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Getting to two cups of tea

March 13, 2012 6 comments

A few years ago we were hired to observe doctors and nurses inserting central venous catheters in hospitals and clinics in order to identify opportunities for reducing the possibility of infection.  We had been working on the project for a few months and had observed in several areas within hospitals and clinics, but were really needing to understand how things might be different in the pre-surgery area of hospitals.  We had worked hard to go through all of the proper channels and had finally secured permission to observe in the pre-surgery area.  We had institutional review board permission and had spoken to the nurse in charge of the pre-surgery area several times and thought we were ready to go.

We arrived at the hospital bright and early, excited for our first day of fieldwork.   After meeting the head nurse and being given a tour of the area, I asked who actually did the catheter insertions in the pre-surgery area and was told that the department of anesthesiology did the insertions.  I asked if they had been informed about what we were doing and was told ‘I don’t think so.’  Years of experience washed over me as I realized this was NOT GOOD, so I headed for an impromptu meeting with the chair of the anesthesiology department.  He was cordial and listened intently about the goals of our project and the process we had gone through to obtain permission.  When I was finished, he exploded.  He let me know that this was just the latest in a long line of events that proved how little his department was valued by the hospital.  He assured me that he didn’t hold me responsible and told me that I seemed like a very nice lady.  BUT he could not allow us to observe any catheter insertions on that day because he needed to do some research, see who had dropped the ball and inform the other doctors about what was going on.  He promised to touch base with me later to update me.  That afternoon, I received a call from the department chair’s assistant telling me we were cleared to observe insertions the next day. She said a memo had been sent out and everyone would be expecting us.  I was thankful to only have lost one day of fieldwork.

The next morning, we arrived at the hospital early and when the first catheter insertion hit the floor we were ready. We had asked permission of the patient and the resident who was doing the insertion.  We were in the middle of the insertion when the attending physician walked in and motioned for us to step into the hall.  He asked what we were doing and I told him it was fine, we had permission from the chair of the department and that there had been a memo circulated about the matter.  He informed me that he had read the memo and asked me if I had (I had not).  He pointed out that the memo clearly stated we were not allowed to observe residents.  My heart sank.  I walked outside and called the chair of the department who was working off-site on that day.  It was then that I discovered the value of inserting someone’s name during a reprimand.  Dr. X said ‘I hold you responsible, Melinda.’  ‘You should have read the memo, Melinda’ (I hadn’t been given a copy of the memo). ‘I will call you later to discuss whether we can work this out.’  We left the hospital completely deflated.  We had now lost two full days of insertion observation, approximately 24 hours of data collection.  That afternoon, the department chair called me and told me we could return the next day.  His assistant had forwarded me the memo and we reviewed the perimeters and rules of our observation.  I took some Advil and tried to refocus my thoughts.

On the third day, we arrive at the hospital earlier than before, we wanted to get settled in and be ready for any and all opportunities for insertion observation.  On that day, because the caseload was low, there was only one doctor performing insertions.  It just so happened this was the same doctor who had exposed us on the second day and he was NOT interested in participating in our study. We again spent the entire day observing the comings and goings of the pre-surgery area, but no catheter insertions.

On the fourth day, we returned, hoping against hope that things would be better.  The first few doctors doing insertions declined to participate in our study, so we had another couple of hours to make general observations.  I was beginning to panic.  What if we didn’t get to see any insertions.  How was I going to explain THAT to the client.  Just before noon, one of the doctors came and sat down next to me and asked me to explain exactly what we were doing.  I gave him my 3-minute elevator pitch on our work, the project, etc.  He seemed to relax a little bit and asked me if I had ever read the book ‘Three Cups of Tea’.  I told him I had not and he gave me a quick overview of the book.  He explained that it was written by a guy who got sick while mountain climbing and was forced to remain in a village with strangers until he recovered.  The title of the book came from the Balti proverb that explains how tea rituals move you from stranger status (first cup) to honored guest (second cup), and then to family member (third cup).  The doctor patted me on the back and said he had just wanted to share that idea with me and then invited me to watch him do an insertion.  For the rest of the afternoon and into the next day, my partner and I couldn’t keep up with the insertions that we were invited to observe.  We were invited to watch virtually all of the insertions that were happening on the floor and were also invited to watch insertions that occurred in other departments and in patients’ rooms.  We were invited into the break room and asked to have lunch with a few doctors.  We ended up with more instances of observation and interviews than we had originally planned.

