The research is guided by methods emerging from anthropology, geography and epidemiological studies, to examine and answer questions involving the complex multi-scale relationships that exist between community health and the environment and how these are adversely affected by pesticide exposure. I examine the thesis that agrochemical application will negatively impact environmental quality resources (water and air) in such a way as to impair the health and well-being of community members.

The research contributes to anthropological thinking and research by offering a multidisciplinary approach for evaluating pesticide exposure at the community and regional level. By incorporating complementary biogeophysical, anthropological, and epidemiological elements, the study contributes to a more holistic understanding and evaluation of the dynamics of culture, health and the environment. 

Several field techniques were used to collect health, environmental and cultural data. These included questionnaire-interview surveys (1998, 1999, 2000, 2002). In terms of sampling techniques, care was given to draw an adequately large and, when it was necessary, stratified, random sample from the overall population. The surveys were written in terms which were understood locally and administered with the help of several field assistants from each of the communities under investigation.

Health surveys, environmental interviewing and participant observation techniques complemented the collection of ethnographic data. The investigator firmly believes that the anthropologist should have a multidisciplinary background. Accordingly, the study incorporates biogeophysical, sociocultural, and health elements, that contribute to a broader and robust understanding and evaluation of community health, in general, and  pesticide exposure in particular.

What emerged from this study was a holistic portrait of communities, which show how rapid development of intensive commercial agriculture has affected environmental quality and community health. This portrait shows in detail how community members “relate” to their changing physical, social, economic, and cultural environment and how that relationship is conditioned by factors, which are external to the region.

It is anticipated that the study will form the basis for a series of articles on the potential adverse health effects of pesticides in regions sharing similar biogeophysical, socioeconomic and cultural characteristics with the Constanza Region. The study region will be treated in comparison with similar studies conducted in the Yaqui Valley, Mexico (Guillette 1998); the Yakima Valley in Washington (Faustman 2002) and in Southeast Asia (Carpenter 2000), so that more perspective is gained and various models tested on the relationship between culture, health and environment, specifically the hypothesis that intensive pesticide-dependent agriculture, will generally impact environmental quality resources (water and air); in such a way as to affect the health and well-being of community members.

 

Methodology

The research used a multidisciplinary approach to understand both the landowner’s and farm worker’s viewpoints. It seeks to understand the relationship that exists between both groups within their cultural and environmental milieu. It examined factors such as meteorological conditions, biogeophysical setting and human activities, behavior, and decision-making. It looks at how these factors increase the rate of pesticide exposure in the four communities under investigation.

I use anthropological, geographical, and epidemiological methods to: (1) identify factors (biogeophysical, socioeconomic and cultural) that lead to pesticide exposure; (2) identify characteristics of communities at risk from pesticide drift; (3) identify behavioral patterns and activities that serve as pesticide exposure pathways; (4) examine cultural beliefs and perceptions regarding illnesses that show clear pesticide exposure etiologies, but that are often culturally linked to “supernatural forces”; (5) examine the strategies used by community members to cope with these illnesses; (6) capture cultural interpretation of symptoms and illness  through narratives; and (7) recommend health buffer strips that would provide a measure of protection for communities at risk from pesticide  drift.

Figure 1 describes the conceptual framework that I use to study the systemic relationships between culture, health, biogeophysical components that affect environmental and community health. Although this conceptual model is powerful in its inclusion of both environmental and human-based processes, important interactions and feedbacks influencing long-term community health dynamics are absent. For example, pesticide use, traditionally seen as a driver, also can be viewed as the result of more fundamental socioeconomic patterns and processes. Because many of these missing features relate to the social sciences, using a multidisciplinary approach may greatly enhance our understanding of the relationship between environment, culture, and human health in general, and pesticide exposure in particular.

 

Data Collection Methods 1998-2002

Three sets of data were generated: biogeophysical, health and anthropological (cultural). Most of the biogeophysical data were obtained through rapid rural appraisal and direct observation. On-site collection and measurements of biogeophysical data were obtained using meteorological, environmental quality, and geographic survey equipment (See Table 1). In addition, general field observations; participant observation, general questionnaire/interview and cemetery investigation formed  part of data collection process.

