Example proposal: Cultural Anthropology
Exploring connections between religious beliefs and medical decisions in Accra, Ghana
Describe your general goals and expected outcome. What do you want to do? Why is it important? What methods will you use? What question(s) do you hope to answer?
This research project aims to explore the ways in which religious beliefs affect the medical-decision making of Ghanaians in Accra. Due to the medically pluralistic environment of Accra, many citizens employ complex combinations of both biomedical and spiritual healing modalities. Many Ghanaians have adopted informal guidelines according to their belief systems that dictate which medical healing modalities they seek when illness arises. In order to investigate the ways in which biomedical and spiritual thought intersect in Accra, this research will be conducted through various interviews, observation of patient-doctor interactions, and a quantitative analysis of the incidence of malaria and hypertension at Alpha Medical Center in Medina, Accra. Other churches, mosques, shrines, and clinics will provide additional fieldsites for this research. The main objectives of this research project are to give insight into the various etiologies of disease that are adopted by both the biomedical and spiritual healing systems in Accra, to identify complementary aspects of both explanatory models of these systems, and to further propose practical steps towards building trust and collaboration between these systems and in patient-healer relationships in order to ultimately take steps toward improving health outcomes in partnering institutions within Accra.
Background & Long Term Objectives
What is the overall goal of this research? Why is it important? What are the “big questions” in your discipline that you expect to address? How does your proposed research relate to the work of others in this field?
Due to the medically pluralistic environment of Accra and the surrounding areas, many Ghanaians employ complex combinations of both biomedical and spiritual healing modalities. While researching the connections between faith and medicine in the Duke in Ghana study abroad program, it became evident to me that many Ghanaians have adopted informal guidelines according to their belief systems that dictate which medical healing modalities they seek when illness arises. Often times, patients perceive a dichotomy between physical and spiritual healing, which leads them to trust one realm of healing over another. In particular, some religious patients approach biomedical care with skepticism, ensuring that they seek biomedical care only in conjunction with a more spiritual form of healing. In some of these instances, trust is violated between patients and physicians due to both parties’ miscommunication or misunderstanding of beliefs about disease causation. Consequently, overall patient care is undermined. According to medical anthropologist Arthur Kleinman, much of the success of any form of healthcare is due to positive interactions and communication between caregiver and patient. Specifically, Kleinman urges physicians to clarify the patient’s explanatory model of disease in order to –identify any major discrepancies that may cause problems for clinical management” (2006). Using Kleinman’s model, my research will pay particular attention to patients’ perceived disease etiologies in order to uncover thought processes that govern the medical decisions made by Ghanaians. Similar to Kleinman’s ideas, anthropologist Levi-Strauss stresses that a patient’s own illness narrative can often generate multiple meanings that depict much more about the patient than the physical illness itself (Kleinman, 1988). It is with this in mind that I find importance and meaning in patients’ explanatory models of disease, which is evident in the emphasis on patient interviews in my research.
Additionally, the idea of collaboration between the seemingly separate disciplines of biomedicine and spiritual healing has been a particularly relevant topic in global health and medical anthropology today. With the increasing prevalence of modern biomedicine throughout the world, now more than ever patients in urban areas such as Accra are presented with many healthcare choices to manage and treat disease. According to global health researcher Ama de-Graft Aikins, the act of –healer shopping” is not only the result of complex spiritual beliefs but can also be due to the rising prices of biomedical healthcare in Ghana (2005). Moreover, many research efforts aimed at gaining an understanding of the use of traditional and modern medicine in Ghana concluded that strong influences of both systems will continue to be prevalent in this country and that efforts to collaborate between systems would be beneficial to Ghanaian patients (Tabi and Powell, 2006). It is in light of these results that my research focuses heavily on facilitating discourse between both systems and with patients in order to pioneer new ways in which interactions and collaborations between traditional and biomedical healthcare institutions may ensue.
General Aims/Long Term Objectives:
This research project aims to explore the ways in which religious beliefs affect the medical decision-making of Ghanaians in Accra. The overarching inquiries of this research resemble questions posed in global health research projects in medically pluralistic environments: How does faith in spiritual healing affect patient-healer relationships in both the clinical and spiritual realms? How are patients’ explanatory models of diseases influenced by both the biomedical and spiritual systems? What are some commonalities among the two healing modalities that shed light on ways to collaborate between systems and improve patient care? Researching these questions will give insight into the ways that trusting relationships can be fostered and common understandings can be reached between patient and physician and between biomedical and traditional healthcare paradigms. This in turn will allow patients to receive the healing they ultimately seek and allow physicians to accomplish the goal of assisting their patients in achieving a state of overall wellness.
