takes pretty good pictures, but I also brought a very small basic digital camera as a backup. I packed two digital voice recorders along with four Rite-in-the-Rain field notebooks and several pencils. I packed a Costa Rica travel guide, a Costa Rica map, a rain forest plant identification book, and a small book written about the Bribrí who live in the Kokoldi indigenous reserve. Finally, I packed a good supply of various sizes of Ziploc baggies and a bunch of trashbags, which will be used to keep things dry. The very last thing I packed was a gift for Julio, who served as my guide and mentor on my last trip. Julio served as the main guide for Estibrawpa and only had one of those small book bags with the shoulder straps made of cord which are so popular on college campuses. I decided to bring him a good day pack that was larger and had padded shoulder straps.

Now that I had my gear ready, I was excited to get down to Yorkín. I only had a few loose ends to wrap up (IRB among others) before heading out. I cracked open a Tecate Light and squeezed in some lime. Like we say the first night in camp on a backpack trip “If we ain’t got it, we don’t need it.”

Models, Incongruity, Consonance, and Stress: Implications for Managing Illness

I had a eureka moment when I learned that Toni Copeland had conducted research showing that knowledge of (competence) and behavior which approximates aspects of (consonance) a model of managing HIV among women in Nairobi, Kenya has been shown to be correlated to positive health outcomes, even going so far as affecting T-counts (Copeland 2012). I had obtained similar results in my Master’s research among a group of individuals diagnosed with bipolar disorder and who were attending a peer support group. Among this group there was a shared model of what a person could do to manage their disorder. I found that people whose behavior more closely approximated the model also reported less depressive episodes, mania, anxiety, and stress. In my opinion, this has enormous implications for treatment, especially in the area of my focus – psychological distress. This blog will focus on how the distribution and relationship to individual cultural models relates to health outcomes, the role of stress, and the implications for treatment of psychological distress.

Reflecting what I believe to be a general dissatisfaction with psychotropic medications, the people I worked with in the peer support group often complained of the efficacy and side effects of the drug cocktails they were taking to treat the issues which came with their diagnosis of bipolar disorder. If it can be shown repeatedly that knowledge of a model of managing psychological distress and behavior approximating that model correlate to better health outcomes, a more holistic approach to treatment can be employed.

The concept of cultural models has proven extremely useful to research in the social sciences (Strauss and Quinn 1994; D’Andrade 1984, 1995). If we start with a theory of culture derived from cognitive anthropology which states, culture is that which one needs to know in order to function adequately in any given social system, then the next task of the researcher studying culture would be to determine what exactly is it that the person needs to know. This knowledge is organized in models, consisting of interrelated elements which together represent something (D’Andrade 1984, 1995). Cultural models are not formulated as explicit declarative knowledge (as in theory), but as implicit knowledge, based on schemas embedded in words but not formulated as explicit propositions. Models are actively used, interpreted, and are socially transmitted. It has been shown that people cognitively model their illness experiences in culturally salient ways.

Incongruence, or status inconsistency, to dominant models has been shown to adversely affect health (Janes 1990; Dressler 1992, 2004; McDade 2001, 2002). One example of this is when an individual’s material lifestyle exceeds their social and economic status. This is the classic example of “keeping up with the Joneses”, where there exists a dominant cultural model of what a successful lifestyle consists of, and an individual is stretched beyond his means trying to achieve it. Incongruence or status inconsistency can also happen as a result of rapid cultural and economic change. This happens as a result of emerging markers of social status conflicting with traditional markers, creating discord or stress.

To examine the strength and distribution of a cultural model, or the level to which it is shared among individuals which make up the culture, cultural consensus analysis can be employed. This method was developed by Romney, Weller, and Batchelder (1986) and measures the degree of sharing of knowledge and individuals’ relative degree of shared knowledge. A measure of consensus is then found, weighted by the competence of the respondents. The idea of competence (which was originally raised by Keesing in 1972) is important in that an individual’s ability to meet the expectations of and function within a cultural model affects his or her psychological and physical well-being.

