Human Health Terrain Teams

Public health is the bastard of academia. It's ability to find models and ideas from a wide range of disciplines makes it such a great field to work in. Often, the military can shed some light on how to provided better care to those already sick, or to keep others from getting sick.

Napoleon's chief surgeon, Dominique Larrey pioneered the ambulance to more effectively clear the battlefield of wounded.

The transmission of Yellow Fever was confirmed by an Army Physician, Walter Reed. (Cuban physician Carlos Finlay theorized that the mosquito was the vector twenty years earlier.)

The importance of citrus was discovered by Dr. James Lind, who was in the employ of the British Navy.

Today, public health professionals who are working overseas who are finding difficulty facilitating their programs (and there are plenty of you out there), take note from the Military once more.

"In accurately defining the contextual and cultural population of the task force battlespace, it became rapidly apparent that we needed to develop a keen understanding of demographics as well as the cultural intricacies that drive the Iraqi population."
—Major General Peter W. Chiarelli, Commander, 1st Cavalry Division, Baghdad, 2004-2005

The US is fighting a bunch of someone's somewhere, and not seeing the sort of success that was expected of them. I do not intend to talk at all about American military excursions in Iraq and Afghanistan, other than their creation of Human Terrain Teams. (We will talk about Provincial Reconstruction Teams later.)



Human Terrain Teams are part of the larger Human Terrain System, which is charged with creating Human Terrain Maps. Basically, instead of looking for the enemy, a counter-insurgency war is often fought by winning hearts and minds, rather than military battles. In the US war on terrorism, destroying the enemy is relatively easy to finding them. (I say this with no military experience, but I don't think I'm inaccurate.)

There is controversy as to the role an academic anthropologist can play in a theater of war. The Vietnam War did something similar and created projects like the Phoenix Program, which one might not want to repeat again. I am reasonably certain that these points of contention do not apply to groups conducting medical or health related work, but I could be wrong, and would welcome comments of discussion on that topic.



By understanding more about the populations your fighting around, by interpreting their disputes, language, etc, your can more effectively employ their help to accomplish your goal. So, if your goal is to kill your Tali-buddies, or to convince people to wash their hands, you should familiarize with your surroundings as much as possible. Fortunately already their is a field of medical anthropology that does exactly this. I am curious how systematic or obligatory their efforts are in an applied setting, not just academic.

We see this in marketing: Sierra Mist wanted to distribute their product in Germany. Well, Mist is the German word for Shit. And this is just a simple translation...

From my limited experience, I see examples that land on both sides. On the one hand, academics who go out into the field are typically pseudo-aware that there are cultural forces at work that they need to harness. Perfect example is Paul Farmer and Partners in Health.

There are also many more examples of groups who go to a foreign country armed with their own set of goodwill and ideals (more than likely paternalistic, in the author's opinion) who might be able to accomplish their shot-term goal, but their contribution is more for their own reasons than the people.

-There are NGOs in Southern Africa who provide baby formula for HIV postitive mothers, so as to lower the chances of passing the virus to their infant. However, there are reports that down the road from the clinics are piles of unused baby formula because it is a sign and a stigma of being HIV positive. [Citation]

-The government of Burkina Faso wanted to implement a national health insurance the people could buy into. The program was an utter failure as no one bought into the prgram and it lost several thousand dollars, just in start up costs: the government would have been better off just giving everyone a few thousand dollars. Why did it fail? Because the marketing was geared toward the women in the household, who are not the primary purchasers. A look at a Guinness poster that displays "Black Power" in East Africa is an interesting comparison on why you might be better off hiring a marketing agent rather than an anthropologist! [Citation]

Of course the successes are plentiful as well, however, I believe that many projects might be aided with the employ of converted HTTs.

I am an expert in nothing but making snide remarks, however, I do believe that persons carrying out public health projects in other countries can learn a few things from the military's Human Terrain System. I would be curious if we have something similar in public health, and perhaps maybe we should make one.

Human Health Terrain Teams. You heard it here first.


FURTHER READING-

US Army HTS- http://leav-www.army.mil/fmso/documents/human-terrain-system.pdf

New Yorker Article- http://www.newyorker.com/archive/2006/12/18/061218fa_fact2

New York Times Article- "Army Enlists Anthropologists in War Zones."

Wired Magazine Article- http://blog.wired.com/defense/2007/07/when-anthropolo.html

A Blog from a former member of a HTT- http://iraqht.blogspot.com/2007/07/iraqs-human-terrain.html