Utilitarian and Community Values in Mainstream and Alternative Health Care on Martha's Vineyard

Binghamton University The Open Repository @ Binghamton (The ORB) Graduate Dissertations and Theses Dissertations, Theses and Capstones 2018 Utilitarian And Community Values In Mainstream And Alternative Health Care On Martha's Vineyard Sandra D. Polleys-Bunch Binghamton University--SUNY, [email protected] Follow this and additional works at: https://orb.binghamton.edu/dissertation_and_theses Part of the Anthropology Commons Recommended Citation Polleys-Bunch, Sandra D., "Utilitarian And Community Values In Mainstream And Alternative Health Care On Martha's Vineyard" (2018). Graduate Dissertations and Theses. 43. https://orb.binghamton.edu/dissertation_and_theses/43 This Dissertation is brought to you for free and open access by the Dissertations, Theses and Capstones at The Open Repository @ Binghamton (The ORB). It has been accepted for inclusion in Graduate Dissertations and Theses by an authorized administrator of The Open Repository @ Binghamton (The ORB). For more information, please contact [email protected]. UTILITARIAN AND COMMUNITY VALUES IN MAINSTREAM AND ALTERNATIVE HEALTH CARE ON MARTHA’S VINEYARD BY SANDRA DALE POLLEYS-BUNCH BSN, Pace University, 1994 MS, Binghamton University, 1997 DISSERTATION Submitted in partial fulfillment of the requirements for the degree of Ph.D. in Anthropology in the Graduate School of Binghamton University State University of New York 2018 © Copyright by Sandra Dale Polleys-Bunch 2018 All Rights Reserved Accepted in partial fulfillment of the requirements for the degree of Ph.D. in Anthropology in the Graduate School of Binghamton University State University of New York 2018 May 6, 2018 Thomas M. Wilson, Chair Department of Anthropology, Binghamton University Michael A. Little, Faculty Advisor Department of Anthropology, Binghamton University Gary D. James, Faculty Advisor Department of Anthropology, Binghamton University Gale A. Spencer, Outside Examiner Department of Nursing, Binghamton University iii Abstract Problems endemic to Martha’s Vineyard’s health care system and community efforts to resolve such problems led to the choice to conduct this community study on Martha’s Vineyard, Massachusetts. Such problems included Martha’s Vineyard’s sole hospital and nursing home’s declarations of bankruptcy in 1996, the fluctuation of the quality of Vineyard health care organization relations with the community overall, the rate of uninsured that was two times that of Massachusetts overall, the Island’s isolation from mainland medical specialty services, and its recurring health care service scarcities. This ethnography focuses on utilitarian values to explain difficulties that Vineyarders experienced during their efforts to obtain health care and their efforts to improve Vineyarders’ access to health care. Efforts to promote access included the development and utilization of health care policies and the formation of mainland and local organization business networks and of local community networks (Wellever 2004:228, 229-230) such as the Dukes County Health Council. Participant observation, structured interview (n=262) and archival data were used. Participant observation took place at town, Martha’s Vineyard Commission and other public meetings, and at events such as the annual Tisbury town picnic, the annual West Tisbury holiday party, the Chilmark Community Center 50th year anniversary celebration, and the annual Wampanoag powwow. Structured interviews were sought from iv Vineyarders who had expressed an interest by their positive or negative statements about health care. The Martha’s Vineyard Times Supplement (2006) list of property owner names and their property values enabled interviews with Vineyarders of a wide range of property assessment values whose interviews were solicited by way of cold-telephone requests. Still others who had been employed by or had volunteered for a health care organization were found though recommendations, health care organization and other Vineyard media that listed or discussed trustees, top administrators and clinicians, and chance encounters during participant observation. This dissertation uses content analysis of actions performed by those individuals, organizations, and communities of interest here. Utilitarian values were used to explain Vineyarders’ actions. The types of utilitarian values of interest were not mutually exclusive and could be thought of as “existing” along a continuum of egoistic (individualistic) utilitarian values and collectivistic utilitarian values. Further extremes along such a continuum could be thought of as exploitive egoistic and altruistic collectivistic values. Such a continuum tends to be fluid at any given moment and across time. Such fluidity could be exemplified by an individual’s or