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Social anthropology in INCAP
Richard N. Adams
Abstract
Social anthropology at INCAP evolved through a series
of stages. The initial work in the 1950s was concerned
with finding ways to make INCAP nutritional research
more effective. In a second phase, emerging in the 1960s,
anthropology examined the nutrition process in the
population, especially as it was manifested in child care
and feeding, lactation, and population growth and in the
relation of economic process to nutritional progress. In
the 1970s, anthropology once more became an adjunct
of nutritional research. Anthropological awareness was
introduced into project planning, and field studies were
undertaken by way of shaping the research process to
work in accord with local realities. In the 1980s and
1990s, there was a shift away from more descriptive
research to research directed to supporting and facilitating specific nutrition and health behavior change.
Key words: Guatemala, Maya, nutrition, public health,
social anthropology
Introduction
In 1949, the field known as “applied anthropology” had
been in development for some decades. Social anthropology, of which it was an outgrowth, developed as a
branch of Western learning and principally evolved as
the study of non-Western peoples. In colonial countries
it often carried a colonial stamp. At the time of World
War I, it was not yet conceived of as a particularly
viable colonial tool and was not clearly incorporated in
Richard N. Adams is Rapoport Centennial Professor
Emeritus of Liberal Arts at the University of Texas at Austin,
Texas, USA.
Please direct inquiries to the author: Richard N. Adams,
1801 Lavaca 6A, Austin, TX 78701, USA; e-mail: rbadams80@
yahoo.com.
152
the colonial process. In the United States, the leading
anthropologist, Franz Boas, was seen as a German alien
menace, and Great Britain’s future anthropological
leader, Bronislaw Malinowski, who was later to become
prominent in applying anthropology, spent the war
years in the Trobriand Islands. By the 1930s, however,
ethnographers in various British colonial areas and in
the United States were being recognized as possibly
useful adjuncts to the process of the state’s governing
of non-Western peoples. In 1942, the Journal of Applied
Anthropology (later Human Organization) was founded
and an examination began into the nature of the emerging discipline. By the end of the decade, a code of ethics
[1] had been crafted.
Social anthropology began in Guatemala as an
almost totally foreign interest and had nothing to do
with governing people. Scholarly interest was the principal motivation behind the arrival of Oliver La Farge
II and Douglas Byers in Jacaltenango in 1927 to study
the Mayan “Year Bearers” ceremony [2]. They were
followed by others [3] in the 1930s with similar curiosity. Among these were Sol Tax and Robert Redfield,
who were important because they were responsible for
introducing Guatemalans—Antonio Goubaud Carrera,
Juan de Dios Rosales, and Augustín Pop—to contemporary ethnography.
Local interest in Indians was framed in various
forms of indigenismo, a concern with the place and role
of the Mayan population in national life and usually
promoting a conflicting ideology of assimilation and
segregation. For President Jorge Ubico, the dictator of
the era, the Maya were a people who were supposed to
be dedicated to agricultural production and soldiering.
It was national policy to promote their political and
economic segregation as a labor pool, but they were
also expected to give up their culture and be assimilated
into the national society. There were others, however,
including Goubaud Carrera and, especially, Joaquín
Noval, who, under the revolutionary governments
of 1945–54, saw the issue to be neither assimilation
nor segregation [4]. Rather, they were concerned to
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Social anthropology
find ways of strengthening the economic power of
the Maya and incorporate them into the national
society without destroying their society and culture.
When Arevalo became president in 1945, he directed
Goubaud Carrera to found the Instituto Indigenista
Nacional (IIN), and then promptly sent him as ambassador to Washington.
Social anthropology and INCAP in the 1950s
Before coming to Guatemala to develop the Institute of
Nutrition of Central America and Panama (INCAP) in
1949, Nevin Scrimshaw felt that anthropology could be
important in international public health programs. He
correctly recognized that Central American cultural
norms posed a special challenge to the development
of Western public health. Not only were public health
practices poorly developed in the region as a whole,
but the region contained many different ethnic groups
whose cultures and languages made communication
difficult. Guatemala was a special case, because over
half the population were Mayan Indians, a large proportion of whom were monolingual Mayan language
speakers. In fact, Scrimshaw’s perception had been
anticipated by the work of Juan de Dios Rosales and
Augustín Pop in 1945. In March of that year, these two
anthropology assistants of Sol Tax carried out a nutrition survey in the Central Highlands.*
Prior to this time, there had been little use of anthropology in public health programs. Scrimshaw, therefore,
sought a meeting with Margaret Mead, one of the leaders in the development of applied anthropology. She
strongly encouraged him to pursue this interest but
recommended that he not get “just any anthropologist,”
because most were not interested in the application of
their findings.** When Scrimshaw arrived in Guatemala,
Goubaud Carrera was in Washington. Unknown to
Scrimshaw, however, the ambassador had requested the
Smithsonian Institution to send a social anthropologist
to Guatemala under the Institute of Social Anthropology (ISA) program to teach in the University of San
Carlos (USAC) and provide technical assistance to the
Instituto Indianista (IIN).
