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“Here in Paraguay We Have to Sacrifice So Much to Get Anything”: Perceptions of Health and Healthcare Services Among Subsistence Farmers in Paraguay

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“Here in Paraguay We Have to Sacrifice So Much to Get Anything”: Perceptions of Health and Healthcare Services Among Subsistence Farmers in Paraguay “Here in Paraguay we have to sacrifice so much to get anything”: Perceptions of Health and Healthcare Services among Subsistence Farmers in Paraguay By Sarah A. Flanagan A thesis presented to The University of Guelph In partial fulfillment of requirements for the degree of Master of Arts in Public Issues Anthropology Guelph, Ontario, Canada © Sarah A. Flanagan, September 2012 ABSTRACT “HERE IN PARAGUAY WE HAVE TO SACRIFICE SO MUCH TO GET ANYTHING”: PERCEPTIONS OF HEALTH AND HEALTHCARE SERVICES AMONG SUBSISTENCE FARMERS IN PARAGUAY Sarah A. Flanagan Advisor: Professor Elizabeth Finnis University of Guelph, 2012 In this Master's of Public Issues Anthropology thesis I examine the perceptions of health and healthcare services within a small rural subsistence farming community in South-Western Paraguay from a political ecology of health perspective. Qualitative research data was collected from May to September of 2010 in Lindo Manantial, a subsistence farming village, and Piribebuy, the closest town to Lindo Manantial and the location of the nearest health centre, the Piribebuy Centro de Salud. The primary goals of this research project were to gain an ethnographic understanding of current local health perspectives and concerns, as well as the local frameworks for health provision in Piribebuy. I argue that the introduction of culturally competent healthcare services could greatly improve individual and community health statuses and outcomes in Lindo Manantial and other similar rural subsistence farming communities in Paraguay. ACKNOWLEDGEMENTS First and foremost, I must extend my sincere gratitude to Professor Elizabeth Finnis, my advisor throughout this research process and without whom this thesis would not have been possible. Dr. Finnis not only introduced me to Paraguay and generously welcomed me into her research community in Lindo Manantial, but also secured funding through the Social Sciences and Humanities Research Council of Canada for my project and was a driving force throughout the duration of the research and writing process. She is an inspiration in the field of anthropology, and I am sincerely grateful for having had the opportunity to work with her. I would also like to thank Professor Satsuki Kawano, my internal committee member, for her encouragement and insightful revisions of my thesis. I was first introduced to Dr. Kawano as the professor for our graduate qualitative research methods course, and from that point on she helped shape both the thesis design and my growth as a researcher and writer, and for this I am very thankful. I am also extremely grateful for the advice and input of my external committee member, Professor Lisa Kowalchuk, for generously taking the time to review and contribute to this thesis. Thank you to the faculty and staff in the Sociology and Anthropology Department of the University of Guelph for their support and guidance throughout this research process. Special thanks to Shelagh Daly, our dutiful grad mother, for being a constant source of support and encouragement throughout this process; I am sincerely grateful. A very special thank you to Professor Belinda Leach, for being my unofficial committee member and persistent supporter throughout this process. You remain the person I can always turn to for advice, both professionally and personally. I value your insight, your experience, and your encouragement more than you can imagine. I must extend my heartfelt thanks to Professoras Fatima Candia Romero and Clotilde Benítez, and the entire faculty in the Human Ecology department at the Universidad Nacional de Asunción, for welcoming me into their department, research networks, and homes during my stay in Paraguay. To Fatima in particular, thank you for welcoming me into your family and making me feel so at home throughout my stay. I will be forever grateful for both the research opportunity and the friendship you extended to me. Gracias. Thank you also to Noelia, my wonderful research assistant, translator, and friend. Without Noelia’s outgoing personality and brilliant sense of humor, I do not believe I would have been able to develop meaningful connections with many of the Lindo Manantial participants. ¡Dios mio! I would have been lost without you! iii Muchisimas gracias to my dear friend and translator, Guillermo Achucarro. Guillermo volunteered to battle the cold snap of 2010 in Piribebuy with me, assisting with the interviews and translations at the Piribebuy Centro de Salud, and I am so grateful for his hard work and constant willingness to help. On a more personal note, Guillermo’s friendship