Cultural consonance, or the degree to which an individual approximates, in his or her own beliefs and behaviors, the prototypical cultural model, can also be calculated (Dressler 2000; Dressler et al. 2004, 2007, 2009). In theory, cultural consonance illustrates the relationship of individual experience and culture. Individuals may know a model in a cultural context, but for a variety of reasons they may not be able to act on or achieve accordance with it. If we assume, that for most people, there exists a desire and drive to achieve that which is seen as good or desirable in the model, then the relative ability to meet those ends will have an effect on the individual. Following methods illustrated by Dressler and colleagues (2000, 2007, 2011), individual levels of consonance are shown to be correlated with health outcomes, including levels of psychological distress. These researchers have also found that low levels of cultural consonance to be correlated with high blood pressure.

Stress levels in individuals have long been associated with health outcomes (Cassel and Jenkins 1960; Cassel 1976; Mason 1975). This fact combined with the relationship of incongruity, status inconsistency, cultural competence, and finally cultural consonance to a shared model and stress, illustrates the interrelatedness and importance of the stress process. To create a working definition of the stress process, it is helpful to consider four contributing aspects (Dressler 2004). First of all there are inputs; these can be acute or chronic stressors which an individual perceives as threatening or challenging. Secondly, there are mediating factors which can be psychological or emotional, physiological, metabolic, or morphological. Thirdly, it is helpful to consider resistance resources; these include social support, psychological resources of the individual, and biological resistance factors. Finally, there are outcomes including disease or other chronic conditions. I am suggesting here that by mediating this stress process through either re-evaluating unreachable models of lifestyle or increasing competence and consonance to a model of managing illness, the psychological and biological health of individuals may be improved. In the end, culture matters in both the conception of the meaning of illness and ideas concerning how to manage the illness experience.

Cassel, J.C., Patrick R., and Jenkins C.D. (1960).  Epidemiological analysis of the health implications of culture change.  Annals of the New York Academy of Sciences 84:938-949.

Cassel, J.C. (1976) The Contribution of the Social Environment to Host Resistance. American Journal of Epidemiology 104:107-123.

Copeland, T. J. (2011). Poverty, nutrition, and a cultural model of managing HIV/AIDS among women in Nairobi, Kenya. Annals of Anthropological Practice, 35: 81-97.

Dressler, William W. (1992). Culture, stress, and depressive symptoms: building and testing a model        in a specific setting, pp. 19-33 in Anthropological Research: Process and Application.  John J. Poggie, Billie R. DeWalt, and William W. Dressler Eds. Albany, NY: State University of New York Press.

Dressler, W.W. and Bindon, J.R. (2000). The health consequences of cultural consonance. American Anthropologist 102:244-260.

Dressler, William W. (2004). Social or status incongruence, pp. 764-767 in The Encyclopedia of Health and Behavior. Norman B. Anderson, Ed. Thousand Oaks, CA: Sage Publications.

Dressler, William W. (2004). Culture, stress and cardiovascular disease, pp. 328-334 in The Encyclopedia of Medical Anthropology. Carol R. Ember and Melvin Ember, Eds. New York: Kluwer Academic/Plenum Publishers.

Dressler, William W., Rosane P. Ribeiro, Mauro C. Balieiro, Kathryn S. Oths, and José Ernesto Dos Santos. (2004). Eating, drinking and being depressed: The social, cultural and psychological context of alcohol consumption and nutrition in a Brazilian community. Social Science and Medicine 59:709-720.

Dressler, William W., Mauro C. Balieiro, Rosane P. Ribeiro, and José Ernesto Dos Santos. (2007). Cultural consonance and psychological distress: Examining the associations in multiple cultural domains. Culture, Medicine and Psychiatry 31:195-224.

