Living in a tent camp in Tarangire National Park, it didn’t take Nidal Kram long to see that she would have to find another topic for her independent field project.
Along with her classmates, she was embarking on the six-week fieldwork phase of last fall’s ACM Tanzania: Ecology & Human Origins program. Kram, a biology major at Lawrence University, planned to gather data on the types of parasitic worm infections found among the local Maasai people and the medications that would be most effective in combating the diseases.
Nidal Kram (left) at a clinic where she conducted interviews for her independent project.
The project she envisioned – based in large part on analyzing samples under a microscope – quickly proved to be impractical in an area where local health clinics did not have basic lab facilities, or even electricity and running water.
So Kram changed the focus of her project, and what she discovered set her on a path that will take her to a graduate program in public health at Emory University this fall.
Study of medicines takes both biology and anthropology
“When I first went and started doing my project, I was looking at it purely from a biological perspective,” Kram recalled. “Then when I went to speak to people about medications that they were using, it turned out that it was interconnected with Maasai culture and what they believed about medicine and how it works in the body. So it was really difficult to do the biological part without recognizing the anthropology behind it.”
The connection between science and culture brought Kram’s minor fields of study – anthropology and ethnic studies – to the fore. The cultural context in Tanzania had particular resonance, as well. Kram was born in Sudan, and this was the first time she had been in Africa since her family immigrated to the U.S. and settled in the Twin Cities when she was 11 years old.
|See a video of Nidal Kram talking about her experience in Tanzania at the 2012 Student Symposium on Off-Campus Study!|
“The theory or the concept of analyzing cultures in their context, that’s kind of how I’m living my life,” she said. “I think that’s what drew me to anthropology and ethnic studies specifically, because we do ask those questions and deal with those concepts so often.”
Kram decided to study the availability of resources in the health facilities in villages and towns around Tarangire National Park, as well as the residents’ understanding of the causes of infection and treatments used to cure and prevent parasitic worms.
She gathered her primary information through 25 semi-structured interviews, carried out with the help of an interpreter. Nineteen of the interviews were with Maasai women and men who lived in the area and six were with health care workers at clinics and dispensaries that served the communities.
What Kram found was that a variety of factors – including a lack of health care facilities, diagnostic equipment and supplies, and training for medical staff, as well as misinformation among residents – raised barriers to treating parasitic worm infections.
Nidal Kram with a group of Maasai women she interviewed for her project.
“I realized that it’s an entire feedback mechanism, almost, like a loop,” she said. For example, poorly trained health care personnel or a lack of medicine can lead to incorrect dosages being given to patients, which in turn makes the drugs less effective, which in turn leads people to try traditional herbal remedies for the infections.
Through the interviews, Kram learned that Maasai adults, especially men, were reluctant to admit to having worm infections and to seek medical help for them. There was also, she said, a belief among a number of women she talked to that having a parasitic infection was just a part of life.
“There are just so many complications that I didn’t think about,” Kram noted, “and when I went to do my research project, I saw those complications.”
Life-changing, in unexpected ways
When Kram returned to Lawrence after the Tanzania program, she dove into the science side of the equation by focusing her senior project on two antiparasitic medicines used in the area around Tarangire for worm infections – mebendazole and albendazole. That project helped her understand the biology of the diseases, the effectiveness of the two medicines, and issues such as drug resistance.
“I thought that I would need a Ph.D. in order to continue this research,” Kram said, “but when I realized that there was so much anthropology behind it, I thought a master’s in international public health would probably be best to close that gap in understanding culture and medicine.”
She expects to begin her graduate program at Emory with laboratory research, and then follow that up with a year in the field, possibly in Tanzania, before returning to campus to complete her thesis. Science will meet culture.
“I think that the trip [to Tanzania] changed my life in ways I didn’t expect,” said Kram. “It made me think about health in general – global health. It literally put me in a place where I could see and feel what I wanted to do for the rest of my life. And for that I’ll forever be thankful.”
Photos are courtesy of Nidal Kram.