May 28, 2008

What do they know?

During our mission training, we talked a lot about “isomorphic attribution.” Basically, the idea is that when you are working in another culture and you’re trying to figure out why somebody is doing something, you assess their motives in terms of their own cultural background instead of yours.

In some instances, this is easy. Why do Xhosa men head off into the bush for a month before getting circumcised in a public ceremony instead of just ducking into the hospital for a quick surgery (done with the benefit of anesthesia)? It’s likely because they understand circumcision as part of their journey to manhood and their culture dictates that they prepare for it in a certain way.

But there’s a crucial part of isomorphic attribution that is actually quite difficult. And that is figuring out just what beliefs and traditions the other person is carrying inside of them that dictate their behaviour. It is impossible for me to separate my decision-making process from my years of education, specifically what those years taught me about logic, probability, science, and on and on and on. But when you work with a community of people who are very poor and relatively uneducated, I’ve realized I can’t assume my decision-making processes apply to them as well.

When I was a baby my parents made sure I went to a doctor and got all my required immunizations. No doubt they did this because they had been raised with the belief that they should do what doctors told them and they cared deeply about my health. But some mothers here are downright casual and cavalier about making sure their babies get their immunizations on time. (Many, however, have the same devotion and seriousness of purpose about immunizations that I am sure my parents had.) To a western-educated mind, this is completely irrational. These mothers are turning down a free immunization that will go a long way towards guaranteeing the health of their baby and this in a place where lots of the diseases these immunizations guard against, like polio or measles, are still a credible risk. Why would anyone do this?

There are many answers to this particular question, I think, and it’s figuring out all those answers that makes cross-cultural work so difficult (and fascinating). Some caregivers actually aren’t mothers at all but grandmothers, aunts, cousins, etc. on whom the child has been dumped by the mother. In that case, the child might just be one more problem to be managed and taking preventative steps might just be too much of a demand on a woman already overstretched by other commitments. Or the mother may just not have the same belief that we westerners do in science and medicine. (I saw an article in a magazine not long ago that claimed to link the polio vaccine to HIV. The scary thing is not the claim itself but that people will believe it.) They might believe some of their medical problems can be solved by traditional healers.

I think this question of “just what do they know?” is particularly important when it comes to HIV. I hear about people with multiple sexual partners, who don’t use condoms, who let STDs go untreated, who refuse to get tested for HIV, who, if they are positive, don’t bother to try to get ARVs and don’t do all the little things that will strengthen their health. And I ask myself, “Why on earth would someone ever act like that in a place where HIV is so widely prevalent?” It is, by my standards, completely irrational and inexplicable.

And yet I believe all people make rational decisions within the confines of what they know to be true. Perhaps some men see condoms as an insult to their manhood or a sign that women don’t truly love them. Perhaps people don’t see the connection between STDs and the ease with which HIV can spread. Perhaps people are just too scared too find out if they have a life-altering virus and would rather not know than know. Perhaps they don’t realize that HIV can, in many instances, be managed and is not an immediate death knell.

The challenge, then, is sussing out all these different beliefs and attitudes that are deeply enmeshed in a person’s brain and that lead them to rationally make irrational decisions. It is a difficult task and a difficult adjustment, not helped by a gargantuan language barrier. But I’ve learned that asking someone, “Have you been tested for HIV?” really doesn’t get you very far. No one wants to talk about this and everyone would prefer to just change the subject. A better way, if you can get on to the topic of HIV in the first place, is to ask why they don’t use condoms or talk about all the treatments available for HIV now and how people can live quite long with the virus if only they find out early.

The dominant approach to HIV prevention used by aid agencies around the globe is the ABC method: abstain, be faithful to one partner if you don’t abstain, use condoms if you’re not faithful. It is completely rational and easily understood…in the Western context in which it was created. But in another culture? Maybe not. How can I abstain when I’m being raped? How can I be faithful when my partner isn’t? Why would I only want one partner when more would be a sign of my status? How can I use condoms when he refuses to? Why would I use condoms when I believe HIV has been put in them to kill Africans? I have heard it said - and I think I mostly agree - that combatting HIV in sub-Saharan Africa is as much or more a cultural battle as an educational one.

So, anyway, isomorphic attribution… easier said than done. What else is new about mission?


Judi (JAZ) said...

Hey there, Jesse--I appreciate your thoughts and comments about isomorphic attribution, and the depth and perspective you bring to your experience in Itipini. Interesting that you should raise the question of vaccines and why on earth a mother/caregiver wouldn't take the chance to immunize a child she is responsible for...TIME mag this week addresses the issue of American parents who don't want their kids vaccinated. Not sure if this link will attach, but see,8599,1808438,00.html for more.