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© COPYRIGHT by Laura S. Gilchrest 2021 ALL RIGHTS RESERVED Dedicado a todxs lxs que se atrevan a imaginar otro mundo mientras sobreviven a este. CONTEMPORARY MEDICAL MISSIONS AND IATROGENIC VIOLENCE IN HONDURAS BY Laura S. Gilchrest ABSTRACT The goal of this dissertation is to assess the health and broader social effects of contemporary medical missions in Honduras. Though medical missions are a popular phenomenon that has garnered the attention of researchers across disciplines, existing literature has not provided a framework for evaluating how medical missions are filling gaps in local services, if at all. Nor does existing scholarship evaluate for potential or actual harms that may result from medical mission activities. I conducted participant observation among 11 medical missions and a Honduran health center in the Department of Colón on the northeastern coast of Honduras. This study considers the medical mission encounter through assessments of local health resources and consecutive medical mission clinics and interviews and participant observation with local healthcare workers, residents and mission volunteers. I demonstrate that contemporary medical missions are a revival of missionary medicine and the iatrogenic violence they engage in is directly related to the colonial roots of biomedical healing. I frame the mission encounter as a dialectic of self- and Other making and identify dominant discourses medical mission volunteers circulate to establish moral and intellectual authority and rationalize ongoing interventions, even when they are acknowledged to be ineffective. The mission organization and its volunteers engage in actions that are frequently misaligned with the needs, identified structural factors that complicate health and well-being, and the national priorities for improving access to healthcare identified by local healthcare providers and residents. As a result, the medical mission encounter leads to various forms of clinical, social, and cultural harm. By undermining or discursively erasing local healthcare resources contemporary medical missions contribute to the provoked crises in the Honduran public health system. I apply recent innovations in anthropological approaches to examine the missionary medicine encounter in Honduras as a dialectic and mutually constitutive process – putting the experiences and narratives of local communities at the same level of analysis as that of mission volunteers. This study contributes a much-needed framework for evaluating and analyzing the iatrogenic violence of medical mission encounters and may inform rubrics for monitoring and managing medical mission encounters in host countries. iv ACKNOWLEDGMENTS This research project and the resulting dissertation have been over a decade in the making, which means there are a great many people to acknowledge and not nearly enough space to do so. I will do my best to get it right in these pages. However, I will most certainly be thanking people in person for years to come. Let me start by acknowledging the support of my friends and family. Many of you have endured me as an academic for years now. Dissertations and the research that accompanies them do not happen outside of our lives as social beings. In the grand scheme of things, they are but one aspect among many others. Sometimes the other chapters of our lives make dissertations seem like footnotes. And a lot has happened in the past ten years. In the midst of “finishing” my dissertation, I was thrown off course by harrowing personal experiences and one in particular that has forever altered who I am. In so many ways my friends and family encouraged me and supported me through the most unimaginably difficult moments of my life. Moments that, frankly, I would not have survived without you. In the face of that reality the dissertation seemed insignificant. I am so grateful to those who surrounded me with love, held me up, cleared a path, and gave me time to find my way back (if I wanted to). Thank you. Tackling the research and dissertation involved the input, participation, support, and assistance of hundreds of people! I am grateful to them all. I want to thank the people of Playa Felumi for welcoming me, befriending me, tolerating my questions and curiosities, for asking me questions and sharing your lives with me. Thank you for participating in this research, this dissertation and the degree it has earned me would not have been possible without you. There are a few people in particular for whom I am so grateful, I cannot name them here, but I am so glad we continue to be part of each other’s lives and that I can thank them beyond these pages as well. Seremein! v Without the friendship, support, and collaboration of Dr. Luther Castillo, this research would not have been possible. Thank you for your energy, your faith and trust in me, and your friendship. Thank you for sharing your resources, your time, your presence, and for the many, many animated conversations about medical missions, healthcare, politics, and revolution, we have had over the years. Seremein! Thanks to my colleagues at American University, who read early proposals and chapters and offered insights and feedback. Thanks to the Center for Latin American and Latino Studies at American University, and Eric Herschberg, for your support and invaluable connections. My gratitude to the Tinker Foundation, and the College of Arts and Sciences and the Office of the Provost at American University for funding support for pre-dissertation research, fieldwork, and writing grants. Thanks also to Lauren Tabbara, a font of wisdom and a behind-the-scenes advocate for students (especially in emergencies). Thank you to Nikki Lane, Matthew Thomman, Nell Haynes, for your wisdom, guidance, and mentorship. Thank you also for your friendship and example. Special thanks to Joeva Rock, Jeanne Hanna, Beth Geglia, Justin Uehlein for your friendship, collaborations, love, and accompaniment on this journey. Thank you for reading early drafts, later drafts, being soundboards, and writing partners. Thank you for the best brunches, impromptu babysitting, and pandemic provision deliveries! Thank you to Sarah Leister for your time, feedback, and keeping me on schedule! Thank you to Amy Ruddle for all of your help from babysitting, to pandemic provision delivery, to reading multiple drafts and offering feedback and support. I am honored and humbled. All of you inspire me! I am proud and grateful to know each of you. Thank you to my parents for the variety of ways you have supported me my entire life, but especially in these last few relentless years. When I was a young child and people asked me vi what I wanted to do when I grew up, I would answer “I want to go to college.” Today, I am the first person in our entire family to earn a PhD. Thank you for supporting me in making a career of being a perpetual student. Finally, thank you to my committee for believing in this research. Thank you all for the compassion and patience you have extended to me as well. It has meant the world to me. I am grateful that you have all pushed and encouraged me, and that you have cared enough to do so. Dr. Koenig, thank you for your sincerity and frankness, and for your extremely detailed readings of my work. Dr. Carruth, thank you for your guidance, mentorship, and expertise. Dr. Vine, thank you for your support and advice, and for your guidance during my fieldwork. Dr. Pine, thank you for your support, mentorship, and friendship and encouraging me to take this idea on when it was still just a spark. Thank you all for encouraging and pushing me, and for caring enough to do so. vii TABLE OF CONTENTS ABSTRACT ................................................................................................................................... iv ACKNOWLEDGMENTS .............................................................................................................. v LIST OF TABLES ....................................................................................................................... xiii LIST OF ILLUSTRATIONS ....................................................................................................... xiv LIST OF ABBREVIATIONS ....................................................................................................... xv CHAPTER 1 HELPERS AND HEALTH SEEKERS IN HONDURAS........................... 1 The Research Problem ............................................................................................ 1 Research Questions and Hypotheses ...................................................................... 2 Country and Fieldsite Context, Health Indicators, and Short-Term Medical Missions .................................................................................................................. 3 Playa Felumi ............................................................................................... 5 Health Indicators ......................................................................................... 9 Cotemporary Short-term Medical Missions.............................................. 13 Organization of the Study ..................................................................................... 17 CHAPTER 2 CONTEMPORARY MEDICAL MISSIONS: SELF AND OTHER-MAKING IN THE MEDICAL MISSION ENCOUNTER.......................... 19 Short-Term Medical Missions .............................................................................. 19 Measuring STMM Outcomes: Success is in the Eye of the Beholder
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