The ISA proposed me for the work, and with Goubaud Carrera’s approval, I arrived in Guatemala at the
end of 1950, having recently completed a year of field
research in the central highlands of Peru. Goubaud
Carrera and the then Dean of Humanities at the University of San Carlos, Hugo Cerezo, had scheduled
me to provide a course in social anthropology at the
* Augustín Pop’s diary notes from this nutritional survey
are in the Microfilm Collection of Manuscripts on Middle
American Cultural Anthropology in the University of Chicago Library.
** From a talk by Nevin Scrimshaw at the 1998 meeting of the
American Anthropological Association, Chicago, Illinois.
university and to assist in the development of programs
in the IIN. When Scrimshaw heard of my presence, he
invited me to work with INCAP to solve some problems they were having in research in communities in
the Department of Sacatepequez. Although my initial
obligations were to IIN and USAC, it was clear after
one term of teaching that USAC was not interested
in sustaining courses by a foreign anthropologist, so I
shifted my efforts to work with INCAP.
My immediate task was to aid research teams in
certain Mayan Indian communities where INCAP
programs were doing research on the improvement
of nutrition and public health [5–11]. The goals of the
projects had been defined by the scientific personnel
of INCAP and were not questioned. I decided that, in
order to provide the INCAP practitioners with a better
understanding of the cultural process within which
issues of health and nutrition were understood in the
communities, it would be necessary to study the community’s beliefs and practices associated with illness.
Three rather different kinds of problems emerged
in the research. Most classically, there were important
differences in the cultural perception of health and
medical processes [12]. It developed that many Maya
were rejecting the work of the project because of the
way they dealt with blood. In the Mayan perception,
blood was not necessarily regenerated, and the taking
of blood for tests permanently deprived the individual
of that amount of blood. It was suggested that medical
personnel show great restraint and diplomacy in the
taking of blood [12].
The core problems, however, tended to arise from
social relational issues. These were generally of two
kinds: those inherent in the community and those
engendered by the presence of project personnel. The
first derived principally from the existing divisions
within the communities. These included the problems
between Ladinos and Indians, and between residents of
different barrios or neighborhoods. There was also an
internal split between progovernment villagers, called
“communists,” and the opposition, called “anticommunists” [12]. Finally, villagers clearly distinguished themselves from outsiders, especially North Americans.
As the INCAP activities became identified with
one of these divisions, they were vulnerable to being
rejected by the other. The principal problem with
respect to North Americans concerned giving feeding
supplements. In one village, this was interpreted as
intending to fatten the children in order to take them
the United States to be eaten [12]. Another set of social
relational problems developed around project personnel. Medical doctors, especially, tended to be authoritarian and insensitive to Indian villagers. In some part,
this was a manifestation of urban superiority over the
rural, but it also reflected a traditional Ladino disdain
for Indians [12].
An additional consequence of my cooperation with
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R. N. Adams
INCAP was the preparation of a textbook in applied
anthropology. Confronted with the need to give courses
to public health workers—nurses, dietitians, health
educators, and doctors—I found no adequate teaching
materials available in Spanish and therefore prepared
a textbook in 1953 that was mimeographed and used
in a number of courses, both in INCAP and in IIN. A
decade later the Seminario de Integración Social Guatemalteca issued a printed version of this text, and it saw
considerable use in courses in social work and general
anthropology [13]. It also later became the object of
attack by some Guatemalan social scientists for its
failure to adhere to Marxist concepts of sociology.
I was asked to carry out studies in two villages—
Magdalena Milpas Altas and, somewhat later, Santa
María Cauqué—where parents were resisting the
INCAP research. The INCAP program involved an
experimental design that required that schoolchildren in each of several villages receive a different
combination of nutrients and submit periodically to
examinations to determine their nutritional status [5,
14]. INCAP was working in a number of localities,
however, and as other problems arose, my time was
not sufficient, and it was recommended that additional
anthropological personnel be contracted. Two anthropologists, Raymond Scheele and Judith Freedman,
came to work on this basis.
Scheele worked for a month in the village of Santo
Domingo Xenacój. His report [15] revealed the high
degree of suspicion with which the outsider workers
were viewed and showed that this was exacerbated
by serious social relational problems in the village.
INCAP’s research was being seriously and intentionally opposed by various village leaders who saw in it
a threat to their hegemony. Overt efforts were made
to cast doubt on the outsiders, especially the “gringos”
and the “blancos.” This was now intensified by injecting “communism” as another related threat. Not only
INCAP personnel, but also schoolteachers, came under
suspicion and overt opposition. Additionally, Scheele
encountered issues parallel to those found in other
towns, such as the concern with the extraction of blood
and giving of injections. The opposition was not merely
a question of campesino suspicions, but was manipulated by some town Ladinos who saw their control over
the community as being threatened by INCAP activities. Ladinos had traditionally exercised control over
commerce and much of the land, and even extended it
to the ownership of saints that the Indian population
needed for their ceremonies and religion.
In 1955, INCAP studies had made it clear that
infant multideficiency syndrome, by then known as
kwashiorkor, was a major killer and constituted a clear
challenge for an institute of nutrition. It was decided
that a woman anthropologist would be more likely to
find out the problems faced by mothers, and Dr. Judith
Freedman was invited to undertake a study. She worked
in Guatemala from August until the end of December
1955 and left a report [16] that successfully clarified
many of the problems.
