Formative research on elder health and care in Comitan, Chiapas, Mexico

Abstract

This dissertation documents my active involvement in anthropological research on elder well-being in Comitan, Chiapas, Mexico, and how my research was a springboard for local dialogue on the need for primary health care for the elderly, an issue with global significance. I describe my work as part of a larger process, still unfolding, that I helped initiate and continue to trace as an ethnographer engaged in participant observation. My long-term residence and applied health research in Chiapas, graduate training in medical anthropology, and institutional backing from the Comitan Center for Health Research (an NGO where I have worked since 1994) equipped me to catalyze engagement around elder health in Comitan. To do so, I drew on formative research, a multi-stage participatory process that is iterative and draws upon multiple methods and actors to identify and define a problem, then develop, monitor, and assess locally-congruent interventions. Specifically, I conducted: 1) ethnographic research on middle and lower class elders living alone and with family; 2) an elder health needs and resources survey of 300 households; 3) interviews with elders, home-based caregivers, and formal care providers; 4) an interinstitutional elder health conference and 5) a strategic planning meeting, which spawned 6) an independent working group that is currently exploring potential elder care strategies, with 7) my ongoing facilitation. In detailing elders' lives, problems, and care, I at once address the specific issue of elder well-being in Chiapas as seen by elders, caregivers, and providers, and describe the social relations of community action to provide basic elder care. I take stock of historical factors that have altered family relations and elder care dynamics in Chiapas, including structural adjustment, epidemiological and demographic transitions, globalization, and migration, as well as resultant local and regional socio-political struggles. I give special consideration to the household production of health, gendered differences in elder health and care resources, and the social relations of health care-seeking and therapy management. My findings challenge popular misconceptions regarding elder entitlement and access to economic, cultural, and social capital, and indicate potential solutions. This dissertation, then, illuminates how anthropological research can facilitate community-based problem solving.