Tuberculosis and health care in Highland Chiapas, Mexico: An ethnographic study.

摘要

This dissertation presents a study of illness and medical care among the Maya Indian population of Highland Chiapas, Mexico. The study focuses on the serious health problem of tuberculosis and the various difficulties encountered in implementing tuberculosis control programs in Indian areas. Ethnographic investigation of these problems was conducted in the Tzeltal community of Yochib (municipality of Oxchuc) and among Chamula refugees in San Cristobal.;After overviewing the society of Highland Chiapas, I present a general ethnography of the community of Yochib. While I highlight wide-ranging transformations, I also provide a detailed description of community life as a context for the discussion of health issues. In the medical ethnography of Yochib, I show the health consequences of poverty and emphasize the influence of Protestantism in the people's acceptance of Western medicine. I describe the activities of the Indian paramedics working in the community and analyze the difficulties Indians encounter in utilizing urban health care services.;The study then focuses on tuberculosis and tuberculosis control programs. I relate the high incidence of tuberculosis in Indian communities to poor economic and nutritional conditions and discuss the problems of tuberculosis control programs in rural areas. In the sections on Yochib, I present the patients' interpretations of the disease and the problems associated with supervising three tuberculosis patients in the Spring of 1988. I then focus on a particularly difficult case of tuberculosis among the Chamula refugees in San Cristobal. The patient's course of illness illustrates, on a microsocial and concrete level, the health care delivery problems previously discussed in a macrosocial framework.;My study of tuberculosis and health care among Tzeltal and Tzotzil Indians enriches the ethnology of Highland Chiapas. While it contributes to the anthropological study of tuberculosis and its sociocultural aspects, the study also augments ongoing research in the fields of public health and international health care.