Examining social determinants of food insecurity, common mental disorders, and motivations among AIDS care volunteers in urban Ethiopia during the 2008 food crisis 公开
Maes, Kenneth Charles (2010)
Published
Abstract
By mixing ethnographic and community-based epidemiological
methods, this
dissertation aims to illuminate the challenges facing AIDS care
volunteers in urban
Ethiopia, a setting characterized by low income, high rates of food
insecurity, and
ongoing scale-up of highly-active antiretroviral therapy programs.
Shortages of health
workers - widely recognized as the greatest threat to global health
- are addressed
throughout sub-Saharan Africa by using community volunteers.
Whether it is unjust
and/or unsustainable to rely on volunteerism in such settings has
become a major concern
for a widening group of social scientists and global health
practitioners. This dissertation
demonstrates that acute-on-chronic food insecurity during the 2008
global food crisis
impacted psychosocial health and motivations to continue
volunteering among AIDS care
volunteers serving local non-governmental organizations in Addis
Ababa, Ethiopia. This
dissertation also proposes a theory of how volunteers' pro-social
motivations are shaped
and sustained by local norms of reciprocity and empathy, as well as
by global group
rituals organized by the institutions that rely on volunteer labor
in rolling out
antiretroviral therapies in settings of chronic food
insecurity.
Participant observation was conducted in neighborhoods adjacent to
a large public
hospital in southwest Addis Ababa, including attendance at
volunteer trainings, caregiver
and care recipient homes, volunteers' reporting and planning
meetings, and volunteer
recognition ceremonies, over 20 months between May 2007 and January
2009. A
sample of 13 volunteer caregivers was recruited to complete a
series of semi-
structured interviews. In addition, a random sample of 110
volunteers from
two local NGOs was surveyed 3 times over 11 months in 2008. Surveys
included
measures of food insecurity and common mental disorders, care
relationships, and
motivations for being an AIDS care volunteer. Text analyses,
regression analyses, and
cultural consensus analyses were triangulated to test hypotheses
and interpret results.
Results indicate that volunteers faced unrelenting poverty, but
also built
positive, empathic relationships with others in their communities.
They also expected
divine rewards as Orthodox Christians caring for marginalized
people. Nevertheless, this
dissertation concludes that "volunteerism" is an optimistic and
loaded term that over-
simplifies the motivations of low-income individuals and
potentially masks a system of
unsustainable labor exploitation within AIDS treatment and other
development-focused
movements.
Table of Contents
TABLE
OF
CONTENTS
Chapter
1
(Introduction)
Examining health care volunteerism in a food-insecure world --
Page 1
Chapter 2
Food insecurity among volunteer AIDS caregivers: Highly prevalent
but buffered from the 2008 food crisis -- Page 36
Chapter 3
Food insecurity and mental health: Surprising trends during the
2008 food crisis -- Page 62
Chapter 4
Volunteer home-based AIDS care: Sustainability in the face of
chronic food insecurity -- Page 87
Chapter
5
"My stress is because I am not working." HIV serostatus,
food insecurity, and psychosocial health -- Page
111
Chapter
6
"We will continue volunteering, but how can we live with this
life condition?" Displacing the myth of the selfless community
health
volunteer -- Page 142
Chapter 7
The ritual basis of sustainability: Motivating the "untapped
volunteer spirit" in HIV/AIDS treatment programs in urban Ethiopia
-- Page 195
Chapter
8
(Conclusion)
What future for global health volunteer labor in sub-Saharan
Africa? -- Page 235
References
Cited -- Page
245
About this Dissertation
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