Health data were obtained through health survey questionnaire-interviews, observations, water quality testing (See Table 2) the examination of cholinesterase test results, which were provided by health survey participants. Using anthropological (cultural) methods strengthened the overall research design by incorporating the perceptions, attitudes and beliefs of the people most affected by pesticide exposure.

Respondent’s long-term observations of environmental quality and community health filled the gaps left by biogeophysical and health data analysis. Their observations offered valuable insights on how environmental quality has changed and affected community health in the last two decades. These observations validated and strengthened results obtained from statistical analysis. All three data types were instrumental in understanding the causes and effects of deteriorating environmental quality and community health, as well as discovering the linkages and relationships between the two.

 

Table 1 Field Survey Equipment Used Field Study

Equipment	Type of Use
Laptop Computer	Data storage and analysis
Meteorological Conditions (Kestrel 3000 Pocket Weather Station)	Wind speed and direction
Hach Nitrate-Nitrite Test Kit (Model Nl-12-Cat. No. 140881-00), Hydrogen Producing Bacteria Test Kit / Pathoscreen Medium Presence-Absence Powder Pillows 100ML	Water quality testing
Measure Wind Direction (Wind Sock)	Wind direction
Height Meter -Pesticide Spray (Clinometer/heightmeter / SILVA)	Measure pesticide spray height
Digital Distance Measuring  Wheel (DigiRoller Plus II)	Measure distance
Cameras: Video, Photo (Digital) Binoculars	Record Health survey

Table 2  Types of Data Used in the Research

Type of Data	Source	Use
Digital data	Secretaria de Estado de Agricultura	GIS: Proximity, Overlay and Site Selection Analysis
Air Photos	Instituto Cartografico Militar Dominicano	Buffering Analysis
Cholinesterase Test Results	Health Survey Participants	Pesticide Exposure  Determination
Heath Data	Health Survey Questionnaire	Health Survey
Environmental Quality Data	Field Sampling (Water Quality)	Health Survey
Ancillary Data	Literature Review, maps, newspaper, documentaries	General Use
Meteorological Data	Direccion Nacional de  Meteorologia (Historical Data) Field Measurements	Biogeophysical Analysis

 

Participant Observation

Using participant observation methods and immersing myself in the community life, I gained an understanding, perhaps more deeply than could be obtained by other methods, of community values, social relationships and structures, familial ties, and conflicts. The first-hand information obtained while living in the communities and participating in daily household and community routines facilitated my acceptance in the communities and gained their trust. The residents of Tireo would say: “eres de nosotros” or that “I was part of  them.” In Colonia Kennedy I was constantly labeled a Constancera  or a native of Constanza. In essence, I became part of the cultural landscape. My involvement with the community as a whole had been on-going for four years, an involvement that provided much of the fundamental data for the dissertation.

Participant observation was an excellent method for identifying pesticide exposure pathways and other behaviors that can increase exposure levels. Bearing in mind I already had developed strong community ties in the selected communities. I had access to participant homes, where I was able to observe and record behavior patterns conducive to pesticide exposure.

 

Study Design

A secondary data review was conducted before conducting the field research    in the field. A search was made of existing reports and records on the Constanza Region. Relevant information was found at various U.S. and Dominican government agencies, universities, research centers, and other institutions. Relevant information included: project documents, research papers, annual reports, previous survey results, maps, as well as journals and books and even newspapers.

In 1997-1998, I conducted an informal exploratory study of the region to establish an understanding of local environmental conditions, community health problems and cultural characteristics. The Rapid Rural Appraisal Approach (RRA) used in the study generated basic information on the feasibility of beginning the survey project in the Constanza region. The new information assisted in formulating new hypotheses about the relationship between culture, health and the environment in the region.

Specific RRA techniques used included: (1) direct observations of patterns of crop production, landuse, land tenure system, and farm worker / farm household behavior; (2) on site face-to-face informal interviews with farm workers and their families; (3) formal interviews to identify potential key informants; interviews with landowners and agribusiness class. Information obtained from RRA was recorded on a tape or written down.