Dressler, William W., Mauro C. Balieiro, Rosane P. Ribeiro and José Ernesto dos Santos. (2009). Cultural consonance, a 5HT2A receptor polymorphism, and depressive symptoms: A longitudinal study of gene x culture interaction in urban Brazil. American Journal of Human Biology 21:91-97.

Janes, Craig. (1990). Migration, changing gender roles, and stress: The Samoan case. Medical Anthropology 12: 217-248.

Mason, John. (1975). A historical view of the stress field. Journal of Human Stress 1:6-12; 22-36.

McDade, Thomas W. (2001). Lifestyle incongruity, social integration, and immune function among Samoan adolescents. Social Science and Medicine 53:1351-1362.

McDade, Thomas W. (2002). Status incongruity in Samoan youth: A biocultural analysis of culture change, stress and immune function. Medical Anthropology Quarterly 16:123-150.

Romney, A.K., S.A. Weller, and W.H. Batchelder. (1986). Culture as Consensus: A Theory of Culture and Informant Accuracy. American Anthropologist 88:313-338.

 

Biomarkers

In previous posts I have discussed the use of self-report questionnaires to measure aspects of health, for example stress and depression. In this post, I will describe two methods for measuring “biomarkers” which are characteristics that are objectively measured and evaluated as an indicator of biological processes. As part of my research in the Bribri village of Yorkin, Costa Rica, I would like to measure health in the village in order to show that because of their initiation of an ecotourism project, which has allowed them to work in the village rather than in plantain and banana plantations, their overall health has improved. In order to accomplish this, I have chosen two biomarkers to examine health which are relatively easy to conduct in the field in minimally invasive. The first biomarker is blood pressure, which is one of the principal vital signs used in many healthcare settings. Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels. High blood pressure can be a warning sign for hypertension which can lead to strokes and various heart conditions. The second biomarker I intend to use is the level of the stress hormone cortisol (CORT), which provides a measure of hypothalamic-pituitary-adrenal axis (HPA) system activity or more simply, physiological stress. Prolonged periods of physiological stress have been found to have negative health effects including impaired cognitive performance, suppress thyroid function, blood sugar imbalances, higher blood pressure, immunity impairment, and increased abdominal fat.

To measure blood pressure in the field I will use an automatic blood pressure monitor, the OMRON HEM-711, one of which we have in the Human Behavioral Ecology Research Group HBERG lab run by Dr. Chris Lynn at the University of Alabama. Similar OMRON models have proved adequate for measuring blood pressure (Wan et al. 2010). To use this instrument, the cuff is placed on the left arm above the elbow at approximately heart level. It is suggested that the participant has remained seated for 10 minutes before taking the measurement and the person should not have consumed tobacco or caffeine for at least 30 minutes before the measurement is taken. Researchers suggest taking multiple measurements, for example three, and then calculating the mean of these measurements (Wan et al. 2010). Below is a video describing the use of the automatic blood pressure monitor.

To measure the stress hormone cortisol I intend to use the hair extraction method. Cortisol is slowly incorporated into the hair of humans and other mammals and allows for the measurement of physiological stress over several months. The process involves first obtaining a sample of hair from a participant. A portion of hair up to the width of a pencil is first secured with a clip or rubber band and then cut as close to the scalp as possible with sterilized scissors. The sample is taken from the posterior vertex portion of the skull. To examine the distribution of cortisol over time, the hair sample can be cut into 1 cm segments, the segments furthest from the scalp being the oldest. The samples can then be placed into a paper envelope and then secured in a container. Upon returning from the field, the samples can then be taken into the lab, I plan to use Dr. Jason DeCaro’s lab here at the University of Alabama, to be analyzed. The samples are washed in an alcohol solution, dried, ground, and then the cortisol is extracted and analyzed. The above procedures were described in an article by Meyer et al. (2014). Below is a video provided by the same authors describing the methodology.

http://www.jove.com/video/50882/extraction-and-analysis-of-cortisol-from-human-and-monkey-hair

I have chosen these two measurements of health because they will be logistically easy to perform in the field, require no more special instruments, and do not require refrigeration. By combining these two biomarkers with self-report measurement scales, I believe I will be provided with a robust survey of health in the village.

