THE POWER OF NARRATIVE AND LOCAL TRADITION IN INTERNATIONAL HEALTH DEVELOPMENT: REDUCING THE INCIDENCE OF MALARIA AMONG THREE VILLAGES IN SE ASIA

Ellen A. Herda¹⁺ --- Valerie G. Dzubur²

¹University of San Francisco, Contra Costa, San Pablo, CA, USA
² Samuel Merritt University, Harbord Drive Oakland, CA, USA

Keywords:Sustainable development, Anthropological research, Critical hermeneutics, Narrative, Social imagery, Malaria, SE Asia.

ARTICLE HISTORY: Received:6 December 2016 Revised:9 February 2017 Accepted:23 February 2017Published:16 March 2017

Contribution/ Originality:This study, one of very few, demonstrates the viability of critical hermeneutics as a foundation for research, planning and implementation in international development. In distinction to traditional development, it illustrates the creative power of narrative and social imaginary unleashed through conversations with local populations who fully participate in the development act.

1. INTRODUCTION

The United Nations’ reviewed results of their Millennium Development Goals (2000) project and reported (Millennium Development Goals Report, 2015) general success in reaching their eight goals. World Vision (2015) on whether or not the goals were met is entitled: “Were the Millennium Development Goals a success? Yes! Sort Of.” United Nations Secretary General, Ban Ki-moon, was cited in this same report saying that the “… MDGs helped to lift more than one billion people out of extreme poverty, to make inroads against hunger, to enable more girls to attend school than ever before and to protect our planet.” However, he continued with critical insight: “Yet for all the remarkable gains, I am keenly aware that inequalities persist and that progress has been uneven.” 

Many researchers, academics, and NGO’s agree that, in general, improvement among some of the eight goals has been seen over the last fifteen years, but considerably more progress is needed in the lives of the poor. The United Nations holds their fifteen-year project to be the ‘the most successful anti-poverty movement in history’ (MDGR, 2015). Others are less generous in their assessment and point out several problems with the United Nations’ efforts: it has become “dysfunctional” (Weiss, 2012) there is a lack of awareness on the part of the target population about what these development projects are created to do (Waigwa, 2016) and the nature of the evidence used in reaching development goals is scarred with power and politics and leads to incorrect results as does the reliance on the idea of incremental rather than transformational change (Burns and Worsely, 2016). Perhaps the most relevant criticism that supports our position is Jason Hickle’s insight. Hickle (2016) an anthropologist at the London School of Economics, points out the goals are dangerous because they lock the development agenda around a failing economic model. The economic models traditionally used in development, and the nature of understanding that humans change through transformation, and not on an incremental scale, show those of us working in international development that we are most likely at the edge of one paradigm and are looking for new ways to think and act in this field.  Now that sustainable development is in the forefront of most conversations, projects, and publications on how to change the narratives of the poor, we clearly recognize chaos and confusion in many areas. Moreover, we hear calls for a broader spectrum of assessment procedures to be used for both determining problems and how they should be alleviated, as well as involving the local people in the project designed to serve them. Most importantly, we see the need to follow different models in how we think about economic and social reality.

How we measure and determine progress cannot always rely on the results of large-scale data collection and analysis. For most developers who work on the ground with recipient populations, there are often problems with matching research results with the realities people face in everyday life. Two examples found in the literature exemplify the problem of serious misrepresentations with traditional ways of measuring whether or not goals are successfully reached. Célestin Monga, former chief economist of the World Bank and currently Chief Economist and Vice President of Economic Governance & Knowledge Management at the African Development Bank, pointed out the situation in Rwanda illustrating the inaccuracy of surveying the results of economic transformation programs (Devex, 2014). He notes: “Rwanda … scores very well by the metrics of the survey, but the reality is that there is a massive unemployment problem preventing true economic growth and poverty reduction in the country.” Another example is from Tanzania, which is even starker in its failure to represent what happened on the ground. To determine whether or not goals have been met calls for results, which, in turn, calls for measuring the right indicators. In the attempt to measure achievements in primary education, one of the most extensive surveys of Tanzanian children found that half of fourth grade students were not able to read at the second grade level (Uwezo.net, 2011).  Morisset and Wane (2012) argue that these results are far from believable. Adding to the ludicrous nature of this situation, just as these results were released, Tanzania won the Millennium Development Goal Award for Achievement in primary education. Large-scale data collection will remain in international development; it is not going anywhere, nor should it. However, there is a need for increased recognition of alternative forms of data collection and project implementation in trying to address the world’s most serious problems- changing the lives of the most poor by creating conditions wherein they can live with dignity.

