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Research Abstract

Land, People and Environment

• Constanza: Poisoned Paradise

The Problem

• The Politics of Pesticides

• "Silent Spring" in Constanza

• Culture and Illness: The Pesticide Curse

The Research

• Literature Review

• Research Objectives

• Contribution to Research

• Research Methods/Design

Data Analysis

• Biogeophysical Data Analysis

• Health Survey

• Anthropological Data Analysis

• Buffer Analysis

• Conclusion

Geo-Cultural Visual Tour

• Research Photos

• Space, Place and Environmental Contamination

• Environment and Geography

• Patrimonio Nacional Cultural Dominicano

About Me and My Reserach Interests

• CV / Resume

• Abstracts

• Creating a Taino Identity

• Creando un Identidad Taina

• Favorite Links

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So far, in this analysis, human behavioral factors in pesticide exposure have been linked to specific activities at work, school and home. These activities are seen as potential risk factors that can increase the potential of exposure. However, there are culturally prescribed beliefs and perceptions that can influence the outcome of an adverse health event caused by pesticide exposure.

The purpose of this section is to present the cultural data as they were recorded, while trying to establish therein possible relationships between health and biogeophysical variables. Cultural data discussed are the key data which could explain differential attitudes, perceptions, beliefs and behaviors between lesser and greater pesticide exposure groups. This part of the data analysis, together with the rest of this section, should stimulate the reader to look at the data holistically and to understand how anthropological (cultural), biogeophysical and epidemiological data relate to pesticide exposure.

Of particular importance to the research is how cultural beliefs and perceptions regarding disease and illness influence the kinds of healing treatments people seek, how they narrate or interpret their ill health experiences; and how cultural interpretations of symptoms, many of which are associated with pesticide exposure, are attributed to supernatural forces, and the health repercussions of such beliefs and perceptions.

Identifying Cultural Beliefs and Perceptions Regarding Adverse Health Events Associated with Pesticide Exposure

There was a major difference among participants in the four communities regarding the types of healing treatments they opted for during an adverse health event. In most cases, the adverse health advent was attributed to supernatural forces, which was beyond the person’s control. Illnesses and symptoms, which had similar pesticide exposure etiologies, were blamed on evil spirits sent by revengeful neighbors, jealous mates and lovers.

To cope with the evil spirits, participants would seek the help of curanderas, espiritistas, santeros and vudu priests to remove the evil spell (Table 1). Table 1 shows that the preferred folk healing method for removing such spells was espiritismo or spiritualism. The popularity of the espiritista (spiritualist) can be directly related to the connection between this folk healing method and the Catholic Church. Although the Catholic Church shuns espiritismo, it is practiced by the majority of those that participated in the study (N=34).

Table 1          Folk Healing Types Used by Health Survey Participants

Table 2 addresses the issue of how survey participants perceived folk healing and biomedicine, especially under the potential health risks posed by pesticides. Survey participants who frequent folk healers (N=67), were asked if they visited a biomedical professional if the folk healer was unable to cure their illness or relieve their symptoms. The majority (N=40) said that if the folk healer is unable to cure them they would see a biomedical professional.

Table 2     Number of Health Survey Participants  that Visit Folk Healers and Biomedical Caregivers

There are several reasons that may explain why community members seek folk healers, apart from cultural ones, rather than biomedical caregivers. Given the lack of health care facilities and the poverty level of the rural communities, the assumption is made that community members consult folk healers on health matters because they are inexpensive and accessible to all community members.

Folk Healing Survey, 2000

The folk healing survey was conducted using semi-structured interviews, which included asking questions, listening to and recording the answers in a computer database, and then posing additional questions to clarify or expand on a particular symptom or illness. Questions were open-ended and respondents were encouraged to express their own beliefs and perceptions about their symptoms, illness and the types of treatments and cures they used, in their own words.

A list of interview questions guided the survey to ensure that the same information was obtained from the 67 respondents. Respondents were selected using two methods: key informants identified community members that consult folk healers and randomly asking community members. Breakdown of respondents by community was as follow: 24 from Tireo-El Café, 27 from Colonia Kennedy, 11 from La Hortaliza and 5 from El Gajo-Barrio Lindo. The distribution of responses is summarized in Table 3.

Table 3          Number of Respondents Who Visit Folk Healers by  Community

The survey began by asking respondents what their symptoms were; what they thought was the cause(s) of their symptoms or illness; how they alleviate the symptoms or cure the illness; what types of medical and traditional healing alternatives they seek for alleviating the symptoms or curing the illness; and what they hoped to achieve by consulting or seeking folk healers. Certain responses that were not clear were pursued in greater depth.