As I left the hospital on the last day, I was relieved and excited to begin the process of breaking my observations down and figuring out the patterns that separated catheter insertion in the pre-surgery area from the other areas that we had observed.  But it wasn’t until a few days later as I was reviewing my fieldnotes from the first three days that that I realized what a wonderful gift I had been given by things not going according to plan.  I had been given the opportunity to observe the context of the pre-surgery area for hours without having to focus on the technical aspects of catheter insertion.  I had noted a lot about the patterns of interaction and the flow and movement of patients and staff within the pre-surgery area.  This allowed me to really place my specific observations about the challenges that doctors faced in inserting catheters in the pre-surgery area into a more understandable context.

When I reached the point in my fieldnotes where I had written about the doctor telling me about ‘Three Cups of Tea’, I realized that there had been a hidden message.  At the time, I thought he was telling me about the book because I was a sociologist and he thought I would appreciate the story.  It was only later that I realized that by telling me the story, he was inviting me to my second cup of tea.  While sitting in the pre-surgery area for days, we had become a fixture and had transcended the ‘stranger’ status and became if not an honored guest, at least an ‘okay observer’ (as evidenced by the number of invitations we received for observation and interviews).

This experience taught me two things:  1) Never forget to look for the opportunities that are presented when things go wrong.   2)  Remember how different your access and perspective is when you are having the first cup of tea versus the second cup of tea.  And always try to get to the second cup of tea before leaving the field.

I’m often asked if it is really possible to do ‘real’ ethnography while working within the kinds of timelines that working in business contexts require.   That conversation will be saved for another blog post, but for now I will say that it is often possible to get to the second cup of tea pretty quickly if you are a skilled ethnographer.  In fact, I’m often at two cups of tea within the first few hours of spending time with someone.  You would be really surprised how much rapport and intimacy can be built when someone realizes that you really ARE interested in their story.

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Keeping our balance in a world of rapid change: Lessons from ‘Fiddler on the Roof’

March 5, 2012 Leave a comment

 

When I used to teach introduction to sociology and sociology of marriage and family, I always had my classes watch the movie “Fiddler on the Roof”.  It was a great way to bring to life many of the sociological concepts that we were learning in class. In that one movie, there are probably more than 100 sociological lessons, and the music is pretty fantastic too.

My favorite part of the whole movie is the opening sequence.  The main character, Tevye, asks and answers the question:  “How do we keep our balance?”  “That I can tell you in one word.”  “Tradition.”  “Here in Anatevka, we have traditions for everything.”  “How to sleep, how to eat, how to work, how to wear clothes.”  “You may ask, ‘how did this tradition get started?’’  “I’ll tell you. . . .I don’t know”  “But it’s a tradition, and because of our traditions, every one of us knows who he is, and what God expects him to do.”

Truer words were never spoken, and in my line of work, I see Tevye’s observation in action all the time.   We could easily replace the word ‘tradition’ with the word ‘norm.’  No matter who the person, or what the context, behavior and ideas are driven and ruled by norms.  And this is the case, long after we have forgotten (or perhaps even before we have learned) the reason for the norm.  Norms are powerful forces that let each of us know who we are and what is expected of us.  The number and diversity of norms that each person follows every day is staggering.