The focus of the MDGs was to meet the set eight goals. The United Nations’ succeeding project, the Sustainable Development Goals (SDGs), now in its second year of another fifteen-years, also focuses on goals, seventeen in total, more than double the last number of development goals. The traditional object of meeting goals is, of course, an admirable purpose, and success has been noted. However, we argue for more culturally and socially centered purposes, than just meeting goals by traditional survey techniques or the use of big data. The reason for our position is that, at times, the only way to actually know if changes have taken place is to see them first hand over time and to hear these changes talked about in people’s own narratives. This approach reveals a different kind of data than those stored in terabytes or petabytes of information. There now is an increased awareness of the need for a broader spectrum of data collection processes both in terms of big data and various field based research approaches (e.g. (Herda, 1999;2010; Dzubur, 2007; Bhushan, 2013; Fahy and Rau, 2013; Burns and Worsely, 2016)) in international development.  For example, Burns and Worsely (2016) argue that assumptions of developers do not match social reality. Specifically, they write: “(n)ot understanding that social systems are characterized by complexity and non-linearity has resulted in major development failures.”  The majority of received research programs cannot yield a “meaningful understanding of how change happens.” There are many now writing in the field of economics and development who question the viability of the received, general approach to development research and implementation, be it with the United Nations projects or others (Moyo, 2009; Harmon and Williams, 2013; Easterly, 2014; Rifkin, 2015; Cimadamore et al., 2016; Milanović, 2016).  With the critical literature that abounds and from our own field research and work with vulnerable populations, those of us who are associated with development have a vantage point as never before, accompanied by a moral obligation to critically assess our projects, our philosophies and our ideas of what works, and why it works, as well as why it does not work.

The remainder of this article attempts to accomplish three purposes: point out the economic model, and its assumptions, that underpins the questions and approaches to research in the field of international development; discuss an alternative theory, an interpretive theory of change and action based on narrative and culture; and outline one example of the application of interpretive theory among three villages fighting a high incidence of malaria. The last section discusses considerations in the international development arena.

2. ECONOMICS AND SCIENTISTIC THINKING: PROBLEMATIC BASIS FOR DEVELOPMENT

Economic growth has been thought to be a critical key to successful development, often to the exclusion of understanding and capitalizing on the nature of human reflection and transformation. There were two primary reasons for this thinking: If the country were less poor, the people would be less poor and there would be the opportunity for development growth. A natural step was for the economist to come into the picture of remediating the situation of the poor.

Secondly, economics was considered the best of the social sciences because it could more closely emulate the natural sciences, through representational numerical valuations, and logical and algorithmic approaches to research and data display. As noted earlier (Herda, 2011):

…throughout past decades, approaches to international development have been primarily influenced by a reliance on the natural science paradigm. Survey, numbers, methods, and funding formulas have characterized such approaches. This approach toward ‘doing science’ in social science endeavors, such as international development, kept the idea of objectivity and logic at the helm of field research and application…

Whether the research framework is considered quantitative or qualitative, there is little difference in the nature of the data that undergird the platforms leading to program planning, funding, policy and development action. In both approaches toward attempting to improve the lot of the poor, there is still the same thinking that relies on an either/or division between the researcher or developer and the policy or program recipients. Reality in each paradigm, qualitative or quantitative, is understood from an epistemological perspective—in which information and knowledge reign, rather than from an ontological perspective where meaning and understanding are central to working with local participants in development projects.

