Chronic Conditions, Fluid States explores the uneven impact of chronic illness and disability on ... more Chronic Conditions, Fluid States explores the uneven impact of chronic illness and disability on individuals, families, and communities in diverse local and global settings. To date, much of the social as well as biomedical research has treated the experience of illness and the challenges of disease control and management as segmented and episodic. Breaking new ground in medical anthropology by challenging the chronic/acute divide in illness and disease, the editors, along with a group of rising scholars and some of the most influential minds in the field, address the concept of chronicity, an idea used to explain individual and local life-worlds, question public health discourse, and consider the relationship between health and the globalizing forces that shape it.
Despite successes on the Sustainable Development Goals for access to improved water sources and s... more Despite successes on the Sustainable Development Goals for access to improved water sources and sanitation, many low and middle-income countries (LMICs) continue to struggle with high rates of diarrheal disease. In Guatemala, 98% of water sources are estimated to have E. coli contamination. This project moves toward a novel low-cost approach to bridge the gap between the microbiologic identification of E. coli and the vast impact that this pathogen has on human health within marginalized communities using co-designed community-based tools, low-cost technology, and AI. An agile co-design process was followed with water quality stakeholders, community staff, and local graphic design artists to develop a community water quality education mobile app. A series of alpha- and beta-testers completed interactive demonstration, feedback, and in-depth interview sessions. A microbiology lab in Guatemala developed and piloted field protocols with lay community workers to collect and process wate...
Technology provides the potential to empower frontline healthcare workers with low levels of trai... more Technology provides the potential to empower frontline healthcare workers with low levels of training and literacy, particularly in low-and middle-income countries. An obvious platform for achieving this aim is the smartphone, a low cost, almost ubiquitous device with good supply chain infrastructure and a general cultural acceptance for its use. In particular, the smartphone offers the opportunity to provide augmented or procedural information through active audiovisual aids to illiterate or untrained users, as described in this article. In this article, the process of refinement and iterative design of a smartphone application prototype to support perinatal surveillance in rural Guatemala for indigenous Maya lay midwives with low levels of literacy and technology exposure is described. Following on from a pilot to investigate the feasibility of this system, a two-year project to develop a robust in-field system was initiated, culminating in a randomized controlled trial of the sys...
I had the honour of being a member of the first class of MSc students in Medical Anthropology in ... more I had the honour of being a member of the first class of MSc students in Medical Anthropology in Oxford in 2001. During the MSc I became interested in the intersections of medical anthropology and public health, particularly in considering how medical anthropology theory can be operationalized to improve public health program evaluation. I went on to complete a PhD in Anthropology and a Master’s of Public Health in International Health from Boston University, where my research focused on the long-term impacts of oral rehydration therapy campaigns in highland Guatemala. I then spent a year working with Arthur Kleinman at Harvard University and, drawing on the foundational knowledge I gained from the MSc, became further interested in illness narratives. I conducted post-doctoral research on illness narratives through the Oxford Autopathographies Project, described here. I continue to investigate primary health care delivery in Guatemala and co-direct the NAPA-OT Field School in medica...
Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical mi... more Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical missions (STMMs) hosted by local non-governmental organizations (NGOs) and staffed by foreign visiting medical teams (VMTs). The purpose of this study was to explore the perspectives of individuals based in NGOs involved in the coordination of surgical missions to better understand how these missions articulate with the larger Guatemalan health care system. During the summers of 2011 and 2013, in-depth interviews were conducted with 25 representatives from 11 different Guatemalan NGOs with experience with surgical missions. Transcripts were analysed for major themes using an inductive qualitative data analysis process. NGOs made use of the formal health care system but were limited by several factors, including cost, issues of trust and current ministry of health policy. Participants viewed the government health care system as a potential resource and expressed a desire for more collaborat...
This statement arose from discussions during the Global Health Fieldwork Ethics Workshop held in ... more This statement arose from discussions during the Global Health Fieldwork Ethics Workshop held in Atlanta, Georgia, USA in April 2018, co-sponsored by Agnes Scott College, The Taskforce for Global Health, and Emory University Rollins School of Public Health. As participants from a wide range of academic and global health implementation organizations discussed ethics challenges in fieldwork settings, it became clear that gender-based violence was an issue of vast importance that has not been adequately considered for global health fieldworkers and participants. This statement highlights key themes on gender-based violence that emerged from our discussions and calls for further action.
VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations, 2017
Sharp increases in “child migrants” from Central America detained at the US border in 2014 brough... more Sharp increases in “child migrants” from Central America detained at the US border in 2014 brought unprecedented levels of attention to long extant social and political issues perceived as causing youth migration. While governments on both sides of the US border faced criticism over responses to the migration “crisis,” the presumed causes of this migration presented in US media discourses went largely unquestioned. This article presents data collected in June 2015 from in-depth interviews with Guatemalan and transnational non-governmental organization (NGO) staff, scholars, lawyers, and activists in order to understand the complex interpretations of child migration by NGO actors in Guatemala. Findings illustrate how NGOs may selectively draw on the power of prevailing media narratives to buttress ideological and programmatic goals while simultaneously contesting how the same media depictions obscure the lived realities of migrants. We consider the transnational information politics ...
In global health, we prioritize work where there is no doctor—often in remote and sometimes dange... more In global health, we prioritize work where there is no doctor—often in remote and sometimes dangerous places—and certainly where there is no #MeToo hashtag, no groundswell of activism to support women’s rights. In such contexts, women in the field face distinct challenges. Through sharing my own experiences, I hope to encourage open dialogue and action to address gender-based violence within global health.
As Paul Farmer has observed, “global health remains a collection of problems rather than a discip... more As Paul Farmer has observed, “global health remains a collection of problems rather than a discipline.”1 An exclusive focus on technical problems and the quest for solutions obscures how global health is actually enacted and implemented through fieldwork. In this special section, we consider “fieldwork” broadly to include any on-the-ground research or program design, implementation, or evaluation conducted by or with local participants and communities, which often involves collaborators from abroad. At the very heart of global health fieldwork, relationships—real-world connections among people and across institutions—give meaning to the goals and projects of this multidisciplinary field. Those relationships inspire us and compel us to act to reduce health inequalities and promote health and social justice. Yet, in working toward these goals, we must more fully consider the asymmetries embedded in global health practice—imbalances of power, access to resources, and decision making—ma...
As Paul Farmer has observed, “global health remains a collection of problems rather than a discip... more As Paul Farmer has observed, “global health remains a collection of problems rather than a discipline.”1 An exclusive focus on technical problems and the quest for solutions obscures how global health is actually enacted and implemented through fieldwork. In this special section, we consider “fieldwork” broadly to include any on-the-ground research or program design, implementation, or evaluation conducted by or with local participants and communities, which often involves collaborators from abroad. At the very heart of global health fieldwork, relationships—real-world connections among people and across institutions—give meaning to the goals and projects of this multidisciplinary field. Those relationships inspire us and compel us to act to reduce health inequalities and promote health and social justice. Yet, in working toward these goals, we must more fully consider the asymmetries embedded in global health practice—imbalances of power, access to resources, and decision making—ma...
Global health is an interdisciplinary field engaged with implementation of the human right to hea... more Global health is an interdisciplinary field engaged with implementation of the human right to health, yet ethical dimensions of the on-the-ground realities of this work have been underexplored. Fieldwork in global health produces knowledge through both primary research and the lessons of practical program implementation. Much of this essential knowledge, which often documents health disparities and other human rights abuses, arises from work in dangerous contexts. Work in such environments entails risk to all participants in the global health enterprise, both local and foreign, but affects them differently. The risks of ethical fieldwork must be considered not only for the well-being of project participants and fieldworkers but also in light of how they shape and constrain global health research and program implementation. Drawing on case examples from the authors' fieldwork, this article marks an effort to begin disentangling the realities of risks in the field and the responsi...
Journal of Health Informatics in Developing Countries, 2017
We present an investigation into the feasibility of implementing an electronic medical referral a... more We present an investigation into the feasibility of implementing an electronic medical referral application for short-term surgical missions in rural Guatemala, where the local infrastructure does not support the demand for the surgery. An electronic referral application was implemented for Android smartphones and tablets which allowed the input, aggregation, and secure transmission of patient information that is currently collected on paper forms during surgical missions. The user interface and SMS text message-to-database feature allowed case management data to be entered and transmitted in real time. The referral application was piloted over a 3-day period with a collaborating NGO during a short-term surgical mission in rural Guatemala and was compared to the current standard-of-care paper medical record. This study also assessed the cell phone access and use of community attendees to identify the potential for communication with patients in an integrated electronic referral syst...
