results

So what are the results of the past nine months of work? Well, what I have produced is really a series of hypotheses – that is, laying the groundwork for future research by highlighting how gender creates points of convergence and divergence in TB patients’ experiences that need to be studied in greater depth. Some of the key issues my research raises are

- the role of a machismo culture in experiences of disease and in health care-seeking behavior
- gender differences in the psychological impact of the disease
- gender differences in diagnostic delay (the amount of time that passes between onset of symptoms and diagnosis); my results show that women, on average, experienced significantly longer delays than men, although my sample size is too small to draw definite conclusions
- gender differences in self-care and disease prevention as well as types of treatment sought; many men reported increased self-care as a way in which they would change their lives after completing treatment, and women and men both used a variety of alternative treatments before or during their antibiotics
- incidence of extrapulmonary tuberculosis (TB disease in an organ other than the lungs), which I hypothesize is higher among women, based on a quantitative analysis of clinical records
- gender differences in the effects of perceived and real social stigma related to TB
- the intersection of gender with other social factors such as socioeconomic status, age, legal/migratory status, etc, on patients’ experiences with disease

Because my research question was broad and my sample size small, drawing conclusions about these issues is premature. The success of my study is that I have identified some issues that are salient to the question of TB and gender, hopefully therefore paving the way for future research and encouraging program staff and policymakers to consider some of these questions as they design or re-design TB programs in the Dominican Republic.

While I have enjoyed doing research and have learned a ton, I'm left with a feeling that, in the long term, research is not for me. This is good news, because I'm going to be a doctor, not a researcher. At the end of this project, I feel a desire to stay here and implement the changes that I think need to occur. While I’m not yet at a level where I can influence international policy (it’s only a matter of time, though :), I do feel like my experience here could contribute to changing the experiences of patients at the community level. Ending with a paper (well, several papers, in two different languages) is satisfying, but I want more.

I want to design an intervention or program modifications that can address some of the issues I’ve encountered in my research. Investigation is extremely important; but I think that I would rather be the person reading the outcomes and subsequently applying them. One thing that has bothered me about my research is that my methodology was very traditional. I wanted to use more participatory methods or to incorporate a social change component that would give something directly back to my participants, but I ended up not having the time to incorporate this into my study design. I do want to engage in future research, but I see it being less traditional and more horizontal and participant-inclusive. For example, I don’t want to do a needs assessment of an underserved community; I want the people in that community to assess their needs so that I can just help leverage resources or services to meet them.

I’m haunted by the words of my MDR-TB friend who challenged me, “so what if your research shows that things aren’t good here, that we have problems with the treatment? How is it going to change anything for us?” While I can’t promise that policies will be rewritten and aid money reallocated as a result of my nine-month Fulbright project, I would have liked to at least feel that my participants got something (besides the little nutritional and financial compensation that I gave) out of my research. And maybe they did; one girl with TB told me that being able to participate and share her experiences and concerns was very important for her. But somehow, I doubt that my interviews have made a huge difference in anybody’s life.

I suppose this is where patience comes in; this is all a process, and my work was a drop in the ocean. The benefits of my research may or may not trickle down to the people they’re supposed to help, but at the very least, I have learned so much about listening to patients, about asking the right questions, and about understanding a community, that I believe my capacity to be a good doctor and health policymaker in the future has increased immeasurably as a result of this experience. And who knows – maybe I will end up being one of the people who takes on some of these questions and keeps working to find more concrete answers – in a participatory, horizontal way with funding for an intervention at the end.

At any rate, I’m proud of my work and I have to say that Fulbright has been an amazing experience academically, professionally, and personally. After a week full of despedidas (goodbye parties) – pseudo despedidas (at the clinic last Friday, there was a big activity for TB patients about their rights and responsibilities; since there was food and I got to say a few words, I pretended that it was my despedida, too), others’ despedidas (my roommate’s, also on Friday), and my own (some quality time with close friends from the past four years in the community where I worked with SOMOS and, tonight, a meal with some family friends here) – it’s time to get serious about packing. See you in the United States!