My job as an ethnographer is to try to get a handle on the norms driving the thing I’m hired to understand.  Whether it is how people cook dinner or how one reacts to being diagnosed with a chronic disease, norms are ever present in determining how people think and behave.  There are often well-established patterns in how things are done and even in how people think about and place value upon things, so many norms are obvious and often slap us in the face as soon as we spend a little time watching and listening.  However, other norms are a little more subtle, and the patterns are not always so obvious until we see someone doing it differently or spend some time in analysis, really breaking down and organizing observations.

But the thing is, even the most obvious norms are often not so obvious unless you train yourself to look for them.  Although we all follow cultural norms each day, for the most part, we do it on automatic pilot. The classic sociological example used to bring this concept to life is to ask people to think about what they do when they enter an elevator.  There are some very rigid rules for behavior on elevators.  You must face the front, go to the alternate corner if someone else is already on the elevator, keep conversation to a minimum, etc.  Most of us do not remember reading a manual on elevator etiquette, but very few people ever violate these norms.  And why do you think that is?  T-R-A-D-I-T-I-O-N!

I learned a lot about the power of tradition a few years ago when I was in the Philippines studying how moms took care of their babies.  I had spent the afternoon with a young mom (who also happened to be a biologist) and her one-year old son.  We had spent a lot of our time talking about what was important to her as a mother, and how she made decisions about how to care for her son. She told me that she was very modern, but her own mother was very old-fashioned, and this often caused conflict when they were negotiating how her son was to be cared for.  One of the things that they didn’t agree on was whether he should be seen by a pediatrician or a traditional healer when he was ill.    My participant told me that because she was a scientist, she knew that modern medicine was based on scientific principals and that traditional medicine was based on superstitions and that she didn’t put much stock in superstitions.

I had been playing with the little boy, but after a few hours, it was time for me to leave, and when I walked out the door, the little boy started to cry.  Because I’m a Western mom, I thought I should walk away as quickly as possible because I had been taught the ‘get out of sight, and you will be out of mind’ approach to dealing with crying children.    As I rounded the corner, the mom came running after me and explained that she needed me to come back to her house.  She told me that her son was very upset and she was concerned that he would get sick, so she needed me to place some of my saliva on her son’s tummy.  Saliva from the offending person was the antidote to ward off potential illness.  I of course obliged and then said goodbye again.

At first I thought maybe I had misunderstood the conversation with the mom and her seemed rejection of traditional practices and beliefs.  But after seeing some other mothers, I realized there was a pattern when it came to western versus traditional medicine and that these norms were interlocked with rapid change and younger women’s desires to be more ‘modern.’  This all resulted in a complicated system of ideals, values, and behaviors that actually contained several seeming contradictions.   In a nutshell, times were a-changing BUT many of the behavioral norms were lagging behind the changes in ideals.  And so it turned out that the mother who seemed to WANT to reject traditional medicine, but who didn’t want to take a chance on her son getting ill, wasn’t unusual and wasn’t really a contradiction once the puzzle was put together and the power of TRADITION was factored in.

A lesson on going native and naivety

February 29, 2012 Leave a comment

A few years ago we were hired to help our client understand what it was like to live with schizophrenia.  We were given the unusual luxury of time, so we got to spend an entire year with our participants and really get a deep look at the challenges they faced in dealing with their condition.

One of my participants, we will call him Dave, was a very kind and spirited man who lived in a group home and struggled each day to be productive and build community.  Each time I visited with Dave, I would ask him the same question ‘what have you been up to?’  His answer was always the same ‘Running the streets, drinking coffee, and smoking cigarettes.’  And that was literally how he spent his time.  Each morning, he would get up early, drink coffee, smoke a cigarette and hit the streets.  Dave would walk all day long, drink more coffee and smoke more cigarettes.  On his travels each day, he met a lot of people.  He knew everyone.

As he traveled about, he was constantly making micro exchanges.  He was always bartering and exchanging goods and services. It took me a while to realize that it wasn’t really about the value of the thing he was getting or receiving, it was about the exchange.  The exchange allowed him a mode of interaction and also allowed him to build community.  This meant he was often taken advantage of by others who were more invested in the value of the thing, but this didn’t seem to matter to him.  Dave didn’t feel taken advantage of because he was getting what he wanted and needed from the exchange.

