The following message from anthrodesign is cross-posted with permission of the author, Lynne Lohfeld. It should be of interest to anyone involved with applied or medical anthropology or the role that anthropologists can play in research teams with members from other disciplines. 

Adrian, I like the analogy you make with getting to deep understanding incrementally rather than in phases, because the latter suggests (to me) following a predetermined path in a study. This is appropriate for a well-designed quantitative study (e.g., randomized controlled trial) but such action in qualitative or mixed methods studies leaves no room for serendipity or following leads provided by one's research partners, as in a Participatory Action Research (PAR)  or community-based/guided research model.  

Here's an example of the "ah-ha" discovery moments shifting the focus of a research project.  

I am a medical anthropologist working as a social/cultural scientist consultant on an NIH (National Institutes of Health)-funded project on malaria reduction. This is one of 10 "ICEMR" (International Centers of Excellence in Malaria Research) projects being done in malaria-endemic areas of the world. This project is being done by researchers at Johns Hopkins University in three sites in Southern Africa (two in Zambia and one in Zimbabwe).  I am doing a focused ethnographic study (FES) to understand local laypeople, traditional and biomedically trained practitioner beliefs and responses to symptoms that may be malaria (fever, convulsions, anemia) or "malaria-like illnesses", and then to test that model through case studies (responses to vignettes or scenarios presenting malaria-like symptoms, past illness episode narratives, observation/interviews during current illness episodes).  The first research site has shifted from seasonally high rates of malaria to continuously low transmission rates. The other site continues to experience high rates of malaria, which will allow us to test the community-derived model in two very different settings.  

The extremely low transmission rates in the first community have been attributed in great part to a novel "test and treat" model using a portable diagnostic tool that is the size of a handheld GPS unit and tests a drop of blood taken from the fingertip for parasites. Using this, teams can identify local residents (villagers) who are asymptomatic yet have high levels of malaria parasites (thereby increasing the risk of transmission of malaria to others). When such people are identified, they and their fellow householders are treated with antimalarials, thereby breaking the transmission chain.

This has worked so well that the government is now trialing an expanded test-and-treat project in nearby areas. The goal is to create a malaria-free zone. The challenge, then, shifts from understanding what people do in response to possible malaria (based on beliefs/culture, prior experience, and financial/social limitations) to also understanding the perceptions of laypeople, traditional and biomedical health practitioners regarding the risk of malaria in an area of low transmission (e.g., are people aware of the decline in malaria cases; if so, to what do they attribute this shift; are they concerned malaria may become a problem again and so are willing to use standard precautions -- sleeping under insecticide-treated bednets, allowing indoor spraying of their homes, clearing away land near their homes to avoid stagnant water pools for mosquito breeding, etc.). 

If we had insisted on following the original protocol, we could not expand our work to include this exciting, and potentially important, new area.

 

Agreeing to this cross-posting, Lynne added the following:

I'd enjoy discussing the project and other people's work of a similar (or different) nature!

P.S.

I have a personal and professional/project mandate to involve learners/students in the project.  I encourage people who are interested to get in touch. (Caveat: We can cover the cost of ground transportation, room and board, but not flight or salary for students/learners.)

If you'd like to follow-up, send me a message and I can provide you with Lynne'd email address.

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