Cultural differences come into play when one steps into the development scene. Our understanding of culture requires a complexity and dynamism that allow us to escape overly simple ordering principles and algorithms and yet still be able to carryout out our research and our practice with a focus. When using the economics paradigm, we center primarily on a set of technical principles.  We are learning that the act of development entails far more than an increase in per capita GNP, digging a well, or spraying pesticides on the crops.  Traditionally, the idea of economic growth has served as a marker of success. But increasingly we realize that there is much more to sustainable development than economic growth. Rist (2002) furthers this realization by asking a pointed question: “when will we learn that well-being does not come from growth?” Moreover, in the postwar period there has been an array of “grandiose plans and programs aimed at solving the problems of poverty, inequality, and economic underdevelopment. Despite the dedicated efforts of many people and the expenditure of huge sums of money the results have been disappointing” (Sharma, 2004). Sharma, a political economist, echoing economist (Easterly, 2001) writes (2004: 51) that in “this ‘elusive quest for growth,’ there have been a few unexpected achievements, and a great many failures.” Easterly (2014) in his recent book, “The Tyranny of Experts: Economists, Dictators, and the Forgotten Rights of the Poor,” insightfully critiques the conventional approach to economic development arguing that it is based on a “technical illusion” which is the idea that poverty is a “purely technical problem amenable to such technical solutions as fertilizers, antibiotics, or nutritional supplements.” He argues for recognizing and integrating the rights of the poor into our development schemes. Without a livelihood that celebrates a modicum of human rights, no one can become a full person who knows his or her identity, who knows how to imagine and to have aspirations for the future. Living in such a context gives little meaning to life.

3. INTERPRETIVE THEORY FOR CHANGE AND ACTION

Critical hermeneutics (critical interpretation) was chosen as the foundational framework for our village project because of basic principles in this intellectual tradition that intimately integrate theory and action and that follow an ontological rather than an epistemological direction. Theory drawn from Paul (Ricoeur, 1984;1992;1995) in addition to Dzubur (2007) and Herda (1999; 2007;2010) research protocol, provided the specific concepts that guided both research and development. Each of the three categories below were used to inform data collection and implementation, and contain both an intellectual construct and an inherent guide for action:

1. History: the history of the villagers is a living history; while it changes slowly, it is not static. It holds tradition, culture, and memories. When people retell their history, they tell it in light of the current times, their current lives. If the anthropologist knows the culture well, he or she can hear in the retelling of local stories the openings for new ways of understanding and doing.
2. Social imagination: our understanding of the power of imagination significantly changed when Kant introduced the idea of a productive imagination (rather than a reproduction of images), further developed by Ricoeur (1984) who argued that imagination is a constitutively social function based in language and conversation. Through research conversations, villagers and the researcher can imagine new ways of doing things (Dzubur, 2007; Herda, 2007;2010).
3. Fusion of Horizons: Each of us lives within a horizon of our understanding and experiences (Gadamer, 1988) when we come upon new ways through productive imagination, we fuse our old ways of understanding with the new. Unless people can see their old ways of doing things (that are part of one’s history and culture) in light of the new, innovation has little, if any, personal or social meaning. Without personal and social meaning, new actions will seldom take hold (Herda, 2012).

History, imagination, and a fusion of horizons provided the framework for holding research conversations the point of which was to figure out how to integrate the proper use of family nets in defense of mosquitos carrying malaria.

The offer of aid and development programs to the poor is not, in this article, heralded as a negative, even though some economists from poor regions claim that western help is nothing more than “Dead Aid” (Moyo, 2009).  However, many economists, developers and anthropologists bring into question the way we go about providing aid through our development programs. The point of how we think of social change and how we carry out the “development act” (Herda, 2010) influence how we design adult learning programs in the development context.  The received (traditional) pedagogy by which the adult learns anything new—farming, education, health, technology—assumes the learner is the receptacle that receives the new information and that, in turn, this new information has meaning in their lives. For the most part, it is the developer, researcher, evaluator, and anthropologist, often with good intensions, who feeds the poor new information without understanding how learning takes places in different cultures.  

Sustainable development does not take hold unless adults understand in their own meaning-making processes that which is introduced. Moreover, the introduction of anything new or different most often entails villagers seeing their own lives in new ways and in relationship with different others.  Furthermore, if the personal and collective narratives the villagers use to tell who they are do not cohere with the daily realities they face in development processes, there is no possibility for sustainability. It is at this point that the way in which an adult learning program is designed and carried out determines whether or not local people are integrated into a new way of life. The underpinning of adult learning is key to development in the sense that the question of how changes to the questions of who and why. The approach toward development in this article relies on a different theoretical framework than ones designed from traditional ideas of learning that follow an incremental mentality and a recipe model of learning.