eased my homesickness and made my stay in Paraguay infinitely more fun! Thank you for the Spanish lessons, the fútbol matches, and welcoming me into your lovely circle of friends. ¡Fuerza Paraguay! ¡Adelante Albirroja! I cannot adequately express my gratitude to my research participants and the Lindo Manantial community for welcoming me into their homes and sharing their lives with me. Amongst my participants, I was continually amazed by their openness and encouraged by their belief in the value of my research. I have never encountered a community so generous and so welcoming to an outsider like myself. By the time I left, I truly felt part of the community. In particular, I must thank mi mama y mi hermana Paraguaya for welcoming me into their home and their family for the duration of my stay. Their kindness and affection truly made me feel like part of their extended family, and I remain forever grateful. Suerte. Finally, to my family, for their constant love, support, and encouragement – without you this would not have been possible. Thank you to Mum and Dad for your academic guidance, love, and pushing me through to the end. I am so pleased you were able to come to Paraguay and share in part of this experience with me. I will value those memories forever. To Alison, my brilliant sister: thank you for your support, for lending an ear from as far away as Asia while I was in Paraguay, and for debating theory with me from both your anthropological and medical perspectives. Finally, to Shawn, for being there every step of the way, for your understanding, and for your persistent belief in me. Rohayhu. Gracias a todos. Sarah. iv TABLE OF CONTENTS ABSTRACT…………………………………………………………………………………………ii ACKNOWLEDGEMENTS……………………………………………………………………………iii LIST OF FIGURES………………………………………………………………………...………..vii LIST OF APPENDICES……………………………………………………………………………..viii CHAPTER 1: Introduction…………………………………………………………………………..1 CHAPTER 2: Literature Review…………………………………………………………………….9 Theoretical Framework: Political Ecology of Health……………………………………………..9 Socio-Political Context: Subsistence Farming Politics & Changing Demographics…………….10 Paraguay’s Healthcare Infrastructure & the Decentralization Process…………………………..18 Ethnomedicine & Natural Healing in the Paraguayan Context………………………………….26 Health Implications of Environmental Change…………………………………………………..32 CHAPTER 3: Methodology………………………………………………………………………..38 Primary Research Fieldsite: Lindo Manantial…………………………………………………...39 Secondary Research Fieldsite: Healthcare Providers & Piribebuy’s Centro de Salud…………..41 Data Collection & Methodology…………………………………………………………………43 Identifying & Interviewing Additional Stakeholders……………………………………………47 Anticipated Research Limitations………………………………………………………………..49 Ethical Considerations & Procedures……………………………………………………………51 Summary of Participants & Fieldsite Data………………………………………………………53 CHAPTER 4: Data Collection & Discussion………………………………………………………56 General Perceptions of Community Health……………………………………………………...57 i) Lindo Manantial……………………………………………………………………….57 ii) Piribebuy Centro de Salud……………………………………………………………59 Emerging & Changing Community Health Concerns…………………………………………...60 i) Improved Areas of Health and Healthcare…………………………………………….62 ii) Consistent Health Concerns…………………………………………………………..65 iii) Areas of Increasing & Emerging Health Concerns…………………………………..67 iv) Case Study: High Blood Pressure…………………………………………………….71 Nutrition, Food & Food Preparation……………………………………………………………..76 i) Case Study: Type II Diabetes………………………………………………………….81 Accidents & Injuries……………………………………………………………………………..86 Disease Vectors & Venoms: The Health Implications of Insects & Animals…………………...89 i) Animals & Zoonoses…………………………………………………………………..89 ii) Insects…………………………………………………………………………………90 iii) Spiders & Scorpions………………………………………………………………….95 v iv Snakes…………………………………………………………………………….…...97 Seasonal Health Issues………………………………………………………………………….100 i) Colds, Flus & Viral Upper Respiratory Tract Infections…………………………….101 ii) Gastrointestinal Problems……………………………………………………………102 Ageing…………………………………………………………….…………………………….104 Natural Medicine……………………………………………………………………………….108 Summary of Community Health Concerns………………………………….………………….112 CHAPTER 5: Data Analysis & Discussion………………………………………………………115 Contextualizing Healthcare Service Concerns in Piribebuy Region – Culture-Bound Syndromes, Patient Perspectives & Ethnomedicine…………………………...115 Pasmadura……………………………………………………………………………………...131 Frialdad………………………………………………………………………………………...134 Culturally Competent Healthcare………………………………………………………………137 CHAPTER 6: Conclusion………………………………………………………………………...144 REFERENCES………………………………………………………………….…………………152 APPENDICES……………………………………………………………………………………..160 vi LIST OF FIGURES FIGURE 1: Age and Gender Distributions of Lindo Manantial Participants………………….......53 FIGURE 2: Gender Distribution of Participants at each Fieldsite……………………………..….54 FIGURE 3: The Most Common Health Concerns in the
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