My experience as a CGPH fellow in Tanzania surely exceeded my expectations for my summer internship, and was one of the most, if not the most, important learning and growth experiences I have had since beginning my MPH at Berkeley. This becomes clear to me in reflecting back upon how differently I felt arriving and leaving Shinyanga for the first and last time. While at the beginning of the summer I felt nervous and a bit uncertain, I left Shinyanga feeling confident and accomplished. For me, to have been involved in the development of a study from its very beginnings and have seen to its implementation and completion was an invaluable experience that proved to be both extremely challenging and gratifying. I am indebted to the beautiful country of Tanzania, the wonderful Shinyanga region, the incredible research team I worked with, and of course the women who participated in the study for teaching me so much. It was truly a transformational summer. Asante sana for everything!
This summer, I’ve been working as a Research Intern with the California Consortium for Urban Indian Health (CCUIH) on the Gathering of Native Americans (GONA) longitudinal, cross-site research project.
Usually, as soon as I say GONA, people ask me what this intervention is all about, so let’s start there! GONA is a highly-adaptable health promotion curriculum that is utilized by various Indigenous health care and community organizations. It was developed nearly twenty years ago by Native American social workers in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA). While different intervention sites set unique goals based on community needs, the overarching goals of the GONA are: “1) To provide a training experience that offers hope, encouragement, and a positive basis for Native community action;
2) To provide Native communities with a framework to examine historical trauma and its impact on alcohol and substance abuse issues today; 3) To provide a training experience that emphasizes skills transfer and community empowerment; and 4) To present a prevention strategy framework that is based on values inherent in traditional Native cultures such as belonging, mastery, interdependence, and generosity.”1
In California, two of the members of the California Consortium for Urban Indian Health (CCUIH): the Fresno American Indian Health Project (FAIHP) and Native American Health Center utilize the GONA curriculum as a tool to work with American Indian adolescents. In 2012, these two sites began to survey youth GONA participants prior to their participation in the GONA intervention, directly following their participation and six-months after their participation in the GONA. Now, in 2016, we’ve got five years of data on GONA participants and counting! This summer, FAIHP had 70 youth (between the ages of 11 and 17) participate in their GONA. Check out the group photo from the 2016 FAIHP GONA below. The research team is still waiting to receive the data from the Native American Health Center for their 2016 GONA, as the intervention just wrapped up a couple of weeks ago!
Photo credit: Fresno American Indian Health Project and the Native American Media Lab Team
Given the paucity of research on the health of Urban American Indian adolescents and effective interventions in addressing health disparities of this vulnerable population, we are pleased that so many GONA attendees are willing to participate in the study. I look forward to sharing the results of our longitudinal analysis with the communities from whom this data originates, as well as with the UC Berkeley community!
-Carolyn Kraus, UC Berkeley - UCSF Joint Medical Program, Innovations for Youth Summer Fellow
1: Gathering of Native Americans Trainer Guide. Provided by the Substance Abuse and Mental Health Services Administration Tribal Training and Technical Assistance Center. http://www.samhsa.gov/tribal-ttac
Dining at Central is a journey through the diverse altitudes and ecosystems of Peru. Living in Trujillo, I gathered an appreciation for Peruvian food from the jungle, desert, highlands, and coast. Though Central draws from these same environments, the food was nothing like I had ever tasted before. I have eaten potatoes nearly every day in Peru, but tasting the dozens of potato varietals at Central challenged my notion of how a Peruvian potato could look and taste. My compliments to the chef, the kitchen staff, and especially the wait staff. I could not think of a more perfect way to finish off my 15 weeks of traveling and studying the gastronomy of Peru than by eating a meal at Central.
-Shane Fallon, MPH Nutrition '17
No Peruvian meal is complete without a starch. Though famous for the hundreds of potato varietals, many other starchy items such as corn, wheat, rice, and pasta, have become a fixated part of the Peruvian diet. Oftentimes, a typical dish will serve two starches such as rice with pasta, or potatoes with white bread. The vast majority of these starches lack pigment (e.g. white rice and white pasta), and many of these items are served fried and/or are heavily salted. Converting products such as brown rice into white rice turns the food item into simple sugars and removes the bulk of the fiber and nutrients. Though undeniably tasty, a return to unadulterated products (e.g. whole grains, brown rice) could help keep blood sugar levels from spiking, which is especially important in Trujillo which has a high prevalence of Type II diabetes.