It was sometimes hard for me to remember to see the action from his point of view and I worried about how others seemed to take advantage of him.  He was an easy mark.  But my job was to try to understand what life was like FOR HIM and so I did my best to stay focused on seeing things from his perspective.  After a few months, it became evident that I was succeeding in this goal, when I finally met Dave’s girlfriend.

One of the objectives of the project was a better understanding of how schizophrenia impacted family members and the social networks of the person with the condition.  Dave had been telling us about his girlfriend for several months and we were finally going to meet her.  Dave was clearly enamored with her and talked about her all the time.  In my mind, I had imagined an equally sweet, generous, and trusting partner for him.  That seemed to be how he saw her and I had such high hopes for him.  I think I wanted to believe he had a soft place to land because daily life was so hard for him.

On the morning we went to meet her, my partner, Steve and I rode with Dave to her house.  When we were introduced, we were both pretty surprised, she didn’t seem very friendly and actually seemed a little bit annoyed that we were there.  What’s more, she didn’t seem to like Dave very much.  When Dave left the yard (we were outside the house), his girlfriend turned to Steve and asked ‘Do you want me to do you too?’  As Steve was struggling to find the word ‘No’, I was struggling to believe what was clearly true.  Dave’s girlfriend was not a girlfriend in the traditional sense.  She was a sex worker.

I really couldn’t believe it.  During all of the time we had spent with Dave, and during all of the conversations we had had about his girlfriend, I had not once considered the possibility that this relationship, this exchange, could be like the others.  Although I was sad for Dave, I learned an important lesson that day.  I learned that fieldwork and ethnographic analysis is often a delicate balance of trying to understand things from the point of view of your participant, while at the same time, triangulating that vantage point and looking for patterns in the data that provide a holistic understanding.

Leopard print bikinis and body exfoliation: Living outside my comfort zone

February 26, 2012 Leave a comment

Usually the things that I get to do in the field are sooooo cool. But my job also often requires me to do things that are outside of my comfort zone.  Seriously, I do things when I’m working that I would never do otherwise. It is almost like I have an alter ego that sometimes takes over when I’m in the field.  Outside the field I’m a somewhat antisocial, risk-averse, fussy vegetarian that likes the creature comforts of life.  But my alternate, fieldwork persona, we will call her Mel, is crazily social, fearless, impervious to embarrassment, above gastrointestinal upset, and generally unflappable.

When we were studying hair loss, I visited hair salons, talked to stylists and got my hair cut FOUR times.  When we studied tourism in Atlanta, I visited the Cheetah, a high-end gentleman’s club and also a world famous tourist spot.  I conducted in-context fieldwork while naked women danced all around me.  When we were studying infant nutrition in the Philippines I was offered an expensive delicacy for lunch that just so happened to be congealed cow’s blood!  Although I don’t drink alcohol, I’ve consumed cognac, homemade berry liquor, limoncello and lots of wine during fieldwork.

But last summer, I had one of my most interesting and challenging contextual mapping assignments.  It all began with a trip to Istanbul and a desire to understand hygiene rituals.  A logical stop in this trip was the local hamam (Turkish bath).  I was woefully uneducated about what to expect (this is actually a job requirement—taking an inductive approach so as not to have too many pre-conceived thoughts).

When I arrived in Istanbul, our local ethnographer called to arrange my visit to the hamam.  She told me they said I would need to bring a bikini.  It had been many years since I had owned a bikini, so I asked if it would be possible to do the exfoliation treatment nude (that is how I sometimes get massages and I thought this would be a similar experience).  I was imagining a private room, with towels and blankets to cover me.  My colleague informed me that the hamam was insisting that I wear a bikini but that I could purchase one there.