Maps of the region were created based on field observations.  Communications routes were used as transects since they cut across the main geographic features of the region permitting a comparison of main features, resources, uses, and problems. Basic biogeophysical data was recorded on base maps of the area (scale of 1:250,000). Biogeophysical characteristics such topography, landcover, and wind patterns were identified and the base maps were then annotated to illustrate the relationship of each of the characteristics observed. Other features annotated on the map included: roads, irrigation canals, waterways, and settlement patterns of communities.

To determine the accuracy of Dominican government issued base maps, ground proofing was conducted by driving along the roads identified on the map. To record landuse data, all landuse within 10 feet of either side of the road (or one side if the road is on the area boundary) was recorded on the base map. Communication routes were used in the valleys because there was not wide variations in land height in the flat valley floor. Aerial photographs and satellite images obtained from the Dominican Military Cartographic Institute and NASA were used in planning the field research. The images were also used to identify communities, for the evaluation of natural resources, crop-patterns, landuse / landcover and physical evidence of field edge-pesticide source proximity. Cadastral maps, obtained from the Secretaria de Estado de  Agricultura, identified landownership.

 

Statistics

Statistical results are offered, not to generate numerically exact conclusions but rather to state probabilities about conclusions. Analyses were performed with the SPSS software (SPSS, Chicago, IL) on cholinesterase, proximity to  pesticide  source, symptom severity, occupation, and pathway exposure data. Correlations between variables with near-normal associations were studied using the Spearman Rank correlations coefficient. Chi-square statistic was used for determining if differences between groups were significant.

 

Ethics

All participants signed a consent form after receiving oral and written information on the health survey. The study followed the protocol approved by the Committee on Human Subjects Research of the State University of New York at Binghamton and was approved by my PhD research committee.

 

Potential Errors

A potential source of bias in my study involve confounding factors that, if unaccounted for, could possibly produce spurious associations. To control for confounders strength of associations were estimated. There are two potential sources for confounders. First, my research depends on observational data, which is especially vulnerable to confounding. Second, error in measurement of a confounder, such as cholinesterase level, might create a problem if the laboratory doing the serum count did not follow lab protocol for measuring the levels and reporting the results. In addition, the potential for skewed results on cholinesterase levels exists.

 

Methods Used to Identify Exposure and Exposure Pathaways

Several methods were used to evaluate the contribution of several environmental exposure pathways in children and household pesticide exposure. The study quantified spatial and temporal variability in pesticide residues in and around schools and residences of farm worker (applicators, mixers) families.  School children and farm workers were observed and recorded during periods when both were at highest risk from exposure.

Observations were made using high power binoculars to avoid pesticide exposure. The binoculars allowed clear view of activities and behavior during periods of pesticide application and during periods when children had access to recently pesticide-treated areas. The survey also monitored transport of pesticides from the school and workplace to the residence via clothing, shoes, and agricultural equipment (pesticide sprayers).

 

Exposure Assessment Techniques

In 2002, a six-page health questionnaire was administered to survey participants. A complete health and occupational history was recorded as well as information about intoxication from different chemicals. Questions regarding self-reported symptoms and illnesses, associated with pesticide exposure, were included.

Data collected from field surveys and secondary sources included: pesticide application methods (rate, frequency and intensity of application), proximity (distance) of dwellings to field edge or pesticide spray source, meteorological conditions (wind speed/direction, fog, relative humidity and temperature) present during pesticide application; and observations of farm worker, school children and household behavior and activities. Cultural data included community perception and beliefs about illnesses, adaptive strategies used to cope with these illnesses, and cemetery data of probable deaths caused by pesticide exposure.

The rather comprehensive health questionnaire was used because it covered most of the theories that have been presented in the literature review regarding the etiology of pesticide-caused illnesses. The questionnaire was somewhat modified and extended compared with the 1998-1999 questionnaires that were administered to evaluate community perceptions, knowledge and beliefs regarding environmental change and community health.

