PROPUESTAS CURRICULARES PARA LA ENSEÑANZA DE LAS CIENCIAS

In their discussion regarding participatory action re- search, Cornwall and Jewkes soberly caution, “control over research is rarely devolved onto the community, nor do the communities always want it… participatory research is not a simpler alternative…working with lo- cal peoples is far from easy (1994:1672-73). What is it that really can inspire and motivate otherwise gen- erally unmotivated health providers working in com- munities where there are language and cultural barri- ers that place substantial breaches between them and members of the local population? And what would draw out the more traditional individuals in town, who exert authoritarian control over families, where women and children may be barred from seeking health care for serious illness and even preventable disease vaccination? What can bring together these two important strata from both sides of the health care dynamic in these communities?

4.1 Establishing necessary cognitive and cul- tural congruities to engage health workers and community participants in common goals and action tasks.

Traditional epidemiological research generally involves a process of data collection carried out under unified protocols, and the data then are up streamed, unidi- rectional from local community to the national level,

along the way. One way to dynamically engage people at the local level in a wider participatory approach is to combine experimental formats of participatory ac- tion research (PAR) with the development and piloting of appropriate instructional technologies (IT) materi- als, including the use of native languages and cultural models that make sense from the people’s ethnomedi- cal perspective. The two efforts can be linked within a system where the formal health institutional structure links local community organizations, families, and in- dividuals in PAR activities that are based on meaning, local terminology and indigenously construed biologi- cal ‘ethno-models.’

4.2 Suggested ‘fusion’ methodologies for con- ducting participatory research for discovering and enabling codification and classification of native categories of knowledge

In the case of vaccination, typical PAR techniques, such as community mapping are not as appropriate as they are for malaria and dengue, for example. For detecting and engaging local community members for wider participation in vaccination programs, the type of mapping that could be called to order would be exercises in cognitive mapping; this effort could yield a sense of semantic constructs and native tax- onomies related to vaccine-preventable disease that would be useful for constructing informational mod- ules (through IT, in local languages, using grounded ‘ethno-models’) for broader community participatory engagement.

Cognitive mapping is a methodology of ‘ethnoscience’ that can be carried out with a team of community/ health unit participants without a great deal of train- ing. Who has to be trained is the central researcher who coordinates the activity, but by and large, health auxiliary persons can be trained to use a semantic do- main elicitation technique to obtain terminology in the local language that lends itself to be ordered by com- puter software programs. Weller and Romney (1990) describe the process well, and the software program Anthropac® adequately handles free-listed data, and

plotting on graphs aids in visually grasping termino- logical clustering, that with some additional qualita- tive inquiry, can gain a sense of ethno-taxonomies of diseases.

Ethnoscience was borne out of ethnomedical research (see Frake 1964) and linguistic research on color categories (Concklin 1955), ethno-botanical (Berlin, Breedlove,and Raven 1974), and ethno-zoological classification (Ellen 1993). The methodology and use of multidimensional scaling software, which greatly enables an otherwise tedious analysis is taught at principal schools of public health in the United States. What hasn’t been adequately expanded upon is apply- ing it to the participatory research context where the method can used to engage individuals in a discovery approach to local concepts of body, health and dis- ease. In a recent study (Richards 2007), Guatemalan Mayan school teachers received a two day training, and they subsequently interviewed boy and girl stu- dents and adult women and men, eliciting ‘free-listed’ terminology on body parts (external and internal), dis- eases, and medicines—in addition to another broad set of semantic domains, including animals, foods, geo- graphic features, climate, etc.

With a large enough sample, the computer software develops a matrix, entailing a corresponding to nu- merical value for each term mentioned, and its ag- gregate ranking in order of mention and frequency of occurrences across all speech samples. In one of the more interesting exercises, the clustering of in- ternal body part terminologies from third grade girls from five schools in the Mam region (N=80) yielded interesting associations that correspond to the eth- nographic literature on Mayan concepts of body. For example, in the diagram below can be seen the clus- tering of ‘heart’ (corazón) and ‘brain’ (cerebro); ‘lungs’ (pulmón), ‘veins’ (venas), and ‘our bones’ (qbaq’il). The clustering of ‘liver’ (hígado) with ‘soul’ (qanmi) is con- sistent with the notion that the soul sits in the body inward from the navel, close to the liver (see Guiter-

By undertaking a methodology, such as the one de- scribed above, it is possible to engage broad participa- tion in structured and guided activities that employ linguistic and cultural models order to develop under- standing of native constructs of process models for expanding broader conceptualizations of health. The teachers who participated in the study were not only enthusiastic about the findings, but as participants who were led down an inductive research path, they felt that their work corroborated what they admitted were vague concepts told to them by their parents and grandparents. Most importantly, they pointed out that prior to this experience, they felt they were incapable of undertaking social science research that could be applied to constructivist activities in the classroom. 4.3 Pursuing “Inward and Across” Communi- cation Protocols to Engender Successful and Motivational Action (through Constructivist Principles)

Tape recorders and computers are not a pre-requisite for engaging in this type of PAR. After the experi- ence, many of the teachers who participated in the free-listing of domain-bound terminology indicated that they subsequently incorporated the technique in general semantic ‘webbing’ exercises in the classroom in order to stimulate classroom activities. What they carried with them first and foremostly, was an under- standing that native taxonomies do indeed exists, and that they operate in logical ways. Similar types of ac- tivities could be experimented with in the context of health service centers and in a community participa- tion model. Creating awareness about people’s no- tions about health, especially their fears about disease and their expectations from health care providers, and engaging them in actions that will lead to better prevention of disease and efforts to promote hygiene and environmental sanitation can be built upon these inductive methods.