organization’s self- motivated actions that produced benefits for those they exploited. Put another way, exploitation between two parties could be mutual. Each could exploit the other and thereby, each could give up something and each could gain something by the transaction. Also, those who took part in promoting the community’s well-being most often (if not always) derived personal satisfaction from their altruism. v Though Martha’s Vineyard’s communities were diverse, Vineyarders tended to be united by their sense of community. They made efforts to protect their communities from those they believed held opposing definitions that could threaten their communities. Such threats led Vineyarders to strengthen their community ties and to form new communities. Arguably, the malleable, versatile (Cohen 1985:18) and imprecise (Cohen 1985:21) symbol, “community,” promoted Vineyarders’ social solidarity. Their belief in “community” promoted harmonious social relations because it enabled individuals to reach surface agreements (Cohen 1985:18, 109). vi Dedicated to my mother, Barbara M. Polleys Parker, esteemed giver and protector of life vii Acknowledgments This work likely would not have been completed were it not for my committee members. Professor Tom Wilson, chairman of my dissertation committee deserves many thanks for admitting me to his anthropology boot camp and for the challenges he provided there. He was an excellent advisor. He and the other committee members set excellent examples, provided excellent suggestions, led me to helpful resources, and helped me to greatly improve my writing skills. Professor Mike Little shared his wisdom since my first day at Binghamton University until the completion of this dissertation (and certainly afterwards, given all that he imparted). His unwavering patience, gentle prodding, extra miles he traveled for students, and clarity imparting anthropological concepts during his classes and during our meetings are greatly appreciated. Without his advice, this dissertation might not have been completed. Professor Gary M. James deserves thanks for planting seeds that promoted my understanding of, among other things, rural health care and health care networks. Professor Gale A. Spencer deserves lauds for her heroic efforts and her helpful insights. It was a pleasure working with these professors and also with Dr. Louise Stein of SUNY Brockport who provided guidance early in my doctoral studies. Regretfully, I did not have the chance to express my gratitude toward Dr. Richard Antoun for the wisdom he shared. viii Thank you Vineyarders. While the scenery on Martha’s Vineyard is spectacular, it is Vineyarders who made the Island a wonderful place. Thanks to those who took part in interviews, conducting interviews was one of, if not the most enjoyable experience during my fieldwork. Each interview enriched this work. Study participants shared generously during lengthy interviews. Vineyarders who politely declined being interviewed are appreciated as were those who stated that they were not interested in being interviewed but would do so if it was difficult to find study participants. Fortunately, such offers were declined thanks to Vineyarders’ overwhelming generosity. My appreciation extends to moderators, committee members, political office holders and citizens who made their voices heard and who enabled me to see how Vineyard governance was played out at town, Martha’s Vineyard Commission and other public meetings. Christine Brown who chaired the Martha’s Vineyard Commission was among my Vineyard role models. Vineyarders with whom I laughed and with whom I mourned led me to feel welcomed as a community member. It is with a deeply-felt appreciation to have shared Vineyard sentiments such as those expressed while the Martha’s Vineyard ferry, Islander that touched the hearts of many Vineyarders, was being decommissioned. Vineyarders Sarah Kuh, Mary Leddy, Cynthia Mitchell, and some early study participants provided valuable comments that helped me to improve my interview schedule. Roger Wey helped me to improve questions to political office holders. Anna and John Alley shared their friendship and provided feedback on a dissertation chapter. Tim Walsh enabled me to conduct interviews at Martha’s Vineyard Hospital and Dr. Denise Fraser provided me the green light for interviewing physicians employed by the ix hospital. Didie Wieler offered to collect written responses to a request to be interviewed from hospital physicians. Though no physicians responded to this one item questionnaire, many agreed to be interviewed and all provided valuable data. Many Vineyard health care professionals of all ranks were excellent providers of health care given the observations I made and the accounts study participants provided.

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