Water quality (bacteria and nitrite-nitrate testing) tests results were used as health indicators in all four communities and to account for the prevalence of gastrointestinal symptoms reported by respondents, and that were attributed to pesticide exposure.

 

Health Survey 2002

The 2002 health questionnaire-interview survey uncovered community perceptions of environmental quality and the threats to community health. I wanted to understand (1) how community members, who have a very different world view, understand the risks and ramifications of working and living with toxic agrochemicals; (2) how they integrate ideas about these chemicals into preexisting notions of health, illness and healing; (3) how they conceptualize risks associated with pesticide exposure into their understanding of health; (4) how they integrate supernatural (folk medicine) with biomedical alternatives for improving health and healing; (5)  how they interpreted symptoms associated  with pesticide exposure and other health threats as caused by supernatural forces, and how these  interpretations threaten their health and well  being by preventing or impeding proper and timely treatment; and (6) how their behavior and activities serve as exposure pathways from work place and schools into the homes.

By far the major part of the health survey focused on the self-reported symptoms. Questions were asked about both family and individual health history. Individuals were engaged in the interview process by eliciting information about their most immediate health concerns.  Individuals were asked to keep a journal three weeks before the formal health questionnaire interview. Individuals were instructed to record symptoms they experienced and what factors make them better or worse. It is important to note that the interviews were conducted during high agrochemical application periods.

My particular style of interviewing was to remain quiet and let individuals describe his/her own symptoms. Later individuals were asked to fill out the questionnaire, which listed particular symptoms. The questionnaire also allowed the individual to add symptoms not included in the list. The main objective was to elicit individual response about concerns they have regarding pesticide exposure and their health.  Even if the concerns expressed seemed under or overstated, I wanted their honest and detailed description of their physical, emotional, and mental state at the time of the survey.

The questions were open-ended so that individuals could take the question in whatever way he/she considered most important.  The two opening questions asked were: “What concerns you most about living here? What  concerns you most about your health?” After the individual finished describing his/her concerns, I repeatedly asked him/her to elaborate further. After it seemed that the individual had described everything about their symptoms, I asked him/her if there is anything that aggravates or ameliorates them.  This question was not meant to inquire whether pesticide spraying makes symptoms worse. Rather, it sought to uncover more information about the individual’s unique experiences and the various factors that may affect his/her individual symptoms and overall health. Other questions asked were: “Is there a time in which the symptoms are better or worse? Does temperature or weather (cloudy days vs. sunny days) affect the symptoms? Does motion or rest influence the symptoms?

Rather, it sought to uncover more information about the individual’s unique experiences and the various factors that may affect his/her individual symptoms and overall health.  Other questions asked were: “Is there a time in which the symptoms are better or worse?  Does temperature or weather (cloudy days vs. sunny days) affect the symptoms?  Does motion or rest influence the symptoms?

After the individual has provided this information about his/her symptoms, I asked, “What other symptoms are you concerned about?” I followed this question with a similar barrage of questions to uncover details about these additional health concerns.  After eliciting the primary symptoms the individual had, I asked questions about parts of their body, usually beginning at the head and moving down to their toes. This “body scan” was a way to help jar the individual’s memory about potential symptoms that he/she may have had occasionally but may not have initially remembered.

 

Testing for Hydrogen Sulfide Producing Bacteria

Testing directly for bacterial pathogens was deemed impractical for many reasons, not the least of which was the need for lengthy and involved test procedures (See Table 3). Indicator organisms, which are usually of fecal origin, were used instead. Many serious diseases, such as typhoid fever and dysentery, can be traced directly to pathogenic microorganisms in polluted water (Repetto and Baliga, 1997). These disease-producing organisms are discharged in fecal wastes and are difficult to detect in water supplies. No one organism or group of organisms satisfies all of the criteria for an indicator organism (Interview with Hach product consultant, 2002). For example, in temperate climates total coliform bacteria are commonly used as indicator organisms in potable water supplies. In many tropical climates, however, indigenous Escherichia coli (E. coli) are present in water sources where no fecal contamination exists; yet they will produce positive results in total coliform tests (Interview with Hach product consultant, 2002).