It should be noted that the same traditional practices could be used to achieve different outcomes, depending on the intent of the believer. The individual, either alone or in consultation with an adviser, determines the course of action to follow to achieve a desired result. For example, two respondents (husband and wife) from Tireo described maintaining frequent contact with their santero in Jarabacoa, who recommended ways of achieving relief from their illness. The husband, a farm worker, reported   symptoms that included vomiting, nausea and headaches, which had persisted for months. The santero recommended that he light candles, take baths with special herbs, and wear a special necklace to protect him from witchcraft. The santero also 'worked' on his client’s wife who was complaining of the same symptoms. The wife believed that a jealous neighbor caused the illness by placing a brujo (curse) on them. The couple had purchased a new pasola (motor scooter), which the wife said was the reason her neighbor cursed her – she was envious of the new acquisition. The santero gave the couple a pouch containing an amulet, to be placed on the motor scooter to prevent accidents or other misfortunes.

The most common reason for consulting folk healers was to attain relief from symptoms and illness, which were caused by “supernatural” forces; over 75 percent of community members from Tireo and Colonia Kennedy, that consulted folk healers, said that they were seeking symptom relief of some kind. The 67 (Table 4) respondents said they visited folk healers for the following types of symptom- illness relief (some gave more than one answer): respiratory complaints (N=25; e.g., bronchitis, asthma, gripe, and flu); gastrointestinal illness (N=9; e.g., nausea, vomiting, constipation); headaches (N=15; e.g. pain); mental distress (N=10; e.g., depression, suicidal thoughts, nervousness, anxiety); dermal (N=8; e.g., open sores, rash, itching). Table 5 shows that respondents believed their symptoms and illness were caused by: neighbor’s curse (18); friend’s curse (9); relative’s curse (4); jealous mates’ spell (2); punishment from God (1); did not know (23); multiple reasons (10). All respondents expressed that they wanted to 'clean their bodies’ or 'get rid of the evil spirit.”  Only one of the respondents reported that God had punished her for her behavior.

Table 4          Count of Respondents Seeking Symptom- Illness Relief

Source: Folk Healing Survey 2000

Table 5          Count of Respondents Giving Causes for their Symptoms and Illness.

Source: Folk Healing Survey 2000

Respondents associated certain symptoms with certain folk-illnesses: gastrointestinal complaints were associated with empacho and bilis, and evil eye; mental distress was associated with an embrujo (bewitched by a jealous wife or mate, evil eye, and ataque de nervios; respiratory conditions were associated with pasmo, sereno, susto, and ataque de nervios; headaches were associated with ataque de nervios, bilis, susto, sereno, and pasmo.

Examination of open-ended responses revealed that many participants truly believed that their rituals could result in symptom and illness improvement. For example, one woman described how using a coconut would collect and encapsulate evil spirits while she is sleeping: “I say a few words before the ritual, then in the morning I bury the coconut far from my house…my asthma went away.” Another woman described how she was “dead for twenty-one days in a coma and my boyfriend revived me with a chicken. He cleaned me by rubbing the chicken all over my body and then killing the chicken and the evil inside.”

Over half of the respondents that consult folk healers said they were seeking symptom and illness relief, including relief from constant headaches, vomiting, nausea, mental confusion and more serious illnesses such as asthma, liver disease and skin lesions. For example, many respondents took herbal baths of flowers once a week when the symptoms became “unbearable”; the baths “take the pain away...they give [me] better health”, one of the respondents stated. Others used candles, incense, special herbs or lotions, or other remedies to enhance their spiritual or psychological well-being.

One woman described a nightly ritual; “I rub oil on my stomach and head and recite a special prayer while I visualize destroying all the evil in my stomach and head and chasing them away.” Another stated, “I'm not letting my enemy get me without a fight. I'm going to clean my spirit with banos until I destroy what they sent me.”

About 25 percent of respondents said they hoped to ward off evil through the rituals and other practices. In all four communities, the most common means of doing this was to place a glass of water outside the house to 'take evil spirits out of the environment'; the water is thought to absorb the evil spirits, and is then thrown on grass, which absorbs and destroys them. In Colonia Kennedy, some of respondents use coconuts, which they leave over night on the floor to gather negative forces. In the morning, the coconut is rubbed with a white chalk-like substance, doused with alcohol and burned.

Other ways of warding off evil spirits include cleaning the house with clorox, which is thought to 'remove bad influences', and result in a 'more purified house.’ They believe that evil spirits do not like to live in clean houses. Special oils or lotions and incense were also used to keep evil spirits away. Less common, respondents hoped that folk healing would help them make a life change (e.g. move to Santiago or the capital city or change their situation), promote general well-being (e.g. get through the day), prolong life (e.g. live more years or wait for a cure) or get advice.

In sum, many of the health survey participants in the study exhibited an active belief in the influence of the spirit world on their physical and emotional well-being, and nearly 45 percent reported engaging in folk healing to manage their illness. Surprisingly, involvement in folk medicine was greater among individuals who self-reported severe symptoms and illnesses, suggesting that in the absence of effective biomedical treatment, individuals fall back on culturally appropriate alternatives to manage and alleviate symptoms and illness. This can have serious medical repercussions given that proper medical intervention is delayed.