-Shane Fallon, MPH Nutrition '17
Living in the Bay Area, I am comfortably mobile via foot or by bicycle, which significantly contributes to my overall health and wellness. My life in Trujillo fell to the other side of that extreme because Trujillo is a city with such poor walkability and bikeability. While much of my project focuses on nutrition and caloric input, caloric output (i.e. physical activity) should command equal attention. In the United States, the American Heart Association recommends 30 minutes of physical activity a day, five times a week for adults. (1) In order for the residents of Trujillo to benefit from a similar set of guidelines, the built environment must be assessed and restructured so people can get more exercise through habitual activities such as commuting to and from work.
As a pedestrian in Trujillo, crossing the street mimics a game of tetras. Traffic lights are rare and loosely obeyed; traffic signals for pedestrians are nonexistent. The majority of sidewalks in Trujillo are extremely narrow and riddled with potholes and deep fissures. Moreover, these hazardous crevices are not designated with any marking or warning signs, and most have no timeline for being repaired. Stray dogs and cats linger and dominate the sidewalks, forcing pedestrians into the street so as not to disturb the unpredictable animals. One must also take caution not to step into the fecal material of both wild and domesticated animals who roam the streets unattended. Trash lingers in the street in “designated” pick-up spots (trash collection bins are not distributed to residents), which leaves a retched perfume in the surrounding ambient air. The spot where I placed my trash always has trash sitting there from the previous pick up; it seems as though someone arbitrarily decides what to collect and what to leave sitting on the sidewalk. Thus, walking in Trujillo is neither safe nor inviting.
-Shane Fallon, MPH Nutrition '17
My favorite Peruvian dish is ceviche. Since I cannot take raw fish back in my suitcase to the States, I decided I would learn how to prepare ceviche so I could try to replicate this dish once I return home. On my last day in Trujillo, Peru, I woke up at 5:30am and headed directly to the Mercado Mayorísta with my neighbor, Yessica, to buy the freshest fish possible. We also purchased limes, aji (spicy peppers), red onion, yucca, chocla (white corn) to accompany our market catch.
The beauty of ceviche is the simplicity of the ingredients. The fish is eaten raw but preserved in a robust bath of acidic lime juice, salt, ricotto (a type of Peruvian chili pepper) and garlic. The vendors at the markets in Trujillo will cut the fish into the bite sized pieces desired, making the final preparation process less than ten minutes. Ceviche can be eaten just minutes after all of the ingredients are added together. However, the longer the ingredients mingle, the more juice the fish will absorb. On our plate of ceviche, we added the cooked choclo (big boiled corn kernals), yucca, and seaweed. Ceviche is a refreshing departure from much of the fried food of Peru, and it is one one of the things I will miss most about my time in working in Peru.
Here is an tribute to the ceviche in the north of Peru.
-Shane Fallon, MPH Nutrition '17
I am so thankful to have had the opportunity to spend my summer in the beautiful country of Kenya this year! I will truly miss everyone that I have had the pleasure of crossing paths with. This research opportunity allowed me to explore my love for both nutrition and global health research, making it a summer I will never forget!
I feel so blessed and grateful to have been provided with this summer research opportunity. My summer on Mfangano wouldn’t have been possible without the help and support of my preceptors, faculty advisors, and most importantly the CGPH Fellowship.
Organic Health Response Ekialo Kiona Center Research Team
Asante sana (thank you very much) to this awesome research team right here! My research project wouldn’t have been possible without the help of each and every one of these individuals.
A huge thanks to everyone who followed my journey this summer in Kenya!
This summer I have explored transformations in sex education practice in a region of southern Senegal officially marked by and popularly stigmatized for sexual violence.