In such cases, other bacteria, known to be associated with fecal contamination, may be used as indicator organisms in place of the coliforms. The hydrogen sulfide-producing bacteria have been shown to be associated with the presence of fecal contamination and total coliform bacteria, and they may be used as an indicator organism in place of coliforms (Interview with Hach product consultant, 2002). Table 3 shows the criteria used to determine negative and positive results based on Hach Water Testing Procedures.

 

Table 3   Interpreting Results for Hydrogen Sulfide Producing Bacteria Test

Test Results	Positive	Negative	Follow-Up
Color Changes from Yellow to Black	X
Black Precipitate Forms	X
No Color Change		X	In incubate additional 24-48 hours and re-evaluate. If no color change, record as negative.

 

Geographical Information System (GIS) Database

A relational database was constructed integrating biogeophysical, health, and cultural data collected from the field survey. Arc View, Microsoft Excel, Works and SPSS were used for database construction and querying. The GIS component of the relational database assisted in querying different data sets to gain an understanding of the relationships and interactions between environment, human health, and culture. The database was divided into the following parts to facilitate querying:

 

Research Significance and Data Reliability

The research supports efforts to ensure that health buffer zones and responsible use of agrochemicals will improve environmental quality, which will lead to long-term community health and well-being. The research also supports efforts to ensure that decision and policy makers target their efforts to help those most in need - the poor and pesticide exposed. It encourages the agribusiness sector to adopt a more “responsible” attitude toward pesticide use. It is their responsibility to improve the quality of life of future generations by helping to mitigate the effects of pesticide on communities adjacent to their fields.

Finally, results generated from the research will be presented to the Dominican government for assessment and possible implementation. It is hoped that the approach will be eventually applied in other areas undergoing environmental deterioration in the intermountain regions of the Dominican Republic. Although the study was carried out in the Dominican Republic, the results generated from the research and analysis is expected to have applications in other parts of Latin America and Africa. Hence the study can serve as a model for other intermountainous regions that are undergoing similar human-influenced environmental deterioration, most notably from commercial agricultural production.

 

Data Reliability

The multidisciplinary study recognizes that raw numbers used to generate a measurement may themselves be inaccurate because of errors in survey responses, official records, and so on. In some cases, these errors are random and simply reduce reliability; in others, they are systematic and thus reflect bias and reduce validity.

It was also necessary to estimate values on some of the key variables. Estimation was required because of a lack of coverage and because the reported data were suspect. In the case of the study region, the lack of infrastructure (computer databases) prevented the local or national body from providing reliable and valid data. Against this backdrop, the research relies heavily on primary source data generated from the multiple field surveys.

 

Conclusion

As scientists learn more about the health threats posed by pesticides, especially those which affect children’s health, we begin to understand the effects of these chemicals on the immune, hormone and nervous systems. It has been established that relatively low level exposures to toxic chemicals, occurring at critical stages of development, can cause permanent damage to these systems (Mineau 1991; Harris 2000; Karalliedde, Feldman, Henry, and Marrs 2001). The methods used in the health survey provided good data on pesticide exposure, allowing us to answer some basic, yet specific, questions about pesticide exposure and its effects on community health and environmental quality.

The multidisciplinary methods used allowed for whole system analysis of pesticide exposure instead of concentrating on one or two aspects. Using this approach also increased the reliability and confidence level of data results, thus limiting the assumptions made about pesticide use and exposure. It is hoped that the methods used in this study will allow researchers to better identify other risks and exposure pathways associated with pesticides.

Although the study tried to provide specific details about pesticide exposure and its effects on community health as a whole, the data poor region and the lack of cooperation on the part of the Dominican government necessitated some generalizations. It is hoped that the study will provide better measures for pesticide exposure so that the research can be critically revisited and expanded to include other communities at risk from pesticide exposure. It is hoped that the research will encourage policy makers in drafting more “community sensitive” policies. The objective being to influence policy-makers so that we can prevent a " pesticide crisis" in the near future.