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A Biocultural Study of Anemia and Subjectivity Among the Poqomchi’ Maya in Guatemala

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A Biocultural Study of Anemia and Subjectivity Among the Poqomchi’ Maya in Guatemala FROM CELL TO SYMBOL: A BIOCULTURAL STUDY OF ANEMIA AND SUBJECTIVITY AMONG THE POQOMCHI’ MAYA IN GUATEMALA BY C2014 JAMES WILLIAM HERYNK Submitted to the graduate degree program in Anthropology and the Graduate Faculty of the University of Kansas in partial fulfillment of the requirements for the degree of Doctor of Philosophy ___________________________________________ Chairperson, John M. Janzen ___________________________________________ Sandra Gray ___________________________________________ Brent Metz ___________________________________________ Harold Torrence ___________________________________________ Christine Daley Date Defended: March 25, 2014 This Dissertation Committee for James William Herynk certifies that this is the approved version of the following dissertation: FROM CELL TO SYMBOL: A BIOCULTURAL STUDY OF ANEMIA AND SUBJECTIVITY AMONG THE POQOMCHI’ MAYA IN GUATEMALA ___________________________________________ Chairperson, John M. Janzen Date approved: April 23, 2014 ii Abstract Anemia afflicts nearly 2 billion people worldwide by reducing oxygen carrying capacity in the blood. Practitioners of Western biomedicine consider anemia to be an easily treatable ‘symptom’ that results from some other disease, injury, or pregnancy. Conversely, in impoverished communities anemia has multiple causes, goes untreated, and becomes chronic and endemic. Given anemia’s global prevalence and varied etiology, it stands to reason that anemia may be differently experienced biologically and culturally. A lack of contextual research has inhibited understanding of why anemia persists despite being easily treatable. This dissertation examines the experience of anemia in the Poqomchi’ Maya community of Onquilha’, located above a coffee plantation overlooking the Polochic valley in Tamahú, Guatemala. Blood samples show that 100% percent of school-age children are anemic (N=87). By framing anemia as ubiquitous in a single community, it can be contextualized through local discourse, behavior, and Poqomchi’ subjectivity. A major theme of this dissertation is the liminal thresholds in both human biology and culture. Analysis of these thresholds (e.g. between health and illness, normal and abnormal, or treatable and untreatable) charts how the Poqomchi’ navigate and accommodate illness. The Poqomchi’ mitigate the effects of mild-to-moderate anemia by managing behaviors that alter physiology in response to metabolic requirements. Anemia is normalized through a rich discourse on fuerza (force, an individual’s presence in life). However, severe anemia is abnormal and managed through a more urgent discourse on energía (energy, an individual’s essence in life). When fuerza and energía are lost, severe anemia leads to compounding illness and disease, the loss of individual subjectivity and death, and a narrative of social suffering shared by the community. Anemia is an age-old problem. It is deeply rooted in our mammalian constitution and reliance on blood and oxygen to produce energy and sustain life iii in a variety of environments. For the Poqomchi’, the experience of anemia is the continual experience of fuerza and energía —life and death, limited by oxygen carried in the blood. This dissertation contributes to global efforts to reduce the impact of anemia and to medical and biocultural anthropology by demonstrating how illness is accommodated. iv Acknowledgements This has been an adventure. I would like to thank the many friends who have shared this journey with me, not knowing what we would discover. Thank you to the Poqomchi’ and Q’eqchi’ Maya and all the people of Tamahú, Guatemala, the field nurses and caring professionals at local health clinic, Ramon Chub, German Morán, and the Fundación de Mujeres Maya (FUNMAYAN), Antonio Chiquín, Rigoberto Bac Caal, Kevin Ledwith, Dan Scribner, Lucy, Kendra, Michelle, Colleen, Jed, Rachael and all the Peace Corps folks, Filiberto, Juana, Chepe, my insightful parents Jim and Diane, my siblings Jenny, Matt, Katie and their families, Celia and all my cousins, Dr. Jesús Bulux, Dr. David Hernández Dardón, Licda. Claudia L. Esquivel Girón, Dr. Stephen Zeller, Dr. Carol Ludwig, Rev. Bob Conroy, Dr. Aruna Michie, Dr. Brad Shaw, Dr. Scott Tollefson, Sean Willis, Anne Kraemer Diaz, Rebecca Crosthwait, Meghan Farley Webb, Melissa Flippi, my incredibly adventuresome dissertation committee including: Dr. Sandra Gray, Dr. Brent Metz, Dr. Harold Torrence, Dr. Christine Daley, and my esteemed advisor Dr. John Janzen who taught me how to find order in the universe through human experience. I especially want to thank the Poqomchi’ of Onquilha’ for allowing me to share in their experience and the insight their knowledge brings to all of human kind. v Table of Contents Abstract .......................................................................................................................................... iii Acknowledgements ......................................................................................................................... v Table of Contents ........................................................................................................................... vi Tables, Figures, Formulas, and Equations ..................................................................................... ix Chapter 1. Interpreting an Ambiguous Illness ................................................................................ 1 Anemia, Poverty, and Marginalization ....................................................................................... 4 Methodology and a Call for Research: Innovation, Interdisciplinarity, Contextualization, and Meta-Synthesis of Quantitative and Qualitative Data ................................................................. 8 Contradictory Manifestations of Anemia .................................................................................. 12 Navigation: Anemia Experienced as Processes in a Biological Matrix .................................... 18 Research Question ..................................................................................................................... 20 Outline of Dissertation Chapters ............................................................................................... 21 Chapter 2: Anemia, Accommodation, and Structural Violence ................................................... 24 Defining Anemia ....................................................................................................................... 24 Physiology, Blood, Hemoglobin, Oxygen, and Energy ............................................................ 25 Compensation for Anemia ........................................................................................................ 29 Classifying Anemia: Symptom, Condition, Illness, or Disease ................................................ 30 Symptoms of Anemia ................................................................................................................ 33 Prevalence of Anemia Globally and Nationally in Guatemala ................................................. 35 Etiology of Anemia ................................................................................................................... 41 Accommodation and Stress ....................................................................................................... 42 Structural Violence .................................................................................................................... 48 Chapter 3. Poqomchi’, Endemicity, Colonialism, and Archeological Record ............................. 53 The Poqomchi’ Community of Onquilha’ ................................................................................ 53 Observations on the Occurrence of Anemia in Onquilha’ ........................................................ 60 Structural Violence: Anemia in Relation to Land, Labor, and Power ...................................... 64 Colonial History and the Erasure of Structural Violence ...................................................... 66 Ancient Occurrence of Anemia among the Maya ..................................................................... 84 Preface: Divergent Planes that Converge in the Experience of Anemia ............................... 84 Creation: Corn, Body, Person, and Bone............................................................................... 84 The Gatherer-Hunter Neolithic Transition ............................................................................ 86 Conclusion: The Diet and Disease Dilemma in Sedentary Monoculture .................................. 94 vi Chapter 4. An Iterative Process of Qualitative and Quantitative Methods ................................... 96 Applied Agriculture Work ........................................................................................................ 97 Iterative Process ...................................................................................................................... 101 Participant Observation ....................................................................................................... 103 Triage: Exhaustive and Selective Sampling ........................................................................ 104 Focus Groups ....................................................................................................................... 104 Elicitations: Native Linguists, Women, Men, and Healers ................................................. 105 Blood Samples ....................................................................................................................
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