In Kolda, Senegal, 68% of young women become pregnant by age 18, according to a 2012 study by the UN Population Fund. The Centre Conseil Ado (CCA) of Kolda -- an incredibly dynamic adolescent health center headed by the straight-talking, Zouk-dancing, world-changing Mr. Babacar Sy – conceives teen or unwanted pregnancy as a form of sexual violence, alongside Female Genital Cutting (FGC), child marriage, and rape. Integral to the CCA’s approach to ending this violence is a new UN Population Fund-sponsered sex ed curriculum, Comprehensive Sexuality Education (CSE).
While not ignoring structural problems such as poverty and educational inequality, Babacar privileges a health model of individual agency. T-Shirts worn by the CCA's teen peer educators proclaim: "Information is a human right." Once "correct information" - conceived as objective and transcendent of culture - is disseminated, teens choose what they want to do with their bodies. "It's not up to me to tell them what to do," Babacar told me at our first meeting in 2015. "They make their own choices."
Information must come in particular forms to be considered as such. Intimate life may be intimate, but "open communication" is key; tasoo, often bawdy songs performed at ceremonies, some of which discuss proper sexual and relationship conduct, are considered oblique, coded language. Not only do they fall outside the biomedical fold, they are deemed not "open" enough to be informational.
Babacar and his team are confident that the information + choice will decrease violence. At the conclusion of a peer educator training session, a veteran peer educator proclaimed to a group of 15 year olds, "if you tell your friends what you learned here, there will be no more teen pregnancy! Do your jobs!"
I first met Babacar and his team of teen peer educators last summer, while working on an eHealth project with one of Babacar's colleagues. Two features of CSE intrigued me, and spurred me to pursue an Innovations for Youth (I4Y) fellowship at CGPH.
1) CSE aims to make parents the #1 resource for sex ed for youth. However, the paternal aunt or bajaan, has long played the central role in sex education. She’s often the one with the joking relations required to talk with nieces and nephews about intimate matters that parents and children are reticent to discuss. Furthermore, CSE’s plan for change relies upon a circular communications model; training young people to inform parents of the importance of informing young people.
2) And as indicated by its title, CSE aims to encompass everything within its reach: not just anatomical diagrams and STDs, but relationships with parents, relationships with friends, gender roles – and, crucially, sexual pleasure and desire. The commitment to "open communication" about desire and pleasure, to use Babacar's term, diverges from many other sex ed programs marked by what anthropologist Shanti Parikh identified in Uganda as the “bifurcation or risk and pleasure” (Cf. Parikh 2012).
Fueled by Babacar’s own concern about the CCA’s limited resources for impact studies, I returned to Kolda to assess parents’ responses to CSE. How would it's emphasis on parent-child communication gel with existing intergenerational communication practices? How does one bring questions of intimacy, desire, and pleasure into pedagogy? And what constitutes "open communication" in the first place?
Good times with Babacar Sy and Arona Camara
These questions are dramatized in animated form on www.clickinfoado.sn, a pedagogical website used in peer educator training sessions at the CCA. (Created by One World UK and Butterfly works, ICT for Development agencies).
Clickinfoado.sn’s animated cartoons enact a teleological progress-narrative from the so-called “traditional” preeminanece of the bajaan to “open” communication between parents and children. In tandem, characters learn to express sensuous bodily experience in language.
In one cartoon, the upper class highly educated Astou and her friend Balla school an impoverished villagois named Ouzin, who has just arrived to the city:
OUZIN: sex? Oh la la! What are you talking about? Sex, only adults have the right to talk about it
NARRATOR: In the traditional locale where Ouzin grew up, talking about sex before a certain age is considered impolite, improper, taboo. Only the paternal aunt (bajaan) can speak about sex.
[Cut to photo of thatched huts]
After teasing Ouzin, "It's like you're not part of the 21st century!," Astou and her friend Balla coax Ouzin into naming his sexual desire aloud. In turn, they advocate free communication between parents and children as co-constitutive of modern, 21st century life.
BALLA: Sexual desire, for example, is something that can seize and affect us, and that's natural! Haven't you felt something rise in your body when you see a pretty girl?