The development act (Herda, 2011) in “different words—social change— comes about because people together bring forth a new world which contains enough of their present and past to retain the familiar while at the same time provides a safe cultural medium in which to risk a new future.” This act is interplay between the old and the new, between stability and innovation, between comfort and risk—a comfortable tension. This change process cannot be described as certain, logical or linear, but it does not escape reason. The reason is housed in a community of people who believe that something is better or more appropriate than the former state of affairs. This belief, or attestation, is fundamental to sustainable development because our identity is in part held together because of what we believe. If we do not believe in the new actions expected in the development act, they will not become part of everyday life.

3.1. The Project

The authors are anthropologists who work in development (Herda) and family nurse practice (Dzubur). We have used critical hermeneutic theory in our teaching, our research and our development practice over the past fifteen years. Our work primarily is in SE Asia among rural populations. The example for this article is taken from our  research and development work among the Ahka people group. The challenge among three villages was to reduce the incidence of Malaria which was the sixth Millennium Development Goals This report (MDG, 2015) on the sixth goal addressed malaria and other diseases. The part that pertains to our project reads as follows:

Over 6.2 million malaria deaths have been averted between 2000 and 2015, primarily of children under five years of age in sub-Saharan Africa. The global malaria incidence rate has fallen by an estimated 37 per cent     and the mortality rate by 58 per cent.
More than 900 million insecticide-treated mosquito nets were delivered to malaria-endemic countries in sub-Saharan Africa between 2004 and 2014.

Our work was not only to introduce the usage of malaria nets, but also to actually carry to fruition the actual everyday usage of them. We had brought dozens of malaria nets in previous visits to the village, explained how to use them, and thought we had done our job, but the men of the households rolled them up and used them as pillows. The incidence of malaria was extremely high and in addition to the extreme discomfort associated with this disease, the adults and older children were unable to tend to their fields. If they could not work in their fields, they had no food.  We wonder how many of the more than UN’s 900 million insecticide-treated mosquito nets were actually used on a daily basis in each family.

This project was designed to educate adults, who in turn, educated their children. Adults do not come to a learning activity with a clean slate, rather they carry their history and traditions into any development project which, if not understood and embraced, can be a hindrance to accepting new ideas and actions. Moreover, developers, while respected to a certain degree, do not have as much credence as does one of their own leaders. Leaders in traditional living settings do not long retain their position unless they are valued; hence, the leader is the best person to first educate, provided he (it is almost always a male) is committed to the value of the project and to teaching his villagers. The leader then can work with others, including women, but the village headman or leader most often should lead the beginning of the project. The villagers in the present case are non-literate who live in a traditional manner. Society in many traditional villages in remote areas of SE Asia has changed little in several generations.

We used the following process to engage the villagers, especially the village leaders, in the project implementation of using treated mosquito nets in their houses on a daily basis.

1. Observing and the establishing of friendship and trust over several visits.
2. Talking with the leaders of the villages to explain what our plan was: to introduce treated nets and the importance of their consistent usage.
3. Holding conversations with villagers about what life was like with so many people unable to function in daily life due to malaria. We asked them to imagine what their lives would be like without malaria. We listened to myriad stories and became familiar with their worldviews.

Initial conversations with both leaders and as many villagers as possible revealed their understanding that there was a dire need for changed actions in terms of preventing malaria. Further conversations unveiled a potential process for integrating new actions into the traditions of the villagers. These new actions only would fit if they could imagine these actions as part of their lives. As Dzubur (2007) writes: “Imagination is the wellspring of all human innovation. In order for something to be possible, it must first be imagined.”  The power of conversations cannot be overstated in generating the appropriate data needed in order plot out the best approach to addressing a challenging life condition, such as living with malaria.

Data in traditional development are represented most often through numerical valuations, such as the number of incidences of malaria in one or more villagers, or the dates of the onset of the disease in a particular area, or numerous other numerical facts. Data in our work are gathered through conversations and represented in texts, both written texts and “living texts” (Carey, 2007). This is the case because within the critical hermeneutic orientation, as Shahideh (2004) argues, language is event, not structure. This distinction, between event and structure, moves us out of an epistemological (knowledge) orientation to an ontological (being) orientation. In language, our imagination is at work. Structure cannot hold imagination. An event embraces movement, as in a conversation. A conversation—movement between two or more speakers —, rather than a survey, can generate freedom, a most critical requisite for imagination to take hold.