Freedman visited many of the villages under study,
but more specifically divided her time between a
coffee farm in Escuintla, the agricultural village of San
Lorenzo el Cubo, and the hospitals in Guatemala City.
Although there was an awareness among staff about
some of the social issues her study highlighted, Freedman’s research clearly drew attention to the central
problems involved: that mother’s milk was important,
but more attention needed to be paid to increasing
other food supplements. When diarrhea appeared,
feeding was further reduced and the condition was
exacerbated. Hospitalization included no educational
efforts to enable the mothers to learn that the basic
problem was nutritional and how to deal with it.
On the positive side, the villagers were interested
in food and were not resistant to new diets if they
were presented in a convincing manner. In June 1955,
Nancie Solien (later de González), a North American
dietitian who had just finished an MA in anthropology,
contacted Scrimshaw and, with his encouragement,
arrived in Guatemala to undertake summer research in
cooperation with INCAP. She worked in Santa María
Cauqué and thereby began an informal association with
INCAP that ultimately led to her joining the INCAP
staff. The association was immediately fruitful, as she
published her first paper jointly with Nevin Scrimshaw
in 1957 [17]. From 1956 through 1957, she did doctoral
research in Livingston on the Garifuna, then generally known as the “Black Caribs,” and returned to that
theme from time to time over subsequent years. She
returned in 1960 to take up a permanent post.
INCAP anthropology in the 1960s
The work by Scheele and by Freedman and Adams convinced INCAP that it needed a regular anthropologist
on the staff. In keeping with the original goal of making
it a Central American institution, this required finding
a Central American anthropologist. By chance, in the
summer of 1957, Alfredo Méndez Domínguez, then a
student at the University of Chicago, had returned to
Guatemala looking for support to carry out his doctoral
field research. INCAP had an established practice of
supporting the graduate training of its staff and decided
to do this for Méndez Domínguez. They offered to
underwrite his doctoral fieldwork and the writing of
his dissertation so that he would then join the staff.
Consequently, after finishing his doctorate, Méndez
Domínguez joined the staff in 1960 as its first full-time
Guatemalan anthropologist, and in 1962 he headed up
the Sección de Antropología. In 1964 anthropology was
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Social anthropology
elevated to a separate Servicio.
His first nutritional contribution appeared in 1962
[18] and was derived from data that he had collected
while doing his doctoral research in Zaragoza, an old
Ladino town in central Chimaltenango. It dealt with
the economic reasons for the scarcity of corn, meat,
and eggs in the upper and lower economic strata of
Zaragoza and was innovative in bringing attention
to the nutritional consequences of differences in economic strata in a Ladino rural population. It explained
and related a higher infant mortality to the scarcity of
corn, meat, and eggs in July through September.
Later, Méndez Domínguez collaborated with the
Inter-American Institute of Agricultural Sciences (Turrialba, Costa Rica) in a study of innovation and adoption of foods and medicinal drugs in five villages near
Guatemala City. The findings generally confirmed earlier and parallel studies in Colombia, Costa Rica, and
Peru. Adoption was positively correlated with higher
education, higher standards of living, and younger age.
Moreover, adoption of novelties was closely dependent
on kin connections, especially between mothers and
daughters; daughters tended to do what their mothers
did [19]. The association with Turrialba also encouraged Méndez Domínguez to investigate the processes
of diffusion and led to a study of the patterns of the
spread of innovations in the five communities. He
concluded that the pattern was quite different from that
to be found in areas with greater access to information
media and where social change was a dominant process [20].
In the same decade, Méndez Domínguez joined in
an ambitious project to study the state of nutrition in
all of Central America, from 1965 to 1967, in which
specialists in health, agriculture, biochemistry, dentistry, dietetics, hematology, parasitology, statistics,
anthropometry, and sociology collaborated in the study
of some 23,000 individuals from 3,800 families in 190
rural communities [21]. Among Méndez Domínguez’
contributions was a “sociocultural index” based on
housing, sanitary facilities, conditions of cohabitation,
food production, family income, schooling, mass media
exposure, and occupation.
On the basis of this index, the populations were
divided into three socioeconomic levels—low, medium,
and high. Three biochemical–nutritional characteristics (nonessential/essential serum amino acid ratio,
riboflavin urinary excretion, and serum ascorbic acid
and cholesterol concentrations) were analyzed, and
some indices showed a marked advantage of families
in the ‘high’ sociocultural group. Some relationship
was also found between sociocultural level and mortality in children 1 to 5 years of age. However, there
was considerable variation among countries [22]. The
study, done in collaboration with the Interdepartmental
Committee on Nutrition for National Development
(ICNND), covered a wide range of clinical and anthropometric data and resulted in some 30 papers and 10
theses [23].
Méndez Domínguez’ participation in the studies of the five Guatemalan villages and 190 Central
American communities led his career at INCAP along
a somewhat different trajectory than had characterized the work of his predecessors. He undertook
relatively little of the more traditional ethnographic
fieldwork and resorted more to questionnaires and
statistical differences among diverse segments of the
populations being studied; much less time was spent
in ethnographic research. A by-product of this change
of emphasis led Méndez Domínguez to be more sensitive to methodological issues. He observed that, despite
sociocultural studies, “The relevance of sociocultural
aspects in the introduction of new foods contrasts
with the little use they make of the existing knowledge
and techniques available to them” (translated from the
Spanish language original) [24]. It would be misleading, however, to think that Méndez Domínguez did not
appreciate the more classical field approaches. Later,
as a professor at the Universidad del Valle, he sent out
many students to study and collect data on sickness and
curing, a summary that he published in 1982 [25]. In
1966 Méndez Domínguez left to work in Costa Rica,
but he has continued his interest in problems of health
and nutrition.
