Carolyn Smith-Morris

An Anthropology of Familismo: On Narratives and Description of Mexican/Immigrants

Research on core cultural values has been central to behavioral and clinical research in ethnic groups. Familismo is one such construct, theorized as the strong identification and attachment of Hispanic persons with their nuclear and extended families. Our anthropological research on this concept among Mexicans and Mexican immigrants in the United States elaborates the concept, and promotes greater complementarity between quantitative and qualitative data on the topic. Ethnographic work spanning 3 sites over four years reveal that familismo as expressed in narratives is a more contested and evocative concept than most quantitative and behavioral literatures tend to suggest. By suggesting that when familismo is used in generalizing ways, it neglects the broader significance of nostalgia or of a larger social (extra-familial) connectedness, we do not ignore the need for population-based research. Instead, we hope to forward and crystallize studies of culture change in migrants and to sustain a complementary and simultaneous conversation based on contextual and qualitative data.

Diagnostic Controversy: Gestational Diabetes and the Meaning of Risk for Pima Indian Women

ABSTRACT Gestational diabetes is the one form of this well known, chronic disease of development that disappears. After the birth of the child, the mothers glucose levels typically return to normal. As a harbinger of things to come, gestational diabetes conveys greater risk for later type 2 (previously “non-insulin dependent”) diabetes in both the mother and child. Thus, pregnant women have become a central target for prevention of this disease in the entire Pima population. Based on ethnographic interviews conducted between 1999 and 2000, I discuss the negotiated meanings of risk, “borderline” diabetes, and womens personal knowledge and experiences of diabetes, particularly during the highly surveilled period of pregnancy. I also highlight the heterogeneity of professional discourse pertaining to gestational diabetes, most notably the debate surrounding its diagnosis. Significantly, womens narratives reveal the same set of questions as is raised in the professional debate. Implications for diabetes prevention and for balancing the increased surveillance of pregnant women with clinical strategies that privilege their experience and perspectives are also discussed.

Questioning Our Principles: Anthropological Contributions to Ethical Dilemmas in Clinical Practice

This paper presents an analysis of the applicability of a principalist approach for a global, or cross-cultural, bioethics. We focus especially on the principle of individual autonomy, a core value in ethical discourse. We echo some long-standing criticisms of other anthropologists, sociologists, and many medical ethicists that the individualistic approach to autonomy is a Euro-American value and cannot be ethically applied in all settings. As a remedy, we suggest an adaptation of Kleinmans Explanatory Model approach to questions of decisionmaking. We argue that the analysis and resolution of ethical dilemmas might also benefit from forms of pedagogy that integrate anthropological and other social science perspectives, and the incorporation of ethnographic techniques in ethical practice. We appreciate the extensive efforts of Michelle Amoruso, doctoral candidate in anthropology, who assisted with the preparation of the manuscript.

The Baggage of Health Travelers

The Baggage of Health Travelers Carolyn Smith-Morris a & Lenore Manderson b c a Department of Anthropology, Southern Methodist University, Dallas, Texas, USA b School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Caufield East, Victoria, Australia c School of Political and Social Inquiry, Faculty of Arts, Monash University, Caufield East, Victoria, Australia

Ethnography, fidelity, and the evidence that anthropology adds: supplementing the fidelity process in a clinical trial of supported employment.

This discussion considers the role and findings of ethnographic research within a clinical trial of supported employment for veterans with spinal cord injury. Contributing to qualitative evaluation research and to debates over anthropological evidence vis-à-vis clinical trials, we demonstrate how enactors of a randomized controlled trial can simultaneously attend to both the trials evidentiary and procedural requirements and to the lived experiences and needs of patients and clinicians. Three major findings are described: (1) contextual information essential to fidelity efforts within the trial; (2) the role of human interrelationships and idiosyncratic networks in the trials success; and (3) a mapping of the power and authority structures relevant to the staffs ability to perform the protocol. We emphasize strengths of anthropological ethnography in clinical trials that include the provision of complementary, qualitative data, the capture of otherwise unmeasured parts of the trial, and the realization of important information for the translation of the clinical findings into new settings.

Diabetic Retinopathy and the Cascade Into Vision Loss

ABSTRACT Vision loss from diabetic retinopathy should be unnecessary for patients with access to diabetic retinopathy screening, yet it still occurs at high rates and in varied contexts. Precisely because vision loss is only one of many late-stage complications of diabetes, interfering with the management of diabetes and making self-care more difficult, Vision Threatening Diabetic Retinopathy (VTDR) is considered a “high stakes” diagnosis. Our mixed-methods research addressed the contexts of care and treatment seeking in a sample of people with VTDR using safety-net clinic services and eye specialist referrals. We point to conceptual weaknesses in the single disease framework of health care by diagnosis, and we use the framework of “cascades” to clarify why and how certain non-clinical factors come to bear on long-term experiences of complex chronic diseases.

Independent donor ethical assessment: aiming to standardize donor advocacy

Living organ donation has become more common across the world. To ensure an informed consent process, given the complex issues involved with organ donation, independent donor advocacy is required. The choice of how donor advocacy is administered is left up to each transplant center. This article presents the experience and process of donor advocacy at University of Texas Southwestern Medical Center administered by a multidisciplinary team consisting of physicians, surgeons, psychologists, medical ethicists and anthropologists, lawyers, a chaplain, a living kidney donor, and a kidney transplant recipient. To ensure that advocacy remains fair and consistent for all donors being considered, the donor advocacy team at University of Texas Southwestern Medical Center developed the Independent Donor Ethical Assessment, a tool that may be useful to others in rendering donor advocacy. In addition, the tool may be modified as circumstances arise to improve donor advocacy and maintain uniformity in decision making.

Narrating a Return to Work After Spinal Cord Injury

Perhaps no social scientific tool is more important to the study of illness and rehabilitation than the narrative. They are not only the vehicle by which treatment for spinal cord injury (SCI), recovery, and adjustment occur but are also the essential communicative device that allow social scientists to understand their. And these tasks are not mutually exclusive. In this chapter, we describe the qualitative arm of a clinical trial of supported employment for persons with SCI. Narratives not only reflected informant adjustments to life and work with an SCI but also gave informants an arena – the interview – in which to actively craft and test some of these new adjustments. Our analysis focuses on the productive, perlocutionary task of the narrative, its unique timelessness, narrator authority, and lifelong adjustment.

Care as Virtue, Care as Critical Frame: A Discussion of Four Recent Ethnographies

Amrith, Megha 2016 Caring for Strangers: Filipino Medical Workers in Asia. Copenhagen, Denmark: NIAS Press. ISBN-13: 978-8776941932, 272 pages. Paperback £18.99 (

Blind spots in telemedicine: a qualitative study of staff workarounds to resolve gaps in diabetes management

27.00)Street, Alice 2014 Biomedici...