Our plan was to educate one or two families at a time, who would, in turn, tell other families about the importance of using malaria netting on a daily basis. When a majority of the adults started to understand the importance of the net usage, it was decided that we would hold a teaching ceremony whereby people would learn how to prepare and use the nets. Ceremony is an integral part of their history and social fabric and is important to help cohere ideas and meanings of actions. Time within a ceremony is a different phenomenon than time on a watch or even in seasons. It virtually stands still; other phenomena such as enjoyment, ritual, relationships, traditional clothing, singing, etc. are center stage. When people have to sit still and listen to instructions on how to prepare and use nets, time takes on meaning, which is found in boredom and often is thought of as being wasted.

Organization: The village leader selected several men and women to come up with a plan whereby there would be a ceremony dedicated to teaching adults how to prepare and use the nets. Acknowledgement of improper use of earlier distributed nets was the starting point of the conversation and subsequent plan. People taking part of this organization plan already understood the importance and necessity of taking action in view of the high incidence of malaria.

Ceremony: The day was anticipated with food preparation and traditional dress. Only working adults would participate with children and elderly looking on. The ceremony entailed story-telling of the relation between the mosquito and sickness; the dipping of the polyethylene nets into a permethrin emulsifiable concentrate to strengthen their protective power; a demonstration of net drying and hanging over the family bed. Each family head came forth to the demonstration table to take part in this ceremony. The day ended with food, games, and traditional dancing and singing.

Assessing the Incidence of Malaria: Six months later, we assessed the number of households that reported cases of malaria. There was approximately a 40-50 percent reduction of people contracting malaria. This information was derived from informal conversations with families. Most people understood what caused malaria outbreaks. In recent conversations with the village leaders, the incidence of malaria has continued to fall. Nets are still used.

The village leader and later other leaders who emerged naturally during the project were the primary actors in listening to stories of malaria and how to prevent outbreaks. They were highly cognizant of the difficulty of teaching the proper use of nets because there was nothing visible in the connection between a mosquito bite and later illness. Once they came to understand, through a fusion of horizons, the way malaria is transmitted, they thought of the idea of a ceremony. Their own history was filled with ceremonies, each one for a specific purpose. They imagined a ceremony with the specific purpose of placing a teaching ritual within the existing cultural medium of the villagers. In imagining this ceremony and all its accompanying procedures and decorum, it turned into a concrete plan that represented a constitutively social function based in conversation and community action. The ceremony is repeated about twice a year. The villagers have begun to embrace a new tradition that found a place in their culture, which, in turn, leads to a healthier society, giving them a sense not only of their past but also of their future. One of the signatures of this project is seeing village people work in their fields. We wait to see what the next step is for this resilient group of people. As Dzubur (2012) notes, it is “a community on the way.” They conquered one serious challenge, we have confidence they can overcome others, such as improving the education in their villages.

4. CONSIDERATIONS

It is important to consider the lack of fit often noted between the traditional development plan and the realization of the development project. The earlier efforts to bring mosquito nets that ended up being used as pillows starkly displayed a lack of fit between a well-intentioned plan with the inappropriate, if not innovative, results on the part of the men of the families. Traditions, culture, a local community’s sense of time and work and a proposed world of health, for example, were disclosed through the narratives of the villagers. In asking to hear their story about their health and work challenges and hopes for their families, we saw an order in what was narrated- an order that would be missing in simply asking specific questions about need or implementation suggestions. Ricoeur (1995) writes, “…narration preserves the meaning that is behind us so that we can have meaning before us. There is always more order in what we narrate than in what we have actually already lived…” The nature of this order is an example of the “creative power of narrative.” At the point the story was told, both the villagers and the foreigners saw the possibility of inhabiting a world different than the old—living in a world that reduces incidences of malaria. The story was both revealing and binding. Certain aspects were brought forth while other aspects remained hidden.

The significance of the power of story lies in the fact that while revealing and binding on one hand, narrative opens the door for the new through imagination or the retelling, allowing the hidden to come forth. The plot is key to arranging the events into an order that makes sense to the teller and the listener.  When the development plot includes aspects of what the traditional life entails, such as ceremony, it has more meaning. If it does not make sense, people recognize this and so there is no pull or force of a better argument – it is not convincing.  We are reminded of Waigwa (2016) insight that a lack of understanding on the part of the local people does not provide meaning to the development project. Specifically, Waigwa (2016) in consideration of the viability of the SDGs, warns that leadership is critical to the implementation of these Goals; the projects leaders need to take the responsibility to inform the project recipients and to create conditions in which they participate in the development action. Otherwise, as Waigwa cautions, the development efforts result in only an uphill and futile task. Informing the project recipients, of course, is critical but even as important is participation. Through active participation the recipients understand the purpose and bring their own meaning to the development action. This can result in ownership of the project on the part of both the project leaders and recipients.