Chronic Conditions, Fluid States explores the uneven impact of chronic illness and disability on ... more Chronic Conditions, Fluid States explores the uneven impact of chronic illness and disability on individuals, families, and communities in diverse local and global settings. To date, much of the social as well as biomedical research has treated the experience of illness and the challenges of disease control and management as segmented and episodic. Breaking new ground in medical anthropology by challenging the chronic/acute divide in illness and disease, the editors, along with a group of rising scholars and some of the most influential minds in the field, address the concept of chronicity, an idea used to explain individual and local life-worlds, question public health discourse, and consider the relationship between health and the globalizing forces that shape it.
Despite successes on the Sustainable Development Goals for access to improved water sources and s... more Despite successes on the Sustainable Development Goals for access to improved water sources and sanitation, many low and middle-income countries (LMICs) continue to struggle with high rates of diarrheal disease. In Guatemala, 98% of water sources are estimated to have E. coli contamination. This project moves toward a novel low-cost approach to bridge the gap between the microbiologic identification of E. coli and the vast impact that this pathogen has on human health within marginalized communities using co-designed community-based tools, low-cost technology, and AI. An agile co-design process was followed with water quality stakeholders, community staff, and local graphic design artists to develop a community water quality education mobile app. A series of alpha- and beta-testers completed interactive demonstration, feedback, and in-depth interview sessions. A microbiology lab in Guatemala developed and piloted field protocols with lay community workers to collect and process wate...
Technology provides the potential to empower frontline healthcare workers with low levels of trai... more Technology provides the potential to empower frontline healthcare workers with low levels of training and literacy, particularly in low-and middle-income countries. An obvious platform for achieving this aim is the smartphone, a low cost, almost ubiquitous device with good supply chain infrastructure and a general cultural acceptance for its use. In particular, the smartphone offers the opportunity to provide augmented or procedural information through active audiovisual aids to illiterate or untrained users, as described in this article. In this article, the process of refinement and iterative design of a smartphone application prototype to support perinatal surveillance in rural Guatemala for indigenous Maya lay midwives with low levels of literacy and technology exposure is described. Following on from a pilot to investigate the feasibility of this system, a two-year project to develop a robust in-field system was initiated, culminating in a randomized controlled trial of the sys...
I had the honour of being a member of the first class of MSc students in Medical Anthropology in ... more I had the honour of being a member of the first class of MSc students in Medical Anthropology in Oxford in 2001. During the MSc I became interested in the intersections of medical anthropology and public health, particularly in considering how medical anthropology theory can be operationalized to improve public health program evaluation. I went on to complete a PhD in Anthropology and a Master’s of Public Health in International Health from Boston University, where my research focused on the long-term impacts of oral rehydration therapy campaigns in highland Guatemala. I then spent a year working with Arthur Kleinman at Harvard University and, drawing on the foundational knowledge I gained from the MSc, became further interested in illness narratives. I conducted post-doctoral research on illness narratives through the Oxford Autopathographies Project, described here. I continue to investigate primary health care delivery in Guatemala and co-direct the NAPA-OT Field School in medica...
Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical mi... more Each year, thousands of Guatemalans receive non-emergent surgical care from short-term medical missions (STMMs) hosted by local non-governmental organizations (NGOs) and staffed by foreign visiting medical teams (VMTs). The purpose of this study was to explore the perspectives of individuals based in NGOs involved in the coordination of surgical missions to better understand how these missions articulate with the larger Guatemalan health care system. During the summers of 2011 and 2013, in-depth interviews were conducted with 25 representatives from 11 different Guatemalan NGOs with experience with surgical missions. Transcripts were analysed for major themes using an inductive qualitative data analysis process. NGOs made use of the formal health care system but were limited by several factors, including cost, issues of trust and current ministry of health policy. Participants viewed the government health care system as a potential resource and expressed a desire for more collaborat...
This statement arose from discussions during the Global Health Fieldwork Ethics Workshop held in ... more This statement arose from discussions during the Global Health Fieldwork Ethics Workshop held in Atlanta, Georgia, USA in April 2018, co-sponsored by Agnes Scott College, The Taskforce for Global Health, and Emory University Rollins School of Public Health. As participants from a wide range of academic and global health implementation organizations discussed ethics challenges in fieldwork settings, it became clear that gender-based violence was an issue of vast importance that has not been adequately considered for global health fieldworkers and participants. This statement highlights key themes on gender-based violence that emerged from our discussions and calls for further action.
VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations, 2017
Sharp increases in “child migrants” from Central America detained at the US border in 2014 brough... more Sharp increases in “child migrants” from Central America detained at the US border in 2014 brought unprecedented levels of attention to long extant social and political issues perceived as causing youth migration. While governments on both sides of the US border faced criticism over responses to the migration “crisis,” the presumed causes of this migration presented in US media discourses went largely unquestioned. This article presents data collected in June 2015 from in-depth interviews with Guatemalan and transnational non-governmental organization (NGO) staff, scholars, lawyers, and activists in order to understand the complex interpretations of child migration by NGO actors in Guatemala. Findings illustrate how NGOs may selectively draw on the power of prevailing media narratives to buttress ideological and programmatic goals while simultaneously contesting how the same media depictions obscure the lived realities of migrants. We consider the transnational information politics ...
In global health, we prioritize work where there is no doctor—often in remote and sometimes dange... more In global health, we prioritize work where there is no doctor—often in remote and sometimes dangerous places—and certainly where there is no #MeToo hashtag, no groundswell of activism to support women’s rights. In such contexts, women in the field face distinct challenges. Through sharing my own experiences, I hope to encourage open dialogue and action to address gender-based violence within global health.
As Paul Farmer has observed, “global health remains a collection of problems rather than a discip... more As Paul Farmer has observed, “global health remains a collection of problems rather than a discipline.”1 An exclusive focus on technical problems and the quest for solutions obscures how global health is actually enacted and implemented through fieldwork. In this special section, we consider “fieldwork” broadly to include any on-the-ground research or program design, implementation, or evaluation conducted by or with local participants and communities, which often involves collaborators from abroad. At the very heart of global health fieldwork, relationships—real-world connections among people and across institutions—give meaning to the goals and projects of this multidisciplinary field. Those relationships inspire us and compel us to act to reduce health inequalities and promote health and social justice. Yet, in working toward these goals, we must more fully consider the asymmetries embedded in global health practice—imbalances of power, access to resources, and decision making—ma...
As Paul Farmer has observed, “global health remains a collection of problems rather than a discip... more As Paul Farmer has observed, “global health remains a collection of problems rather than a discipline.”1 An exclusive focus on technical problems and the quest for solutions obscures how global health is actually enacted and implemented through fieldwork. In this special section, we consider “fieldwork” broadly to include any on-the-ground research or program design, implementation, or evaluation conducted by or with local participants and communities, which often involves collaborators from abroad. At the very heart of global health fieldwork, relationships—real-world connections among people and across institutions—give meaning to the goals and projects of this multidisciplinary field. Those relationships inspire us and compel us to act to reduce health inequalities and promote health and social justice. Yet, in working toward these goals, we must more fully consider the asymmetries embedded in global health practice—imbalances of power, access to resources, and decision making—ma...
Global health is an interdisciplinary field engaged with implementation of the human right to hea... more Global health is an interdisciplinary field engaged with implementation of the human right to health, yet ethical dimensions of the on-the-ground realities of this work have been underexplored. Fieldwork in global health produces knowledge through both primary research and the lessons of practical program implementation. Much of this essential knowledge, which often documents health disparities and other human rights abuses, arises from work in dangerous contexts. Work in such environments entails risk to all participants in the global health enterprise, both local and foreign, but affects them differently. The risks of ethical fieldwork must be considered not only for the well-being of project participants and fieldworkers but also in light of how they shape and constrain global health research and program implementation. Drawing on case examples from the authors' fieldwork, this article marks an effort to begin disentangling the realities of risks in the field and the responsi...
Journal of Health Informatics in Developing Countries, 2017
We present an investigation into the feasibility of implementing an electronic medical referral a... more We present an investigation into the feasibility of implementing an electronic medical referral application for short-term surgical missions in rural Guatemala, where the local infrastructure does not support the demand for the surgery. An electronic referral application was implemented for Android smartphones and tablets which allowed the input, aggregation, and secure transmission of patient information that is currently collected on paper forms during surgical missions. The user interface and SMS text message-to-database feature allowed case management data to be entered and transmitted in real time. The referral application was piloted over a 3-day period with a collaborating NGO during a short-term surgical mission in rural Guatemala and was compared to the current standard-of-care paper medical record. This study also assessed the cell phone access and use of community attendees to identify the potential for communication with patients in an integrated electronic referral syst...
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Papers by Rachel Hall-Clifford