When I arrived at the hamam, I was given a box full of potential bikinis.  The one that fit best was a leopard print number that barely covered the essentials.  At this point I should tell you that non-fieldwork Melinda dresses pretty conservatively, usually in black.  No worries, however, Mel was there to put on the leopard print.

Once I walked into the room where the exfoliation experience was to take place, I realized why they had insisted that I wear a bikini.  It turns out that the exfoliation treatment happens in a communal area!  As I sat in the pool and waited for my turn, I experienced a rush of thoughts and emotions.  I went from being embarrassed and resentful of the leopard print bikini to being SOOOOOOO thankful that I had been forced to wear it.  I had rapid images of what WOULD have happened if they had granted my request to do the treatment nude.

My elation was short lived, however, once I had a good look at what was going to happen next. . . .  The exfoliation took place on a large marble slab where 2-3 women could lay at once.  The spa workers prepared each woman for her exfoliation by removing her bikini top and fashioning the bikini bottom into a thong.  Did I mention that my client was with me?  Yes, sitting in the pool, with my client, waiting for the eventual removal of the bikini top and conversion of the bikini bottom into a thong, Melinda and Mel began to have an internal dialogue.  Melinda was saying ‘this is so inappropriate and unprofessional.’  Mel was saying ‘don’t be ridiculous, this is fieldwork, you are just doing your job, pay attention to what is happening.’

Have you ever been so embarrassed that you felt like you were having an out of body experience? The exact moment this happened was during the actual exfoliation process.  There are a lot of details that I won’t share here, but did you know that when you visit a hamam, the exfoliation is so intense and vigorous that everything, and I do mean everything, is in motion?   Laying on the slab, without the shield of my leopard print bikini top, everything was wiggling and jiggling, every which way.  I had jiggles in places that I was well aware of, but also jiggles in places that I had no idea.  Luckily Mel wasn’t bothered.  She was fascinated by the whole experience. We left the hamam with a new leopard print bikini, perfectly smooth skin, and a bunch of interesting observations about hygiene, culture, and tradition.

Bread is Life

August 14, 2010 Leave a comment

By Agnes Brandt, An ERI Partner in Berlin

“Du  bist, was du ißt.” – “You are what you eat.”

This meaningful insight into the sociocultural importance of eating is not just recognized by health food and diet gurus worldwide. Looking at the place of food in a society conveys a deeper meaning about the way a society functions. The importance people attach to eating and food tells us something about their values, beliefs and life-choices.

Being a good ethnographer is about getting access to people’s emic perspectives, to the meanings the people themselves attach to certain behaviours and beliefs. In order to do so, we immerse ourselves in the everyday life-worlds of those we are studying. A part of this is to get to know the specific customs around the preparation, sharing and eating of food.

I especially love this aspect of research. I just love food and I always try to go with local delicacies. Okay, okay, I do admit to being limited to non-meat and non-fish products, but I really do try everything vegetarian that I can get my hands on…

Anyway…I easily adapt to local eating-culture by indulging in whatever foods are popular and available, and I usually do not miss my ‘own’ food (partly because I am German and German food is – let’s face it – not the most exciting food you can find on this planet).

However, there is just one food that I am excited about and that I do miss whenever I stay some where for more than just a couple of months – and this I share with most of my fellow countrymen and women. The food that I am talking about is bread.

Bread. What about it? The pinnacle of German food culture? Maybe. Maybe not. But one thing is for sure: German bread is the most sorely missed food by Germans worldwide, and we are very proud of our baking culture. In fact, we go to great lengths to find it whenever we leave our home country. German bakeries scattered all over the world are proof of this desire for ‘proper bread’, which is usually dark and heavy, nourishing and substantial. Hmmmmmm.

Yummy! I once read somewhere that we have the greatest variety of Brot worldwide! My favourite bread at the moment is spelt bread, but I also like the classical rye and the particularly solid black bread (Schwarzbrot). If I cannot find any ‘proper’ bread at all, I resort to Pumpernickel, a German black bread specialty available in shops even in far-to-reach places such as Samoa!

