Procesos de construcción Objetivo

The thesis proceeds as follows:

Chapter Two consists of the literature review, which explores further the analytical concepts (introduced above) that are used to provide a framework for data analyses. Specifically, the literature examines global public health framing of risk factors for zoonotic disease and contrasts these framings with broader sociological perspectives of health risks, and which consider diverse perspectives on risk. I examine these debates in order to establish knowledge gaps, building on critiques of biomedical disease-based models, which are challenged by the fact that zoonoses are not always visible nor easily managed with the identification and addressing of the risk factors. I explore these approaches using the five analytical concepts explained above: risk, framings, narratives, health systems and health-seeking behaviour, in order to build a conceptual framework that emphasises lay people’s own experiences, with which I analyse the research findings from this study.

Chapter Three describes the methods and methodology that I used to carry out the study. It begins by laying out the epistemological standpoint from which the methodological approaches are drawn. The principal methodology used is ethnography together with mixed methods. This is also informed by principles of grounded theory, where epistemologies emerge from the research rather than pre-conceived opinions of the author. These approaches were necessitated by a desire to explore complex issues by means of methodological diversity. Survey techniques provided the sampling framework within which participants were identified for in-depth, qualitative research. The chapter ends with a discussion of my own positionality and ethics, and a reflection on the research process.

Chapter Four examines livelihoods, livestock and lay framings of risk. It begins by explores the broader risk landscape in Naiti more generally and examines daily life in the village in the context of complex risks. In particular, it discusses local livelihoods that are based on agriculture and livestock production and explores how seasonality impacts on these, producing many risks to people’s livelihoods. It also examines the diverse functions of livestock in WaArusha culture and human-animal interaction (when, where, how, whose, which animal species), including details of the type, intensity and duration of such contact across the spectrum of social differentiation, in order to build a profile of

differential susceptibilities and potential exposure to sick animals (and contaminated animal products). This chapter further explores gendered experiences and lay framings of risk, drawing upon examples from a wide range of herders to show emic diversity in risk perceptions, in order to understand how risk perceptions, play out in people’s everyday life situations, and to illuminate how people live with risk. The conclusion revisits the argument about risk being plural, gendered, and situated within people’s livelihoods, practices and belief systems, and the need to broaden approaches to studying zoonotic risks.

Chapter Five explores the numerous and interconnected ways in which people interpret febrile illness symptoms in both people and livestock. I draw from the data to unveil the complex network of actors and factors that are involved in constructing lay aetiologies of febrile illness in Naiti. Senior male elders and mothers-in-law form an important part of therapy management groups, and their accrued wisdom is mobilised to reach an agreed diagnosis in the event of severe illness. Locally, illness, in the form of fever, is thought of in a number of different ways. It can be a normal and a regular occurrence that people need not worry about, or it can be a symptom of more serious illness that needs treatment, a spell cast by a jealous neighbour or a social sanction for dishonouring ancestors and god, or perhaps it is unusual, and an expert is required to help people understand (and treat) it. I show that, whereas clinicians may approach treatment based on a specific disease, lay people in Naiti conceptualise febrile illness in ways that are complex and that carry plural meanings. These meanings, which draw on indigenous concepts, are co-constructed from and with biomedical terminology, and this chapter therefore argues for broader ways of approaching zoonoses. It advocates involving local people themselves in constructing knowledge about illnesses and their aetiologies, so as to design zoonotic disease control strategies that are culturally appropriate and reflective of the lived realities of agro-pastoralists.

Chapter Six builds on Chapter Five to explore people’s responses to episodes of febrile illness and how healthcare-seeking is approached. I highlight the nature and range of healthcare options (both formal and informal) that are available to Naiti residents, before analysing the ways in which people engage with them by exploring local health-seeking behaviour within pluralist health systems in Naiti. I show that, people’s behaviours and actions in pursuit of health and well-being are not linear and are made complex by collective approaches to health-seeking that go beyond an individual patient or a single

illness episode. I argue that, whereas health systems literature may emphasise conventional barriers to health-seeking, such as affordability of healthcare costs, poor infrastructure and poor healthcare quality, in Naiti, these categories are just some among more powerful determinants of health-seeking, such as inter- and intra-household power dynamics that dictate and define what is a barrier and what is not. I demonstrate that the mere availability and accessibility of health facilities does not mean those who can afford them will choose to use these facilities; rather, families choose those options that are trusted and practicable even when they are not necessarily the most effective treatments. I argue for a consideration of these dynamics, and their incorporation into research on and interventions in lay health-seeking behaviour.

Chapter Seven concludes the thesis by revisiting my research questions and how the study has answered them. I revisit the role of milk, meat and medicine in local epistemologies of risk and the implication of the findings for further research on zoonoses control strategies in low-resource settings. Animals and their products, as with medicine and how it is used, have become subjects of many global public health debates; they evoke images of unsafe foods and drug-resistance in many people. However, there are many competing and ambiguous ways in which these products also symbolise what is good for healthy people, as well as being culprits in the contraction of diseases. Milk, meat and medicine are thus both enablers and inhibitors of good health and must therefore be carefully understood in order to fully appreciate the complexities of zoonoses causality in pastoralist and agro-pastoralist settings such as Naiti. I argue, therefore, that there are no simple causes of zoonoses, or indeed simple solutions to controlling zoonoses, especially in communities where people, livestock, livelihoods and the environment are intertwined in ways that create harmony and a “oneness” of social cohesion. These complex interactions challenge what experts might characterise as “risky events”, which are quite often part of everyday life, which produces risks that people have to constantly manage, with few resources.