on research

Maybe it was the fasting earlier this week, but I’ve gotten a significant amount of work done in the past few days. I’m not sure if it was a function of the fast itself or if I simply had more focus because of not having to think about what to eat every day, but my thoughts were particularly lucid this week and I’ve been reading, writing, and reading for hours each day (which is awesome, because it was basically one of my life’s dreams to get paid to read and write all day, preferably in another country). Also, I was trying to avoid going out too much this week, in part so that I wouldn’t black out from hypoglycemia on the streets of Santo Domingo and in part to avoid seeing any hint of food. Irrespective of its root cause(s), I am getting a lot done, and to tell the truth, it began the moment I got here. I stepped off the plane and hit the ground running.

The sheer amount of literature review I have been doing since I arrived here (and well before that) has had the effect I’d hoped for; I now look at everything with a gender perspective. I have, effectively, gender mainstreamed my own brain.

What I mean is that in looking over USAID materials, reading articles about health issues, and learning more about gender and health here in the Dominican Republic, I have noticed that I now view things from a gender perspective automatically. When I read about the major problem of what is termed “patient noncompliance” in the extensive treatment regimen required to cure tuberculosis, I immediately wondered, “Do the rates of compliance for female and male patients differ? If so, what characteristics of their lives create this disparity?” Noncompliance is a serious issue when it comes to tuberculosis, since not finishing a course of antibiotics can cause resistance and lead to multiple-drug resistant tuberculosis (MDR-TB), an intimidating demon with which Dr. Paul Farmer (of Partners in Health, Mountains Beyond Mountains, the Harvard School of Public Health) has relentlessly waged war in the slums of Lima, Peru and the prisons of Russia. So whether or not gender – more specifically, the expectations, duties, and social roles assigned to men and women based on their sex – plays a part in rates of noncompliance is an important question from both a public health and a social justice perspective.

In our (mostly Fulbright) writing group, it was my turn this week to turn in a “chapter” – well, for those writing dissertations or books, it’s a chapter, but for me, it was a disorganized, half-beefed-up, somewhat distracted, glorified outline, with enough introductory information to define the essentials of my research question without promising too many answers as yet. It was like a sulking teenager who is starting to resemble the adult he will become but doesn’t yet know how to be comfortable in his own rapidly growing skin. After my writing groupies applied their pens and glorious brains to my halfway Thing, I found myself shoved headlong into another set of thoughts like an underwater tunnel. When I came up for air, I was in an entirely different body of water.

What if I focus only on infectious diseases – specifically, tuberculosis and HIV/AIDS, since the two often interact to create significant health challenges here and in many “developing” countries? What if I don’t begin with gender mainstreaming as a framework? What if my framework is simply how gender affects the diagnosis, treatment, and experiences of these diseases for marginalized people in the Dominican Republic? What if I expand the sample population of marginalized people from impoverished communities where USAID-funded organizations work to prostitutes, Haitian immigrants and Haitian-Dominicans (who experience incredible, systematized discrimination and racism here), and adolescents (though that brings me back to the drawing board for IRB)? What if I identify possibilities besides gender mainstreaming as sustainable, comprehensive ways to address TB and HIV/AIDS in these marginalized populations? …And suddenly I have an entirely new Thing on my hands.

It’s a process – is always a process – and most of the good stuff comes from the process, not from the end.