Upon completion of her doctorate, Nancie González
initiated formal employment with INCAP in 1960 and
remained until November 1964. During this era, she
undertook a number of empirical field studies that
expanded both the themes already examined and the
variety of populations under study. Although she continued to develop the study of folk practices initiated in
Adams’s work, she more specifically expanded the use
of anthropology in a number of important directions.
González’ work in nutrition and child development
explored ideas on what constituted illness in children.
She clarified that even where dietary practices might
be generally satisfactory in Indian communities, the
appearance of infant or child illness resulted in the
withdrawing of most solid foods, especially proteins,
resulting in severe deficiencies and, at worst, kwashiorkor [25]. She also devoted considerable time to the
study of maternal and child care, including weaning,
lactation, and menses. An important contribution
resulting from these studies was the recognition that
traditional Maya tended to wean at a much later age
(averaging around 18 months) than did acculturated
Maya and Ladinos. This made the latter vulnerable to
becoming pregnant sooner than was the case where
weaning was delayed. Thus weaning practices could
influence the birth rate [26].
González’ work extended the study of these topics
beyond the Mayan populations of Sacatepequez. She
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R. N. Adams
began to research the process of nutritional acculturation of Indians to clarify what kinds of changes were
taking place in the adoption of Western urban practices,
shifting interest from the heavily Indian focus of early
INCAP work to the study of rural Ladino populations.
Of particular importance was her attention to urban
populations, both Indian and Ladino. Additionally, her
interest in the Garifuna peoples of Livingston revealed
that nutrition and related health patterns among the
Garifuna are quite different from most of the Spanish
and Mayan patterns [27]. However, although their general level of nutrition was poor, illnesses were almost
universally ascribed to human or spirit interventions
and were not connected with nutrition. She also collaborated with Dr. Juan José Hurtado, whose medical
practice specialized in pediatrics, to study breastfeeding
in urban middle- and upper-class Ladino populations.
Hurtado was also carrying on research in the Indian
community of San Juan Sacatepequez. In general, the
popular understanding of the relation of food to health
was defective in most populations. Among Indians,
adequate diet was withheld from sick children. Among
urbanites, food was seen to be important for stature,
but that was about the only way that it was seen to be
directly related to health [28].
A novel finding in which González was instrumental
was of sickle cell trait among the Garifuna population
of Livingston. Her earlier association with the physical anthropologists at the University of Michigan had
alerted her to the possibility that this trait might exist
among Negroid populations of the Atlantic coast. The
study, carried out with Carlos Tejada and others [29],
showed that the incidence of the heterozygote was high
enough among the Garifuna to suggest that sickle cell
anemia (which results when the trait is received from
both parents) might contribute to morbidity and mortality among children in this population. Later studies
carried out at the University of Minnesota suggested
that a high dietary intake of cassava and certain other
root crops can regulate the disease so as to avert its
more serious consequences, including death (Nancie
González, personal communication). The study also
found the presence of the Diego factor, a specific
marker for certain Amazonian groups, thus confirming the mixed ancestry of this apparently Negroid
population.
Finally, González extended her studies to the acculturation of health practices, showing that the variation
in practices available for treating illness was expanding but that indigenous and rural patterns generally
remained, albeit in a diluted form. Acculturation was
especially significant in urban populations. New alternatives in therapy, specialists, and sources of knowledge
come into play [29]. During this period, González
coauthored a general survey with Moisés Béhar [30]
that addressed the questions of why and when people
preferred empirical to scientific medicine. She argued
that they, in fact, would seek any alternatives known to
them, simultaneously accepting the empirical success
of scientific medicine while retaining the explanatory
values of folk medicine [31].
INCAP anthropology in the 1970s
With the departures of Alfredo Méndez Domínguez
and Nancie González in the mid-1960s, INCAP hired
Victor Mejía Pivarál, a Guatemalan anthropologist
trained in Mexico. He joined INCAP in 1966 and
remained on the staff until 1981. During this period,
a major longitudinal study was initiated under the
direction of Robert Klein, a psychologist, that drew
in Jerome Kagan, Howard Freeman, and A. Kimbal
Romney [32]. Klein acted first as a participant in and
later as Director of the INCAP Division of Human
Development. From 1969 to 1979, INCAP was engaged
in a study of four Ladino communities in the department of El Progreso. Mejía Pivarál worked in these
projects, as well as a simplified health program in Patulúl in 1976–77. During the early years of the project,
he undertook general background studies of the four
communities [32]. Thereafter he collaborated in specific components of the research.
Among the products was research indicating that the
frequency of moderate malnutrition in rural farming
families who controlled less than 5 manzanas (3.5 ha)
of land was 2.3 times that of families with access to
more than 5 manzanas. Mejía Pivarál coauthored a
dozen or more papers with his colleagues while at
INCAP, but his role was that of helping to adapt the
research projects to the local societies, and as such
he served as a resident cultural consultant for his colleagues, many of whom were foreigners.
