Forsyth Colin
Department of Anthropology, University of South Florida, 4202 E. Fowler Avenue, SOC 107, Tampa, FL 33620-8100, USA.
Soc Sci Med. 2015 Nov;145:7-16. doi: 10.1016/j.socscimed.2015.09.022. Epub 2015 Sep 15.
Dressler (2001:456) characterizes medical anthropology as divided between two poles: the constructivist, which focuses on the "meaning and significance that events have for people," and the structuralist, which emphasizes socioeconomic processes and relationships. This study synthesizes structuralist and constructivist perspectives by investigating how structural processes impact explanatory models of Chagas disease in a highly endemic area. The research took place from March-June 2013 through the Centro Medico Humberto Parra, a non-profit clinic servicing low income populations in Palacios, Bolivia and surrounding communities. Semistructured interviews (n = 68) and consensus analysis questionnaires (n = 48) were administered to people dealing with Chagas disease. In the interview narratives, respondents link Chagas disease with experiences of marginalization and rural poverty, and describe multilayered impediments to accessing treatment. They often view the disease as incurable, but this reflects inconsistent messages from the biomedical system. The consensus analysis results show strong agreement on knowledge of the vector, ethnomedical treatment, and structural factors related to Chagas disease. In interpreting Chagas disease, respondents account for the structural factors which place them at risk and impede access to care.
德雷斯勒（2001：456）将医学人类学的特点描述为两极分化：建构主义学派关注“事件对人们的意义和重要性”，结构主义学派则强调社会经济过程和关系。本研究通过调查结构过程如何影响高度流行地区恰加斯病的解释模型，综合了结构主义和建构主义的观点。该研究于2013年3月至6月通过位于玻利维亚帕拉西奥斯及周边社区为低收入人群服务的非营利性诊所——温贝托·帕拉中心诊所开展。对患有恰加斯病的人进行了半结构化访谈（n = 68）和共识分析问卷调查（n = 48）。在访谈叙述中，受访者将恰加斯病与边缘化和农村贫困经历联系起来，并描述了获得治疗的多重障碍。他们通常认为这种疾病无法治愈，但这反映了生物医学系统传递的不一致信息。共识分析结果表明，在关于病原体、民族医学治疗以及与恰加斯病相关的结构因素的知识方面，人们达成了强烈共识。在解释恰加斯病时，受访者考虑了使他们面临风险并阻碍获得医疗服务的结构因素。