OUZIN: Uh...yah...I guess; but I have to wait until I have a wife to think about those things
Ouzin thinks: It's true that sexual desire overcomes me sometimes. But I hesitate to speak about it; maybe I shouldn't.
NARRATOR: To get certain information about sexuality, Ouzin pretends to be ignorant to push his friends to tell him more about it.
It is at this point, where Ouzin attempts to translate the visceral feelings that "rise in his body" into words that he is brought into the informational fold, and his modern subjecthood is redeemed. By the
end of the clip, Ouzin, Balla and Astou have pledged to not only discuss sexual desire among themselves, but to educate their parents and elders. "No one will do it in our place," Balla
How do these idealized portrayals of unflinching conversations about visceral sensations, and equally unflinching discussions with grown ups, mesh with actual communication practices?
To begin to answer that question, I began accompanying young peer educators, who trained with these cartoons, on their visites à domiciles or home visits – a kind of flash education spree where teens trained by the CCA as “peer educators” launch 10-minute lightening round discussions about the causes, consequences to and solutions for teen pregnancy with whoever they happen to find in each household.
The routine was this: Babacar would assemble peer educators aged roughly 15-30 under a tree, all dressed in white T-Shirts with declarations like, “STOP! I am too young to get married” or “Information is a human right” printed on the back. We would split into groups and stride, after abbreviated salutations, into autobody shops, hair salons, and family homes, announcing without preamble that we had come to discuss teen pregnancy.
Peer educators on a Visite a Domicile (VAD), or home visit
One young woman we met during a home visit stood out from her kin. Unlike her sister and cousin sitting beside her in the stairwell, she did not wear an airy house dress suitable for cooking, or alternately, a smart outfit for circulating in the neighborhood. She wore a baseball cap, baggy carpenter pants, and a loose-fitting collared shirt. A baby slept on a blanket beside her. Lamine, a veteran CCA peer educator, elicited various points of view on the issue, then synthesized the consequences of premature pregnancy (stigmatization, obsttegric fistula, STDs, educational rupture….), The woman continually buttoned and unbuttoned her shirt. She remained silent throughout the conversation, buttoning, unbuttoning, buttoning again. When Lamine transitionned to the "solutions" part of the session, the woman looked up; "If my mother had talked to me about sex when I was young, I would not have gotten pregnant." The peer educators did not press her for details. Taking this statement as evidence we had “sent the right message,” we took down our interlocutors’ names and phone numbers, shook hands, and moved on to the next house, the next family, the next story.
A friend told me later that this woman’s statement was not a unique position. Nor was the embrace of parent-child communication limited to young mothers. Indeed, though I have not finished conducting surveys, responses of older parents to this youth leadership initiative has not been nearly as frosty as I had predicted…at least on the level of explicit discourse.
Many parents celebrate the push to “break the taboo,” in common parlance, on discussing sexuality between parents and children in general, and mothers and daughters in particular. One mother in a peripheral neighborhood described her delight when a group of her daughter’s 15-year old friends came to discuss teen pregnancy. “It’s time that children take their health into their own hands,” she told me. “They woke us up.”
Of course, narratives about communication practices, and actual communication practices between mothers and daughters, may diverge. They interrelate, but are rarely a one-to-one match. We all have uneven perceptual access to how we use language and why. This poses methodological challenges, and analytical opportunities, in all ethnographic fieldwork. But I would argue especially in the anthropology of sexuality; discussing intimacy is, well, intimate. Furthermore, as I am closely associated with the CCA, responses to survey questions and informal conversations alike may be tweaked to echo what people think I want to hear.
The risk is to dismiss self-description as an inconsequential paraphenomena, a misleading veneer to strip away in search of what people really do, how they really communicate about sexuality. Not only does this position devalue everyday forms of narrative and negate the co-production of ethnographic knowledge, but it also deploys an oft-critiqued language ideology that privileges reference. Language does not simply reflect (or, alternately, conceal) social life. It shapes social life in fundamental ways.
