Rachel Hall-Clifford - Academia.edu (original) (raw)

Papers by Rachel Hall-Clifford

UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive collection of dissert... more UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive collection of dissertations and theses. Learn more... ProQuest, Oral rehydration therapy in highland Guatemala: Long-term impacts of public health intervention on the self. ...

Journal of the Anthropological Society of Oxford, 2015

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...

Health and Human Rights: An International Journal, 2019

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. Gender-based violence in an evidence-based field Global health aspires to be evidence-based, yet a lack of data on gender-based violence among fieldworkers hinders our ability to address it comprehensively within our institutions and protocols. Here, I offer two personal fieldwork experiences as small data points of this vast but unmeasured phenomenon. My experiences are limited and privileged by virtue of my education, ethnicity, and status as a foreigner in the Guatemalan field site where I have worked for nearly 15 years. So many women contribute to global health in important and varied ways-as community partners, local staff, and international researchers and facilitators-but I can only speak to my own experiences in hopes that others will add theirs. I acknowledge that sharing details of sexual assault can re-inscribe a narrative of women as sexual objects, but I believe we must not obscure the "hard facts of corporeality" in fieldwork. 1 This first incident took place when I was a doctoral student, and the second occurred nearly ten years later when I was working as a principal investigator on a large research grant. Soon after moving in with a Guatemalan family in an urban area, it became clear that I would have to arrange research activities and outings during daylight hours. They warned me that the streets were not safe after dark, and that I should not be seen out at night. Months later, I was walking home in the early evening with the daughter of the household, married and in her mid-20s like myself at the time, after an afternoon spent running errands together and chatting with other neighborhood women. We sped up to get past men gathered outside the small shop on the corner of our street. It was not my first encounter with men on street corners, who often catcalled me as I passed in the daytime: "hello, Barbie" and "come here, baby. " My body had learned the geography of the street,

Teaching Anthropology, 2013

The NAPA-OT Field School in Guatemala is a transdisciplinary, applied medical anthropology field ... more The NAPA-OT Field School in Guatemala is a transdisciplinary, applied medical anthropology field school program that puts students from anthropology and occupational therapy in a common framework focused on human rights issues. This paper by the co-directors of the field school will highlight the situated learning-by- doing strategy that underpins the NAPA-OT program and critically examine the benefits and challenges that arise for both students and the host community. Within the context of post-civil war Guatemala, field school students learn ethnographic methods by contributing to applied projects advancing health as a human right; however, the field school must confront critical issues in maintaining student safety to enable effective learning in a sometimes volatile setting. Local collaborators, in turn, are able to build research capacity and utilize the social capital of outsiders to advance local development projects. For example, field school students have examined inequalit...

Bethesda, MD: Partners for Health …, 2004

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.

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...

Revista Panamericana de Salud Pública, Apr 20, 2017

Diarrhea remains a leading cause of morbidity and mortality for children in low- and middle-incom... more Diarrhea remains a leading cause of morbidity and mortality for children in low- and middle-income countries throughout the Americas. The World Health Organization (WHO) has developed guidelines on incorporating zinc supplementation (ZS) with traditional oral rehydration therapy (ORT) in order to shorten the duration of diarrheal episodes and to reduce poor health outcomes. Guatemala adopted these guidelines in 2011, but they have not yet been fully implemented at the community level. The objectives of this study were: (1) to co-design an ORT/ZS training program for community members with local health promoters that is appropriate to the local context and (2) to understand how attitudes and behaviors of community members changed after receiving training from the study promoters. In an observational study, community health promoters in rural Guatemala were trained according to WHO guidelines, and they worked collaboratively with the study team to develop a training curriculum to impl...

Health and Human Rights, 2019

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.

Chronic Conditions, Fluid States

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 ...

Journal of health informatics in developing countries, 2017

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 sy...

Health and Human Rights, 2019

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...

Health and Human Rights, 2019

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...

Health and Human Rights, 2019

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 responsibili...

