'Sometimes they just get sick': Therapeutic decision-making, children's health and poverty in Salasaca, Ecuador.

摘要

In my dissertation, I examine therapeutic decision-making in children's illnesses in Salasaca, Ecuador. Therapeutic decision-making is the process through which illness is recognized and treated; it is a complex matrix through which cultural and personal beliefs, individual experiences and socioeconomic constraints interact. In my research, I worked with 33 families in Patuloma, Ecuador, following the illnesses of their children and the therapeutic strategies, or arrangement of treatment alternatives, that they made in response.;I use a variety of analytical techniques from interpretive, cognitive, biocultural and critical medical anthropologies to examine the intersection of cultural traditions, historical inequalities and poverty in the treatment of children's illnesses. The tension between these approaches produces a unique vantage perspective from which to examine therapeutic decision-making that reveals the dynamic context in which Salasaca caregivers negotiate diagnoses and therapeutic decisions;Salasaca therapeutic decision-making in children's illness is ultimately about pragmatics; in the decision process, caregivers diagnose illness based on multiple health beliefs and use treatment resources from multiple medical systems simultaneously. Caregivers creatively combine ethnomedical and conventional medical beliefs and practices to explain illness and craft strategies in the curing of child illness.;The key factors influencing Salasaca therapeutic strategies are prior experience of an illness and normalcy, a category of the ethnomedical system that defines an illness as meeting certain expectations. Normal illnesses are expected illnesses in children that reflect their vulnerability to dangers in the natural environment or relate to stages in a child's development. Normalcy also functions at another level in through which Salasacas comment on the structures of economic and social inequality that cause their children's illnesses and constrain their ability to make therapeutic decisions. Normalcy is a condition of expectation in which structural constraints of poverty, social inequality and political invisibility become internalized and taken for granted, forming an expectation of malnutrition, ill health and limited access to health and sanitation services. Child illness and child death are normal in Salasaca because poverty is normal. Salasaca therapeutic decision-making is embedded within and reflects upon the context of medical pluralism and structural constraints of social inequality and poverty.