Sheila Cosminsky undertook field research during
the entire year of 1968, with a revisit in 1974, all the
while maintaining an informal relationship with
INCAP. She focused her research on the process of
acculturation in medical beliefs and practices in the
Municipio of Santa Lucia Utatlán. Of particular interest
was her delineation of devices, such as the use of the
categories of fresco and alimento, as a way of incorporating new elements into the cultural repertory of the
indigenous population [33]. This provided additional
understanding of the hypothesis earlier delineated by
González and Scrimshaw [34] that foods were not generally recognized as relevant to health. Cosminsky also
added depth to the earlier work of Adams [35] on the
folk etiology of illness among Guatemalan Indians.
In 1975, anthropologist Timothy Farrell joined
INCAP as Chief of the Program in Rural Development.
He had just completed a study of community development in San Lucas Tolimán. In reflecting on those years,
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Farrell sees his major contribution to have been that
of a program manager and implementer “principally
concerned with designing projects or interventions
to be compatible with what I knew to be cultural and
social factors and issues.”* He became particularly
involved in follow-up research on the 1976 earthquake.
With John Townsend and Robert Klein, he developed
an evaluation methodology for health and nutrition
interventions in rural settings [36]. In July 1979, he left
to join the Foster Parent Plan International, working in
Egypt and Latin America.
It was also in the 1970s that Susan Scrimshaw, a
medical anthropologist at the University of California
Los Angeles (UCLA), came periodically to INCAP to
work with the INCAP Oriente Longitudinal Study. She
identified the need to educate more Central American
anthropologists, and two INCAP fieldworkers, Elena
Hurtado and Sandra Rosenhouse, went to UCLA to
study with her. During this period, INCAP sponsored
a master’s degree in public health. Among those in the
program was Jorge Solares, a former student of Joaquín
Noval, who had also undertaken master’s work in
anthropology at the University of Durham (England).
Solares was already a Doctor of Odontologia and
choose to do his master’s research on beliefs and practices regarding oral health in Patzun, Chimaltenango
[37, 38].
INCAP anthropology in the 1980s and 1990s
In June 1980, the INCAP offices in Guatemala were
taken over by a guerrilla force, and its director and
others were taken as hostages for ransom. Although
the present account makes no pretense of following the
political context within which INCAP worked, after
the dust settled the philosophic charter of the Institute
seems to have shifted from a 30-year dedication to
research to a greater concern with education and diffusion of research products. By 1985, the five health ministries of Central America had agreed upon a 5-year
plan of operation in which all activities were dedicated
to application and none to research [39]. Although
earlier anthropologists had given advice and suggestions about ways to carry the products of research into
the larger society, they had been principally concerned
with research into the processes involved in nutrition,
health, and illness practices.
The major anthropological work of this period is
that of Elena Hurtado, who began in 1979 after her
return from UCLA and continues as of this writing.
Her undergraduate degree was in anthropology and
psychology, but her professional training was in public
health with a strong anthropological focus. Although
* Correspondence from Tim Farrell, 4 February 2000.
the range of her work has been impressively broad,
she started to work at the moment when the interest
of INCAP was shifting from basic research to the lowcost practice of application of knowledge. It is in this
area that she seems to have had the greatest impact. Her
formal employment during these years was irregular,
but she doubtless has one of the longest publication
records of any social anthropologist associated with
the Institute.**
In the 1980s, Hurtado’s work was principally concerned with research. Almost all of her papers were
collaborative and dealt with a wide range of issues: the
relative importance of maternal milk and milk substitutes and other aspects of infant nutrition [40–44], and
a number of papers on the process of anthropological
research [45, 46] and on complexities in beliefs and
practices [47, 48]. Of particular importance was a study
of the changes in Santa María Cauqué over the years
that INCAP had been associated with the community
[49]. Between 1963–72 and 1986–87, infant nutrition
appreciably improved, but in contrast, there was little
change in morbidity and mortality rates. The authors
speculated that major changes that occurred after the
1976 earthquake, with an agricultural cooperative leading to increase in family incomes and more employment, might explain the nutritional improvements but
were not enough to modify the larger health picture.
As the years progressed, more and more of Hurtado’s work was aimed at practical application of
nutritional knowledge. In 1986, a study with Magda
Fisher examined the efficiency of patient treatment
in Roosevelt Hospital in Guatemala City [50]. In the
same year, there appeared papers on how to enhance
health-seeking behavior among rural people [51], both
Indian and Ladino [52]. Next appeared a series of “how
to do it” manuals on handwashing [53], dealing with
diarrhea [54], learning about the community [55], and
evaluating teaching materials [56] and a report on oral
rehydration in Roosevelt Hospital [57].
In the 1980s, Hurtado worked with Susan Scrimshaw
to apply anthropologic methodologies Scrimshaw used
in teaching at UCLA to a Central American study of
cultural factors related to child survival [58]. Later,
she and Scrimshaw brought the methodology that had
evolved through the Central American work to an
international team conducting a study of nutrition and
primary health care from the community perspective
in 16 countries. This methodology was recorded in
their joint publications on rapid appraisal procedures
(RAPs) [45, 46]. During this period, Hurtado prepared a number of texts about how best to work with
people to improve their nutrition and health status.