However, even though the inductive ‘discovery’ ap- proach to the methodology is fairly simple, and can be carried out at relatively low costs, there are limitations

methodology in key areas (and in Guatemala, for ex- ample, key areas must be one in at least every ethno- linguistic region, and optimally more in the larger language areas where major dialects exist), must be a communications effort that remains connected to community participation, but not necessarily so in- tensely as having members of vast numbers of local health units, NGOs and community members doing primary ethnomedical research. The information that is obtained in these exercises can be synthesized and packaged into interactive IT for a more broadly based program of interactive communications between health care agents and local community members. While there are many ways to develop community education materials, new IT formats permit making user-friendly modules. The technological dimension, combined with the incorporation of a team of trained individuals sensitive to cultural features of rural soci- ety, can well enable the development of sound motiva- tional materials for rural and urban communities that simultaneously engage people about specific courses of action. In Guatemala, currently under development are interactive there are some IT programs developed for health and agriculture that engage community participants in their own languages, in addition to Spanish. While some approach an embedded usage of culturally appropriate cognitive models, there is more work that needs to be done in this area. For this reason, the development of IT can interact with PAR, and can generate a dynamic feedback cycle for delving more deeply into people’s deep structure eth- nomedical models through appropriate linguistic and cultural inquiry, such as the ‘ethnoscience’ technique mentioned above.

Other techniques for mobilizing action through instru- ments of village problem mapping exercises, games, enacted drama sequences, etc. can be added as part of an array of PAR tools to bond health care to lo- cal communities. One of the keys to effectiveness of these action-oriented programs is clear identification of problems at the level to which they are significant

to identify problems surrounding health and illness among Mesoamerican indigenous and impoverished marginal populations should be carried out on ex- perimental bases, and the information should become reformulated as part of a process in the PAR model. As local cultural knowledge surrounding vaccine pre- ventable disease is properly synthesized into the in- teractive PAR model, it can then be reformulated and packaged into useful and appropriate IT modules. Although in rural Guatemala today, and even if fairly remote communities, there are computer labs in sec- ondary schools and even internet cafés, and surpris- ingly, these can have internet connection. But even stand-alone systems, using the developed interaction- al materials would be a great aid for health workers as a point of departure for carrying on the necessary face-to-face work, the door-to-door follow through of visiting a mother who it is known has not vaccinated her baby yet, or slipped out of cycle in the required se- quence. Building on the ISIS model and those of other successful NGO interventions that are partnering with the Ministry of Health in Guatemala with an array of sound PAR methodologies, and a vital combination of fieldwork and production and testing of IT materials as auxiliary tools could bring about some formidable changes in the way people in impoverished, marginal- ized, and culturally distinct settings could respond to the offer of vaccination services.

4.4 Measuring Results and Developing Forma- tive Evaluation Protocols

In addition to general monitoring and evaluation through the standard epidemiological protocols, the PAR work necessarily entails a good M&E process cou- pled with the actions, which as more a qualitative area of work, requires a tailor made system. However, this is not difficult to construct, provided that the proto- cols be developed and tested alongside the develop- ment and piloting of the PAR models.

Since there would be various areas of concentration in the community action work with the vaccination pro-

a tiered extension that incorporates IT modules that are developed out of the PAR nodal communities, the M&E system will have to include a relational database for the activities. Fortunately, the Platform for Social Investment is already a powerful geographic informa- tional systems foundation, linked to the Ministries of Health and Education, the National Statistical Insti- tute, the General Secretariat for Planning, the Asso- ciation of Municipalities, so the M&E system could be coupled to broader levels to carry out more complete analyses of the effectiveness of the interventions. 4.5 Establishing “Upward and Outward” Com- munication Protocols based on Action-Oriented Research and Effective Implementation

Finally, as part of an overall M&E system, but also one for outreach in the interest of promoting alliance for- mation and leveraging, the processes, successes, and pitfalls must be communicated beyond the immediate spheres in which the MHI operates. There will be cel- ebratory outcomes, and these need to be adequately divulged in order to replicate the model in other ar- eas of intervention—both within the MHI, in the three remaining pillars of maternal-child health, nutrition, and malaria/dengue, as well as other general areas of health promotion in the region, as well as beyond the region.

5. A Suggested Methodology for Conduct-