Burial Survey

Four cementerios or cemeteries (Tireo, Constanza Rural / Town, Japanese, Spanish) were visited and their respective sepulteros or gravediggers were interviewed at different times during the 1999 and 2001-2002 field surveys (See Table 6). The gravediggers provided valuable information on deaths (N=88) that they believe were caused by pesticides. In the study region, the gravediggers have built a social network that extends to various communities throughout the region. They are in the market of death, visiting families of the sick and dying to make arrangements for sepultura or burial. The gravedigger’s visit and talk with the sick or dying person and are able to observe their symptoms. They are usually present until the end stage, to secure the burial contract.

Table 6    Burial Survey Results

Source:  Burial Survey 1999, 2001-2002

During the velorio or funeral bereavement, the gravedigger is present to console family members and to re-confirm the burial contract. I attended several velorios to observe the gravedigger’s interaction with bereaved family members. The objective was to confirm the gravedigger’s presence at the velorio and types of interactions he had with family members. This increased the confidence level of the information gravediggers provided on the probable cause of death. Of course, my interest was to record all those “suspected deaths” from pesticide poisoning and symptoms prior to death.

It must be noted that in the Dominican Republic, and more so in the rural countryside, a doctor is not required to visit the house of the recently deceased and declare the person as clinically dead, unless the person died at a hospital or clinic. Thus, official records were not available to confirm that the person had died from pesticide poisoning. The only exception was Tireo where relatives of the deceased had official death certificates (N=7).

The lack of official (hospital) records deprived the research of a valuable source of information on the cause of death. However, the relatives of the deceased are required to certify the death and “provide a probable” cause of death. Hence, the research relied on secondary information provided by gravediggers and the family of the deceased. The symptoms the person suffered before succumbing to the illness were recorded as reported by family members and gravediggers. These accounts provided important clues as to probable cause of death.

Information provided by the gravediggers and family members included:  work place, age, sex, symptoms observed, and medical diagnosis. Family members and acquaintances of the deceased verified the information provided by the gravediggers. A total of 88 observations were recorded of deaths associated or linked directly (occupational risk) or indirectly (proximity to high exposure area) with pesticide intoxication in a period spanning approximately four years (1996-2000).

Results indicate that living in close proximity to field edge was seen as a major contributing factor for the deaths according to family members and gravediggers (N=25). Living relatives of the deceased providing death certificates (the only validated cases of deaths caused by pesticide exposure), show that 16.7 percent of deaths were linked to liver disease. The link between organophosphate and organochlorine pesticides and liver disease is well documented (Minton 1988; Mineau 1991; Abebe 1991; Dinham 1993; Saadeh 1996; Guillete 1998; London 1994, 1998; Ecobichon 1999; Karalliedde 2001; Edwards 2001; Fenske 1999; and Cabello 2001). 

Summary

To accurately determine human pesticide exposure we need consistent multiple studies under various pesticide exposure conditions, and with suitable controls for confounding factors. However, my research, based on results obtained from biogeophysical, health and anthropological data analyses, effectively demonstrates that pesticides were the prime suspect in both increases in symptom severity and decrease in cholinesterase levels. Nevertheless, only proximity to field edge (pesticide source), alternative exposure pathways, porosity of dwelling structure and use of protective gear could potentially be related to pesticide exposure.

Based on the results, the research recommends the creation of health buffer strips in pesticide hot spots of the region. The buffer design offered in this study is a model based on the biogeophysical, cultural and socioeconomic characteristics unique to the region. It is expected that creation of health buffers will lead to measurable improvements in environmental quality and human health in communities exposed to pesticides and other environmental contaminants.

Conclusion

To facilitate the usefulness and understanding of the research findings, conclusions about biogeophysical, anthropological and health aspects of pesticide exposure  have been presented separately in the data analysis section. However, the strength of this research is predicated on the holistic and complimentary integration of all three sets of data and on their joint interpretation.

Although, my research subject matter is approached holistically through a diverse set of concerns with the phenomenology of culture, health, environment and pesticides, there are limitations that must be noted. While several methods are used to determine pesticide exposure, including the use of water testing and cholinesterase test results, how do we epidemiologically link the possible relationship between prevalent self-reported symptoms such as headache, dizziness, mental confusion and the person’s exposure to pesticides when numerous other dependent variables may have played a significant role, separately or in combination, over the entire life span of an individual. How can we measure the effects of pesticides exposure that occurred over time? My research shows that there are methods and analytical techniques available that can assist in determining a person’s “short term” exposure to toxic pesticide chemicals.

The research inferred causality from animal studies and relied on case-control studies conducted on humans. This limitation, however, did not limit the overall scope of the study since it was shown that strong associations between pesticides, environmental quality and human health do exist in the Constanza Region. The strength of my research design was that it developed models of associations and relationships. It was not intended to prove causality, whether from one or many causes.

Although results obtained from my study, which indicate that pesticide exposure is a mayor contributing factor for the community health problems affecting the region, long-term cohort studies are needed to conclusively link pesticides and other causal factors to the range of adverse health outcomes in the communities. However, such a study would take years and a major commitment of funds. The communities in question can not wait until a definite causal link is found by environmental health scientists. Rather, sufficient short-term associations exist that link pesticides and adverse health outcomes that encourages a public health action and community response.

Biogeophysical Analysis

Health Survey