Here is something that I found difficult to wrap my mind around: I found out that some cultures consider bread ‘bad’ or even ‘unhealthy’. Now, here is a challenge for the bread-loving German anthropologist!

PS: We have the notion of “liquid bread”–Flüssigbrot. It refers to: beer (what a surprise).

Texting and Driving. Which is the primary act?

June 30, 2010 Leave a comment

by John Kille

Driving scares me. I have never been good at it. I’ve had a number of car wrecks, like a vicious one just two weeks after I bought my first car as a teenager. Yes, it was my fault. Driving has never been good to me either.

I have been hit by a car while riding my bike at ages 7, 12, 13, 28, and the other day had another close call (whew!). Most of those were not my fault.

Driving is quite commonplace in our road warrior culture and takes up a large part of our day. A necessity in most towns and cities, it’s become a standard technology in everyday life. As cities expanded and people drove longer distances, the car introduced various features to keep the driver entertained and informed while driving to work, home or grandma’s house. For example, the radio, seen as a distraction when first introduced, now is standard in every car. This was a change in the way a society viewed its technology, or a shift in the cultural norm.

As we have been studying technology in society recently (a study we did for ourselves, so don’t worry, we’re not violating anyone’s CDA), one of the most interesting cultural norms I have found is related to our new standard for doing more than one thing at the same time, particularly when it comes to technology, which is creating new opportunities for business.

People admitted to texting while driving, which is illegal in some states. It’s actually causing accidents in a lot, if not all, of them. One participant told us how she actually uses her peripheral vision for driving while she texts in the car, another explained her dad texts so much while driving they are afraid to ride with him, a third said she only texts while at stop lights, while someone else bragged she doesn’t need to look at her phone when she texts while driving. Yeah, we didn’t feel any better knowing that, but we all had to admit we’ve done at least some of that stuff ourselves.

Sometimes, as ethnographer, we listen to people tell us that they “sometimes” break rules, or don’t follow the rules, or don’t do things the way they are supposed to do, such as texting while driving. As professional strangers, we listen and learn about these cultural norms and watch them change, turn in either direction, slow down or speed up.

It is one of the interesting things about working as an ethnographer, watching and learning about cultural norms changing. And not getting hit by cars. I’ll expand on this changing, turning and slowing/speeding thing in a few.

The Culture of Vuvuzelas?

June 16, 2010 Leave a comment

My cousin did the Peace Corps in South Africa in the early 2000s. Last night while talking with her on the phone I asked about the history of the vuvuzela. She laughed and responded, “I didn’t see a single vuvuzela when I was in South Africa. I went to soccer games, cricket games and rugby games, and not once did I see those things. I only lived there for two years so maybe that’s one part of South African culture I didn’t learn about.”

Source: Reuters

Photo Source: UK Reuters

So that got me thinking, what exactly is the history of the vuvuzela? It’s certainly become big news as some fans argue for a ban on the horn while others say that doing so is ethnocentric. Curious, I did some searching and came across this post in a 2009 thread from the Language Log.

“The vuvuzela, contrary to revisionist history, is not a traditional South African trumpet, but the product of a very recent, corporatist inspired history. That’s problematic of course, but I would even be forgiving, if it wasn’t so annoying.”

The post led me to Football is Coming Home, where a 2009 blog post discussed how the first vuvuzela prototype actually came from the U.S., and that further inquiry traces its roots back to a Chinese woman’s basketball team. Apparently vuvuzela controversy began as South Africa geared up for the World Cup, and now the rest of the world is catching on.

Cultural emergence? Perhaps. Socially constructed? Absolutely. I am not here to debate the true origins of the vuvuzela or to under/overstate its importance in World Cup 2010 and South African soccer. Love it or hate it, the vuvuzela IS part of South African football culture, at the very least for this World Cup (and maybe even worldwide football culture after this), whether that culture began hundreds of years ago or 10 days ago. How about that?

Categories: Social Norms