Specific Aims & Short Term Objectives
What are the specific research questions that you will ask this summer, and what methods will you use to address them? What are your hypotheses?
1. This project seeks to qualitatively analyze and elucidate patient etiologies of malaria and hypertension. In order to determine how patients perceive disease causation in light of their religious beliefs, this research component will primarily consist of focused patient interviews. When piloting this research in the past, conducting interviews proved to be the most effective way to gain qualitative insight into the complex explanatory models of disease in Accra. Moreover, it became evident that malaria and hypertension are two diseases that often have varied explanations of causation between patient and doctor. Focusing specifically on malaria and hypertension as models will give insight into the ways in which biomedical and spiritual thought intersect to influence two of the most common diseases in Ghana.
To further conduct this research, I will develop a target community of Accra residents who frequent biomedical clinics but also believe in spiritual origins of disease. I will ensure that it is a diverse group, including a variety of ages, genders, and religious backgrounds. I want to learn how this population conceptualizes the etiology and treatment of disease. Do they see diseases such as malaria and hypertension as spiritual illnesses? Or might they be strictly biomedical? Or do both biomedicine and spirit interact, and/or complement one another in accounting for sickness? I intend to use anthropologist Dr. Arthur Kleinman’s –Eight Questions” method to guide semi-structured interviews of this population. These questions are as follows:
- What do you call your problem? What name does it have?
- What do you think caused your problem?
- Why do you think it started when it did?
- What does your sickness do to you? How does it work?
- How severe is your sickness? How long do you expect it to last?
- What do you fear most about your illness?
- What are the biggest problems that your illness has caused for you?
- What kind of treatment do you think you should receive? (Kleinman et al, 2006).
The primary site where many of these patients will be found is the Alpha Medical Center in Medina, Accra. This hospital is run by the Pentecostal Church of Ghana, and it serves a community of 400,000 people in a primarily Muslim district. The clinic stands out from its Muslim surroundings, declaring Bible verses through loudspeakers on a regular basis. While it has its roots outside of the government, this facility has recently been integrated into Ghana’s national health system. Moreover, Alpha Center’s physicians state that malaria is one of the most common diseases plaguing Alpha’s patients. This fact, combined with the complex mingling of religions and the diverse group of Ghanaians in this biomedical setting, makes this center a highly relevant and fascinating site for this research. My primary contact at Alpha Medical Center is Dr. Matthew Kwame Edusei, who supports my research and has agreed to host me in the clinic. My partnership with Alpha Medical Center and my experience conducting similar patient interviews in Ghanaian clinics in the past will allow me to successfully complete this research component.
2. This research will include a quantitative analysis of the number of malaria and hypertension cases that are confirmed at the Alpha Medical Center in order to view any relevant trends when comparing the perceived incidence vs. diagnoses of these diseases.
In order to accomplish this research component, patients associated with symptoms of malaria and hypertension will be identified by Alpha Medical Center, and I will record both the perceived cases of malaria and hypertension as well as the confirmed diagnoses by the clinic. The analysis of this record may reveal meaningful trends that quantify the relation between patient perceptions of illness and biomedical confirmation of disease. Particular attention will be paid to instances when patients perceive their illness as malaria or hypertension but testing by the clinic indicates otherwise; further interviewing these patients will give unique insight into the extent in which spiritual or medical systems influence their perceived illness. The partnership of Alpha Medical Center in this endeavor will make this research component feasible.
3. This project will analyze patient-doctor interactions within partnering institutions in Accra.
The clinical discourse surrounding malaria and hypertension will be of interest to this research, illuminating the effects of biomedical explanation of disease on patient-doctor relationships. At Alpha Medical Center and in other partnering clinics, I will observe the daily interactions of patients and physicians. The goal of this observation is to examine the ways in which differences of knowledge and spiritual beliefs between patient and medical institution can breed misunderstanding between patient and physician, and may subsequently lead to an inability to help sick Ghanaians. Specifically, these observations will give insight into the healthcare providers’ understandings of disease etiology and the ways in which they explain the disease to patients, give specific information regarding disease management, and present the information in a manner that is clear, as well as culturally and spiritually sensitive. In addition to observation in clinics, I will interview willing biomedical professionals about their experiences encountering or believing in spiritual etiologies of disease. The observation component of this research is feasible because my partnership with the Alpha Medical Center; interviewing physicians will be subject to their willingness to participate.
4. A qualitative determination of religious communities’ perception of disease causation will result from the work of this research.