** She was on the staff from 1989 to 1992 and from 1995
to 1999 but gave up formal relations with INCAP when her
husband, Hernán Delgado, became Director of INCAP.
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R. N. Adams
Hurtado’s work also addressed child survival issues as
well as mothers’ care, health, and nutrition. One of the
applications of the work conducted by her and Christa
Valverde in the 1990s is the use of social anthropology
in the design of health, nutrition, and food security
interventions by active participation in the assessment
phase to determine KAPs* as well as in the design of
educational programs to modify or strengthen existing
behaviors and not just to pass on information.
During this period, Isabel Nieves, with a master’s
degree in anthropology, worked at INCAP between
April 1976 and November 1978 and again between
1985 and 1991, primarily concerned with the social
and cultural implications of nutrition and nutrition
education and communication. She carried on research
and provided technical assistance to governments on
behavioral issues in child care, feeding, and nutritional
status. She also focused on women’s role in the food
and nutrition chain and advocated closer attention
to gender issues in research and in policy and program formulation. Her focus shifted emphasis away
from the concern with cultural constructs toward an
understanding of health-, food-, and nutrition-related
behavior within the household, such as allocation of
resources, decision making, and the contribution of
women’s income and work. She was also involved in
maternal and child health program evaluation and the
development of qualitative methodologies.
Finally, beginning with the work of myself in the
early 1950s, INCAP sponsored courses in anthropology for nutrition and public health personnel. At first
these were for INCAP staff members, but in subsequent
years courses were offered to students in a Program on
Nutrition and in the Master’s Program in Public Health.
These later courses were taught by Alfredo Méndez
Domínguez, Nancie González, Juan José Hurtado, and
most recently by Elena Hurtado. Over the years these
courses covered applied anthropology, social and cultural factors in health and nutrition, field methods in
cultural anthropology, and anthropologic qualitative
data collection.
Overview
* KAPs are assessments of knowledge, attitude, and practices. These have been used as part of formative research to
determine what are the variables and considerations that are
affecting key health and nutrition problems and that need to
be taken into consideration for the design of interventions.
Acknowledgments
The trajectory of social anthropology at INCAP has
seen a gradual evolution through a series of stages. The
initial work by myself, Scheele, and Freedman was concerned with finding ways to make INCAP nutritional
research more effective. In a second phase, emerging
with the work of González and Méndez in the 1960s,
anthropology examined the nutrition process in the
population, especially as it was manifested in child
care and feeding, lactation, and population growth
and in the relation of economic process to nutritional
progress. I was joined in the field by Raymond Amir, a
student volunteer from California. Amir’s contribution
to the studies was substantial and included identifying
the problem in beliefs about blood regeneration. In
the 1970s and 1980s, the work of Robert Klein and his
colleagues was extensive and rich, but this chapter will
not try to cover it here, as it was more social psychology
than social anthropology.
In the 1970s, anthropology once more became an
adjunct of nutritional research with the work of Méjia
Pivarál, Cosminsky, and Farrell. Anthropologic awareness was introduced as a part of project planning, and
field studies were undertaken by way of shaping the
research process to work in accord with local realities.
In the 1980s and 1990s, principally with the work of
Hurtado, Nieves, and others, there was a shift away
from more descriptive research to research directed to
supporting and facilitating specific nutrition and health
behavior change.
The imaginative decision of Nevin Scrimshaw to
introduce applied anthropology into the program of
INCAP generated a process that not only continued
through the subsequent history of the institution
but also influenced nutrition and health programs
throughout the world. The present chapter concerns
itself with social anthropology, the study of human
behavior. INCAP has also worked in other areas of
anthropology, especially physical anthropology, for
example, in blood typing, anthropometry and nutrition, mental and cognitive development, and even in
archaeology [59].
The textual contributions of Nancie Solien de González
and Sheila Cosminsky are gratefully acknowledged.
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159
Social anthropology
References
1. Code of Ethics of the Society for Applied Anthropology.
Hum Organ 1951;10(2, summer):32.
2. La Farge O II, Byers D. The year bearer’s people. In: Publication No. 3, Middle American Research Series. New
Orleans, LA, USA: Tulane University of Louisiana, 1931.
3. Bunzel R, Jena LS, Tax S, Lincoln J, Wisdom C, Redfield
R, Juárez Múñoz JF, El indio guatemalteco. Ensayo de
sociología nacionalista, Guatemala, 1931, and El indio
guatemalteco. Guatemala: La Tipografía San Antonio,
1946.
4. Bunzel R, Jena LS, Tax S, Lincoln J, Wisdom C, Redfield
R, Juárez Múñoz JF. El indio guatemalteco. Ensayo de
sociología nacionalista. Segunda Parte. Guatemala: in
La Tipografía San Antonio, 1946.
5. Adams R. A nutritional research program in Guatemala. In: Paul BD, ed. Health, culture and community:
1955:435–58.
6. Adams R. On the effective use of anthropology in public
health programs. Hum Organ 1955;13(4):5–15
7. Adams R. Notas sobre el uso de la antropología en el
campo de la salud pública. Bol Oficina Sanit Panam
1955;37:473–90.