Meyer, J., Novak, M., K. Rosenberg, and A. Hamel 2014 Extraction and Analysis of Cortisol from Human and Monkey Hair. Journal of Visualized Experiments (83).

Wan, Y., C. Heneghan, R. Stevens, R. J. McManus, A. Ward, R. Perera, M. Thompson, L. Tarassenko, and D. Mant 2010 Determining which Automatic Digital Blood Pressure Device Performs Adequately: A Systematic Review. Journal of Human Hypertension 24(7):431-438.

Ecotourism: How do you know it when you see it?

Last month (August 2014) I had the opportunity to work as a volunteer for an ecotourism project named Estibrawpa in the Bribri village of Yorkin. The Bribri are an indigenous group in Costa Rica who live in scattered villages on indigenous reserves near the border with Panama. Estibrawpa was started by a group of women in 1992 as a way to bring money into the community, preserve their traditions, and address health issues. The women explained that before they started their ecotourism project, the men of the village were for the most part employed in wage labor on banana plantations. Due to the fact that traveling in and out of the village involved a daylong journey in a dugout canoe, the men who were working in the plantations were away from the village for long periods of time. As the women describe it, this led to much “depresion” in the village due to fractured and disrupted households. The men were also suffering from respiratory and skin ailments caused by working with chemical fertilizers and pesticides in the plantations. Reflecting on the fact that ecotourism is very popular in Costa Rica, the women decided to start their own ecotourism project.

Visitors arrive via dugout canoe
Visitors arrive via dugout canoe

From its humble beginnings, Estibrawpa has grown over the past 10 years. At first visitors had to commit to a three-day trip to the village; a one-day journey in dugout canoe to the village, a day in the village, and a day return trip out of the village. In time, the community made enough money to buy two outboard motors for their dugout canoes, enabling visitors to come for day trips, increasing the number of visitors. The women explain that now men are able to stay in the village working as guides, canoe captains, and construction workers. Women are involved in organizing the program and scheduling trips, cooking, and giving demonstrations on cacao production which is the exclusive domain of women among the Bribri. Children are taught how to be guides, construction workers, and organizers, and are educated in the stories that make up the Bribri “historia” and the native Bribri language. The women conclude that as a result of their ecotourism project, the village enjoys better mental and physical health.

Entering the village
Entering the village

I decided this situation provided an excellent opportunity to conduct my dissertation research. My first order of business was to peruse the literature on ecotourism and community-based development. I recently found an article by J.K Reimer and Pierre Walter (2012) entitled “How do you know it when you see it? Community-based ecotourism in the Cardamom Mountains of southwestern Cambodia.” Their research involved analyzing an ecotourism project by comparing its aspects to a framework devised by Martha Honey in her book “Ecotourism and sustainable development: Who owns Paradise?” (2008). Honey’s analytical framework for ecotourism includes seven components that should be present in an ecotourism project. It includes: the project involves travel to natural destinations, minimizes impact, builds environmental awareness, provides direct financial benefits for conservation, provides financial benefits and empowerment for local people, respects local culture, and supports human rights and democratic movements.

Traditional bow and arrow
Traditional bow and arrow

In my opinion, analyzing the Estibrawpa project in Yorkin according to Honey’s framework will provide a fruitful beginning to the process of describing and analyzing the community’s efforts. In addition, the collection of biomarkers including blood pressure readings and the administration of the CES-D scale for measuring depression will provide measures for health which can then be compared to similar populations throughout the world. This project will also illustrate how the interaction between biological bodies and their environment affects physical health as measured by blood pressure and mental health (and its neurological correlates) as measured by the CES-D. It is my hypothesis, that through the process of niche construction (modifying their environment and their interactions with it through their ecotourism project) the residents of Yorkin are benefiting the community and improving physical and mental health.