As many anthropologists of language and sexuality have long asserted, silences, dissumulations, coded language should not be uncritically taken as dissimulations of meaning, but as meaningful gestures in themselves. Purinama Mankekar, for example, attends to her interlocutor's "silences, hesitations, and discursive detours," arguing that this “non-logocentric approach” to communication may reveal "surreptitious commentaries" on sexuality and ethical life that she might have otherwise overlooked (Mankekar 2012).
Much work has been conducted on claims of silence and taboo attributed to sexualities in Africa; the attribution of a silence often ignores other forms of embodied knowledge through which people communicate about sexuality(Cf. Arnfred 2004).
IN this case, silence is the stuff of explicit discussion. Alongside celebrations of open communication come claims that sexuality is “taboo” throughout Senegal. “Parents don’t talk to their children about sex,” agreed staff member Fatou, “because there’s a taboo.” This statement is interesting on a number of levels. First, it works as a classic performative: by stating “sexuality is taboo,” one in effect breaks the very prohibition one cites. Second, what happens to claims of taboo when one looks at poetic engagements with sexuality through songs called “tasoo,” performed at weddings and other ceremonies? Songs that often explicitly discuss not only marriage and proper conduct but also the sensory pleasures of touch?
While continuing to shadow teens on their VADs, I decided to analyze “taboo-breaking” as a meta-discourse – a discourse deployed by animated cartoon characters, teens and parents. I vowed to attend to these practices of speech and silence, and speech about silence. Silences, detours, and embodied knowledge that may not fit into CSE’s approach. Things that may or may not emerge on a two-page survey. Combining surveys, interviews, and participant observation, I thought, might grant me a fuller picture of the intergenerational communication practices that reflect and shape youth sexuality.
However, studying discourses of taboo-breaking led to deploying that discourse myself…
Lamine and other peer educators have taken it upon themselves to train me as a peer educator, and shape me in their image. By June, I was explaining the menstrual cycle in Wolof. By July I was leading my own causeries (chat sessions) with groups of fifteen year old girls about teen pregnancy, HIV/AIDS, and most interestingly, a sweeping lesson entitled simply, "sexuality.” This lesson explicitly addresses questions of sexual desire and pleasure.
An underlying assumption of these lessons is that the peer educator must "break the taboo" on sexuality. This meant that I would be deploying some of the language ideologies and notions of silence that I wanted to study.
My job was to get beyond teens' reluctance to discuss their bodies, their boyfriends, their desires, their fantasies. I must "Break the silence," said Sylvie, a 17-year old star at the CCA, as part of her pre-causerie pep talk. But I hesitated to adopt the unflinching, no holds barred approach of the veteran peer educator, which involves shocking young women out of their shyness with provocations like:
“I know you have boyfriends. Admit it!”
“What parts of your body have your boyfriends touched. Tell me!”
“If you don’t speak, how will your parents speak?”
or simply, “Tell the truth!”
The CCA staff and peer educator cohort has been so generous with their time and expertise. But this meant deploying some of the same linguistic ideologies that I want to study. End the dissimulation, straighten the detours, get the "truth" of youth experience and tailor the lesson accordingly.
The biggest methodological challenge, and analytical opportunity, of this summer has been navigating the dissonance between my training as an anthropologist and my training as a sex educator.
In the next post, I will recount some successful and not-so-successful stints as a sex educator in Kolda.
One morning when walking through Trujillo, I saw a woman and her two children sitting on the sidewalk next to a scale that read, “controle su peso” or “check your weight” for the price of 0.50 soles (approximately $0.15). Perplexed by the idea of someone making ends meet by charging those passing by for the chance to step on a scale, I came to learn that this was not an isolated incident. There are many “scale vendors” sprinkled throughout Trujillo, in part because the majority of people do not have access to a scale. I started asking why this may the case as I began drawing comparisons to the weight-obsessed culture I come from.
Adriana (community health worker), Claire (CGPH fellow), Fabio (UFF professor), Paula (CHW), Lee (Berkeley professor), Carina (CHW), and Robbie (past CGPH fellow) at the top of the community.
Not pictured: the countless other individuals helping our research projects!