8. Adams R. Un programa de investigacione sobre nutrición en Guatemala. In: Cultura indígena de Guatemala:
Ensayos de antropología social. Guatemala City: Ministerio de Educación Pública, 1956:247–82.
9. Adams RN. Notes on the application of anthropology.
Hum Organ 1953;12(2):10–14.
10. Barrett B. Integrated local health systems in Central
America. Soc Sci Med 1996;43:71–82.
11. Guillermo Bonfil Batalle, Diagnóstico sobre el hambre
en Sudzal, Yucatán, Mexico: Instituto Nacional de Antropología e historia, 1962, Capitulo 1, 1962;1.
12. Amir RG. Magdalena Milpas Altas, 1880–1952. In:
Political changes in Guatemalan Indian communities: A
symposium. New Orleans, LA, USA: Middle American
Research Institute, Tulane University, 1957, 9–15.
13. Adams RN. Introducción a la antropología aplicada.
Guatemala City: Seminario de Integración Social Guatemalteca Publ No. 13. 1952.
14. Mata LJ. The Santa María Cauqué Study: health and
survival of Mayan Indians under deprivation. In: Scrimshaw NS, ed. Community-based longitudinal nutrition
and health studies: Classical examples from Guatemala,
Haiti and Mexico. Boston, MA, USA: International
Foundation for Developing Countries, 1995:29–78.
15. Scheele RL. Reporte dual sobre estudios socioantropológicos, Guatemala, 1951 (Santo Domingo
Xenacój, 1944–1951). In: Political changes in Guatemalan Indian communities: a symposium. New Orleans,
LA, USA: Middle American Research Institute, Tulane
University, 1957:37–40.
16. Freedman J. The social factors in the etiology of kwashiorkor in Guatemala. Health Information Digest for Hot
Countries 1957;6.
17. Solien NL, Scrimshaw NS. Public health significance of
child feeding practices observed in a Guatemalan village.
J Trop Pediatr 1957;3:99–104.
18. Méndez Domínguez AM. Organization social y prevalencia de la malnutrición protéica en una comunidad
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
de Guatemala. Guatemala Indígena, 1962;2(2):5–15.
INCAP /E-267.
Deutschman P, Méndez A, Herzog W. Adoption of drugs
and foods in five Guatemalan communities. San José,
Costa Rica: Programa Interamericano de Información
Popular, 1967:43–69.
Méndez A. Social structure and the diffusion of innovation. Hum Organ 1968;27:241–49.
Interdepartmental Committee on Nutrition for National
Development. Nutritional Evaluation of the Population of Central America and Panama, 1965–1967. Vol.
INCAP V-34. Guatemala, 1971.
Méndez A. Método para medir la situación sociocultural de las familias rurales centroamericanas y su
aplicación a los programas de salud. Arch Latinoam
Nutr 1970;20:281–91. OMCA [E-438].
Interdepartmental Committee on Nutrition for National
Development. Nutritional Evaluation of the Population of Central America and Panama, 1965–1967. Vol.
INCAP V-34. Guatemala, 1971.
Méndez A. Modernization as strategy in nutrition and
mental development research. In: Kallen DJ, ed. Nutrition, development, and social behavior. Washington,
DC: Department of Health, Education, and Welfare,
1973:156–67.
Méndez A. Illness and medical theory among Guatemalan
Indians. In: Kendall C, Hawkins J, Bossen L, eds. Heritage
of conquest: thirty years later. Albuquerque, NM, USA:
University of New Mexico Press, 1982:267–98.
Solien de González NL. Breast-feeding, weaning and
acculturation. J Pediatr, 1963;62:577–81. INCAP /I-265.
Solien de González NL. Patterns of diet, health and
sickness in a Black Carib Community. Trop Geogr Med
1963;15:422–30.
Solien de González NL. Beliefs and practices concerning
medicine and nutrition among lower-class Guatemalans.
Am J Public Health 1964;54:1726–34. INCAP /I-278.
Valenzuela CT, Solien de Gonzáles NL, Sánchez M. El
factor diego y el gene de células falciformas entre los
Caribes de Raza Negra de Livingston, Guatemala. Rev
Col Med Guatem 1965;16(2):83–6.
Solien de González NL, Béhar M. Child-rearing practices, nutrition and health status. Milbank Mem Fund
Q 1966;44:77–96.
Solien de González NL. Health behavior in cross-cultural perspective: A Guatemalan example. Hum Organ
1966;25(2):122–5.
Mejía Pivarál V. Características económicas y socioculturales de cuatro aldeas ladinas de Guatemala. Guatemala
Indígena, 7(3)1–300, Guatemala City: Instituto Indigenista Nacional, 1972:300.
Cosminsky S. The changing food and medical beliefs
and practices in a Guatemalan community. Ecol Food
Nutr 1975;4:183–91.
Cosminsky S. The impact of methods on the analysis of
illness concepts in a Guatemalan community. Soc Sci
Med 1977;11:325–32.
Adams R. La antropología aplicada en los programas de
salud pública de la America Latina. Bol Oficina Sanit
Panam 1952;33:298–305.
Delivered by Publishing Technology to: Guest User IP: 69.138.57.60 on: Mon, 10 Mar 2014 14:18:09
Copyright (c) Nevin Scrimshaw International Nutrition Foundation. All rights reserved.
