Beyond the Pavement: The NAPA-OT Field School Completes Second Session in Guatemala

By Rachel Hall-Clifford
University of Oxford
Associate Director, NAPA OT Field School

The NAPA-OT Field School faculty is looking forward to our upcoming session to be held from July 18 through August 12, 2011. We have planned an exciting new core curriculum focused on health as a human right and social and occupational justice, and we will also offer small group research and practice experiences in: early childhood development, gerontology participatory action research, and NGO networks for health. We are accepting applications for our 2011 session through December 31, 2010. To learn more about our 2011 program and for information on how to apply, please visit us at

For six weeks in July and August this past summer, students and faculty from anthropology, occupational therapy, and related social science disciplines came together for the second session of the National Association for the Practice of Anthropology – Occupational Therapy (NAPA-OT) Field School in Guatemala. Based in Antigua, the program focused on the distribution of health care, social justice, and occupational justice in Guatemala. With our 28 students and 12 faculty evenly divided between social science and occupational therapy backgrounds, the field school facilitated transdisciplinary learning and collaboration. The opportunity to work outside the classroom and travel unpaved roads, both literally and figuratively, provides a unique route to a deeper understanding of applied anthropology and the cross-cultural practice of occupational therapy.

Our 2010 field school program offered students a focused learning experience through participation in one of the following components: disability studies, gerontology OT clinical practice, gerontology research, pediatric OT clinical practice, and medical anthropology. Within these components, students received hands-on mentorship from specialist faculty in research and clinical methods and explored the contextual and cultural factors unique to the Guatemalan field setting. All students and faculty participated in integrative seminars centered on small-group discussion of case studies illustrating health care delivery issues in Guatemala. Students also completed Spanish language instruction and lived with host families to increase their understanding of Guatemalan life and culture.

NAPA-OT Medical Anthropology students meet with curandera

The 2010 session marked the first time that medical anthropology was offered as a specific component of study at the field school. As the Instructor of that component, I had the exciting opportunity to explore applied medical anthropology and public health issues with students through direct observation in the field. The component included lectures, readings, and discussion on anthropological and public health topics critical for understanding health and health care in Guatemala, such as basic infectious disease epidemiology, the political economy of the global development system, embodiment theory, and Guatemalan ethnic identity politics. These discussions were then reinforced through guest lectures from Guatemalan and international NGOs and government agencies and through field visits to various health care delivery settings. Our weekly field visits quickly became known amongst the medical anthropology students as our “Friday Adventures,” during which we all looked forward to encountering new facets of health care and health-seeking in Guatemala.

One of our early “Friday Adventures” involved a winding drive up into the central highlands from Antigua to meet with a Kaqchikel Maya curandera, or traditional healer (Figure 1). With the assistance of an interpreter from Kaqchikel to Spanish, she spoke with us about her most commonly used treatments and showed us the garden in which she grows the plants integral to many of those treatments. Perhaps most memorably, she spoke about susto, or soul loss, and her method for rejoining the soul to the physical body. The students were able to ask questions of the curandera raised by our theoretical readings and discussions in medical syncretism and treatment evaluation, which brought to life how these theoretical concerns can be useful tools for understanding real world phenomena. Students were able to consider susto as a condition embedded in real life circumstances rather than as the exotic ephemera of textbooks. As we climbed back into our passenger van to return to Antigua, the students commented that they felt like “real” anthropologists. This was a sentiment echoed on each of our field visits where, yes, occasionally the pavement did literally end as we visited rural villages, health centers and hospitals, and health-focused NGO projects.

Another highlight of the medical anthropology component during our 2010 field school session was the opportunity to assist the Behrhorst Partners for Development, an NGO establishing rural community centers to promote health and nutrition education, in the development of an impact evaluation of their programs. Students worked together with the Guatemalan NGO staff to create survey instruments for community center promoters and participants, which the students subsequently piloted in two rural villages. They were then charged with the task of analyzing both quantitative and qualitative aspects of the pilot data and preparing a report for the Behrhorst Partners for Development to be utilized in planning programmatic changes and future impact evaluations. Not only was this activity an excellent vehicle for methods training, but it also allowed students to see how anthropological skills and concepts can be applied to help solve real challenges in health service delivery.

NAPA-OT Medical Anthropology students conduct a pilot focus group discussion.

Finally, medical anthropology students at the 2010 NAPA-OT Field School developed their own pilot research projects on health issues ranging from the distribution of nutritional supplementation through the Guatemalan primary health care infrastructure to the perceptions of mental illness amongst indigenous and non-indigenous Guatemalans. These projects enabled students to explore a topic of their own interest more deeply and allowed for direct mentorship in the development and implementation of field research methods, including in-depth interviewing and focus group discussion (Figure 2). The students put together presentations on their pilot research in which they were challenged to describe the importance of their specific research questions, their pilot research findings, and how these could be further understood through the application of a particular medical anthropology theory or concept.

I have highlighted the activities of the medical anthropology component in the 2010 NAPA-OT Field School, and the students and faculty involved in other components of the school also undertook a wide array of engaging research and practice activities. Across the field school, we all benefitted from the chance to query and confront health and social inequalities and to explore beyond where the paved route of classroom learning can take us.

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