In order to understand spiritual etiologies of disease, it will be essential to accompany my clinical research with interviews of Ghanaians in various religious communities. Three of the major spiritual paradigms in Accra are Christianity, Islam, and traditional African religions. I plan to use an adaptation of Kleinman’s –Eight Questions” in interviews with willing traditional healers and members of various churches, mosques, and shrines about their beliefs regarding disease causation and healing (Kleinman, et al. 2006). Some of my past partner institutions in Accra will be sites for these interviews: Agape House Church, Action Chapel International, The BEST Chapel, Alafia Shrine House, and The Culture Shrine House. These interviews will provide me with a fundamental base knowledge of spiritual explanations of disease in order to accurately analyze the results gained from the clinical components of this research. My previous visits to these field sites and the rapport established between Duke in Ghana and these institutions will allow this research aim to be met successfully.
5. The fostering of collaboration between biomedical and traditional healing institutions will be directly involved in the completion of this research.
This research aims to give relevant background information revealing helpful ways in which current and future healthcare institutions can improve spiritual sensitivity during consults in order to ensure success in the collaboration between patient and doctor, as well as between spiritual and biomedical healing institutions. To this end, upon the completion of this research I plan to invite biomedical and spiritual healers involved in the research process to a final meeting in which both parties are given the opportunity to discuss ways to improve collaboration and patient care. Additionally, upon return to Duke, I will compile the information obtained during this research endeavor and integrate it in a report that can be useful and made accessible to partnering institutions in Ghana. Finally, I plan to develop this research project into a senior thesis that highlights the findings of this research with the guidance of Dr. Charles Piot through Duke’s Cultural Anthropology Department. It is through these proposed outcomes that this research could lend a valuable perspective of the interactions between biomedical and traditional healthcare systems and has the potential to improve patient care by providing the framework for future initiatives to collaborate between spiritual and medical institutions.
Aikins, A. D. (2005). Healer shopping in africa:new evidence from rural-urban qualitative study of ghanaian diabetes experiences. British Medical Journal, 331(737), 1-7.
Kleinman, A. (1988). The illness narratives. (pp. 3-30). United States: Basic Books, Inc.
Kleinman, A., Eisenberg, L., & Good, B. (2006). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Focus: The Journal of Lifelong Learning in Psychiatry, IV(1), 140-149.
Tabi, M. M., Powell, M., & Hodnicki, D. (2006). Use of traditional healers and modern medicine in ghana. International Nursing Review, (53), 52-58.
Budget Total: $ 5,000.00
- Flight from Grand Forks, ND (GFK Airport) to Accra International Airport: $2,470
- In-country travel (daily travel throughout Accra to partnering institutions): $240
- One meal per day not covered by host family: $3/day for 60 days: $180
- Homestay Fee (includes 2 daily meals): $25/day for 60 days: $1,500
- Veronica and Edmond Kumordzie Mempasem, Accra
Supplies & Equipment:
- Visa: $60 Health and Medication (anti-malarial): $60
- Ghanaian cellphone: $60 Internet: $60
- Assistant Stipend: $150 (This money would be used to fund the transportation and assistance of a Ghanaian to help me around Accra when going to new partner institutions. A part-time assistant was tremendously helpful when conducting this research previously.)
- Misc supplies: $100 (field notebooks, recorder, etc.)
- Unanticipated Need: $120
Additional funding sources (applied):
- Duke Civic Engagement Summer 3,000.00
- Duke Global Health Institute 5,000.00
- International Studies Overseas Summer 3,000.00
Preliminary IRB Application Does your project involve human subjects in any way? Yes
Who will be your subjects? My research subjects will be the following: adult patients at the Alpha Medical Center in Medina, Accra; general physicians at the Alpha Medical Center and partnering clinics in Accra; members of partnering churches, mosques, and shrines in Accra; spiritual healers in partnering churches, mosques, and shrines in Accra.
Will you be working with a local or on-site organization? The main site for this research will at the Alpha Medical Center in Medina Estates, Accra. Contact: Dr. Matthew Kwame Edusei Email: firstname.lastname@example.org/ Office Phone: (+233) 0302422110/Mobile Phone: (+233) 0277603195
In what form(s) will you collect your data? The primary collection of data will consist of field notes. Given permission from my subjects, audio recordings will be taken of their interviews. Afterward, I will transcribe these interviews electronically.
What will you be asking your subjects to do? Participants will be asked to participate in 30 minutes-1 hour interviews. If a follow-up interview is necessary or desired, they may be asked for a second 30 minute-1 hour interview at a later time of their convenience.