160
R. N. Adams
36. Townsend JW, Farrell WT, Klein RE. Problemas especiales de la medición del impacto de programas en los
países en desarrollo (Special problems of evaluating the
impact of programs in the developing countries). In:
Klein RE, Read MS, Riecken HW, Brown JA, Pradilla A,
Daza CH, eds. Evaluación del impacto de los programas
de nutrición y de salud. Washington, DC: Oficina Panamericana de la Salud, 1982:52–64.
37. Solares J, Valenzuela CT. Creencias populares sobre salud
oral en Patzún. Primer Parte. Rev Guatem Estomatol
1973;3(1):9–24.
38. Solares J, Valenzuela CT. Creencias populares sobresalud
oral en Patzún. Segunda Parte. Rev Guatem Estomatol
1973;3(3):89–98.
39. Delgado HL, Valverde V, Hurtado E, Palmieri M. Health
and nutrition conditions in the Central American countries: An overview and feasible strategies for the near
future. Mobius;5(3):116–28. 1985 INCAP /I-1421.
40. Delgado HL, García B, Hurtado E. Crecimiento físico,
nutrición e infección en los primeros años de vida. In:
Cusminsky M, Moreno EM,Ojeda ENS. Crecimiento
y desarrollo: hechos y tendencias. Washington (DC):
(OPS); 1988. 250–62. INCAP /E-1263a.
41. Delgado HL, Valverde V, Hurtado E. Lactation in rural
Guatemala: Nutritional effects on the mother and the
infant. Food Nutr Bull 1985;7(1):15–25.
42. Delgado HL, Valverde V, Hurtado E. Effect of health
and nutrition intervention on infant and child mortality in rural Guatemala. New York: United Nations,
1986:145–70.
43. Delgado HL, Valverde V, Hurtado E. 3 simplified projects
of primary health care and their effects on child nutrition
and health. Bol Oficina Sanit Panam 1987;103:340–50.
44. Hurtado E. La lactancia materna en la etiología de la
diarrea (Breastfeeding in the etiology of diarrhea). Arch
Latinoam Nutr 1989;39:278–91.
45. Scrimshaw SC, Hurtado E. Field guide for the study of
health-seeking behaviour at the household level. Food
Nutr Bull 1984;6(2):27–45.
46. Scrimshaw SC, Hurtado E. Anthropological involvement
in the Central America diarrheal disease control project.
Soc Sci Med 1988;27:97–105.
47. Parker ME, Schroeder DG, Begin F, Hurtado E. Maternal
preferences for consistency of complementary foods in
Guatemala. Food Nutr Bull 1998;19(1):6–12. INCAP/
PCI/081.
48. Vielman L, Hurtado E. Informe final de la investigación
etnográfica sobre algunos aspectos de salud y nutrición
realizado en la Colonia Juarez, Guanagazapa. Guatemala:
INCAP, ene. 1986.
49. Delgado HL, García B, Hurtado E. Nutritional improvement without better health: Santa María Cauqué, 15
years later. Lancet 1988;2:1303–4.
50. Hurtado E, Fischer M. Producción y pretestado de
mensajes educativos a transmitirse durante el período
post-parto en el departamento de Obstetricia, Hospital
Roosevelt, Guatemala. Guatemala City: Institute of
Nutrition of Central America and Panama, 1986.
51. Hurtado E, Esquivel A. Health-seeking behavior at the
household level in a highland community in Guatemala. Guatemala City: Institute of Nutrition of Central
America and Panama, 1986.
52. Delgado HL, Hurtado E, Valverde V. Aceptabilidad de
programas de salud en poblaciones rurales indígenas
y ladinas de Guatemala. Tradiciones de Guatemala
25(0):109–11, 1986.
53. Hurtado E, Mills Booth E. A handwashing communication intervention in Guatemala. Waterlines
1995;13(3):19–22. INCAP/PCI/070.
54. Molina de Palma V, Hurtado E. Lo que toda mam debe
saber sobre los asientos. Guatemala: Hospital Roosevelt,
s.f. 23 p. [INCAP/V-61]. Guatemala City.
55. Hurtado E, Palma V. Lo que todo trabajador de salud
debe averiguar sobre la comunidad donde trabaja: una
guía para el diagnóstico comunitario rápido en salud
y nutrición. Guatemala City: Institute of Nutrition of
Central America and Panama, 1991.
56. Hurtado E, Molina de Palma V, Fischer M. Técnicas para
validar materiales educativos. Guatemala City: Institute
of Nutrition of Central America and Panama, 1992.
57. Schieber B, Mazariegos de Fernández A, De León F,
Amurrio R, Hurtado E. Informe: Desarrollo de unidades de rehidratación oral (U.R.O.s) en los Hospitales
Roosevelt y San Juan de Dios de la Ciudad de Guatemala. Guatemala City: Institute of Nutrition of Central
America and Panama, 1993.
58. Scrimshaw, SCM and Hurtado E. Anthropological
Involvement in the Central American Diarrheal Disease Control Project, Social Science and Medicine,
27(1):97–105, 1988.
59. Borhegyi SF, Scrimshaw NS. Evidence for pre-Columbian goiter in Guatemala. Am Antiq 1957;23:174–6.
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