Health and Human Rights, 2019

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...

UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive collection of dissert... more UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive collection of dissertations and theses. Learn more... ProQuest, Oral rehydration therapy in highland Guatemala: Long-term impacts of public health intervention on the self. ...

Journal of the Anthropological Society of Oxford, 2015

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...

Health and Human Rights: An International Journal, 2019

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. Gender-based violence in an evidence-based field Global health aspires to be evidence-based, yet a lack of data on gender-based violence among fieldworkers hinders our ability to address it comprehensively within our institutions and protocols. Here, I offer two personal fieldwork experiences as small data points of this vast but unmeasured phenomenon. My experiences are limited and privileged by virtue of my education, ethnicity, and status as a foreigner in the Guatemalan field site where I have worked for nearly 15 years. So many women contribute to global health in important and varied ways-as community partners, local staff, and international researchers and facilitators-but I can only speak to my own experiences in hopes that others will add theirs. I acknowledge that sharing details of sexual assault can re-inscribe a narrative of women as sexual objects, but I believe we must not obscure the "hard facts of corporeality" in fieldwork. 1 This first incident took place when I was a doctoral student, and the second occurred nearly ten years later when I was working as a principal investigator on a large research grant. Soon after moving in with a Guatemalan family in an urban area, it became clear that I would have to arrange research activities and outings during daylight hours. They warned me that the streets were not safe after dark, and that I should not be seen out at night. Months later, I was walking home in the early evening with the daughter of the household, married and in her mid-20s like myself at the time, after an afternoon spent running errands together and chatting with other neighborhood women. We sped up to get past men gathered outside the small shop on the corner of our street. It was not my first encounter with men on street corners, who often catcalled me as I passed in the daytime: "hello, Barbie" and "come here, baby. " My body had learned the geography of the street,

Teaching Anthropology, 2013

The NAPA-OT Field School in Guatemala is a transdisciplinary, applied medical anthropology field ... more The NAPA-OT Field School in Guatemala is a transdisciplinary, applied medical anthropology field school program that puts students from anthropology and occupational therapy in a common framework focused on human rights issues. This paper by the co-directors of the field school will highlight the situated learning-by- doing strategy that underpins the NAPA-OT program and critically examine the benefits and challenges that arise for both students and the host community. Within the context of post-civil war Guatemala, field school students learn ethnographic methods by contributing to applied projects advancing health as a human right; however, the field school must confront critical issues in maintaining student safety to enable effective learning in a sometimes volatile setting. Local collaborators, in turn, are able to build research capacity and utilize the social capital of outsiders to advance local development projects. For example, field school students have examined inequalit...

Bethesda, MD: Partners for Health …, 2004

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.

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...

Revista Panamericana de Salud Pública, Apr 20, 2017

Diarrhea remains a leading cause of morbidity and mortality for children in low- and middle-incom... more Diarrhea remains a leading cause of morbidity and mortality for children in low- and middle-income countries throughout the Americas. The World Health Organization (WHO) has developed guidelines on incorporating zinc supplementation (ZS) with traditional oral rehydration therapy (ORT) in order to shorten the duration of diarrheal episodes and to reduce poor health outcomes. Guatemala adopted these guidelines in 2011, but they have not yet been fully implemented at the community level. The objectives of this study were: (1) to co-design an ORT/ZS training program for community members with local health promoters that is appropriate to the local context and (2) to understand how attitudes and behaviors of community members changed after receiving training from the study promoters. In an observational study, community health promoters in rural Guatemala were trained according to WHO guidelines, and they worked collaboratively with the study team to develop a training curriculum to impl...

Health and Human Rights, 2019

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.

Chronic Conditions, Fluid States

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 ...

Journal of health informatics in developing countries, 2017

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 sy...

Health and Human Rights, 2019

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...

Health and Human Rights, 2019

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...

Health and Human Rights, 2019

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 responsibili...

Health and Human Rights, 2019

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...