Waigwa, a Kenyan, points out that many Kenyans who were supposed to be helped by the MDGs had never heard of these goals at the end of the 15 year project. Nor did they have any idea that they were recipients of any development efforts. We need to consider whether a project that is without out meaning, or is not convincing to the local people, is worth trying to implement in terms of both time and expenditure.

Our health project required time, certainly as the westerner sees time, and an informed interpretive stance toward development. The survey, undoubtedly, is quicker but there are times when only taking the time to inform people, holding conversations and listening to stories bring forth the requisite understanding needed on the part of both the developer and the recipients to create and implement a workable plan. If we are serious about the tyranny of poverty, we need to consider changing some of our ways of going about development.

Development traditionally has rested on assumptions that are scientistic in nature. Moreover, traditional development has been informed by standards reflected in economic growth, globalization, and ideas about modernity, and validated by western concepts of science and time.  In addressing the MDGs specifically, Hulme and James (2010) write that the Goals are guidelines whose aims are to be achieved by the rich or developed countries with little input from developing countries:

What is striking is that this was a process that was led by rich countries with comparatively little involvement of the lower and middle-income countries that are the main subject of the MDGs. The developing countries’ only major input was to ensure that there was a goal related to what the developed countries should do.

Moreover, with the current SDG’s in place, there is continuing criticism related to the relationship between the rich and the poor. Even if the move has been from human development to sustainable development, many of the same problems remain mired in the plans and implementation of the goals.  For example, as Sengupta (2016) who argues the SDGs are an improvement over the MDGs, points out, there is a lack of “… any real determination to tackle the root causes of poverty and unequal relations of power, either nationally or globally.” We argue that to hone in on the root causes of any sociocultural problem, the researcher and developer need to use data collection processes that underscore the values, understanding and narratives of the local people who are expected to play a significant part in the development act.  Such data cannot be collected merely by surveys or second hand reports provided to the authors of the SDGs sitting around a table determining what is best for the poor. Sengupta rightly points out the need for developers to meet the “…challenge of improving the data collection capacities of developing countries…” When the local population feels engaged in collecting, interpreting and providing needed data in order to design a workable project, a sense of ownership is established and provides a bedrock for local critique, questioning, and partnership with the developer and researcher. In using the interpretive orientation to collect data, design and implement a program, anonymity and objectivity are not the valued indicators they are in traditional social research. In this orientation, the art of inquiry housed in conversations with the local people provides a critical road to understanding the root causes of the very problems we seek to eradicate. 

It is time we consider what is worth keeping from the traditionally economic-based paradigm and move beyond it to include more than one primary development focus in our efforts to alleviate the conditions of the poor.  A sense of identity, culture, tradition, and imagination are part of who we are, developers, researchers, planners, or recipients alike. These aspects of the human being are critical in understanding how best to work with vulnerable, or any, populations. Such development concepts derive from a critical hermeneutic orientation toward both theory and practice. Within this orientation, development policy is highly flexible and attempts to match the real world rather than be based on a set of standards by which people would be measured, and most often, by others far different than they are.  The most important implication deriving from an interpretive development orientation resides in the very nature of human beings. Andretta (2005) acknowledges that, “[h]umans are the only beings capable of distancing themselves form their experiences and thus capable of raising questions about their being in the world.”  Questions open up possibilities. Our, often the foreigner’s or outsider’s, questions and their, the local’s, answers are not the imperatives requisite for sustainable development. Consider, rather, that it is their questions to themselves and to us, as well as their answers that open up ways to work together to bring a unifying preamble into place in the name of the development act.

Notes

1. Ellen A. Herda, PhD, Professor Emerita, University of San Francisco, is a development anthropologist whose fieldwork, teaching and project implementation and assessment are from a critical hermeneutic perspective. Areas of research and practice include SE Asia and Uganda.
2. Valerie G. Dzubur, EdD, Associate Professor, Samuel Merritt University, teaches in the Family Nurse Practitioner program. Her research interests include healthcare for fragile populations, anthropological field research in SE Asia, and program development that focuses on identity and responsibility.

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