Re: South American Water-Boiling

From: Tim Rhodes (proftim@speakeasy.org)
Date: Thu Feb 15 2001 - 00:19:45 GMT

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    From: "Tim Rhodes" <proftim@speakeasy.org>
    To: <memetics@mmu.ac.uk>
    Subject: Re: South American Water-Boiling
    Date: Wed, 14 Feb 2001 16:19:45 -0800
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    Joe Dees wrote:

    <<<Where can I find the article concerning some South American tribal
    peoples' reluctance to boil their water even though it helps them to
    avoid disease?>>>

    Chapter 1 of Rogers, Everett M. and Shoemaker, F.F. (1995) Diffusion
    of Innovations. A Cross-cultural Approach. 4th ed. Free Press: New York.

    (Quoted below)

    -Tim Rhodes

    ====================
    Water Boiling in a Peruvian Village:
    Diffusion That Failed

    The public health service in Peru attempts to introduce innovations to
    villagers to improve their health and lengthen their lives. This change
    agency encourages people to install latrines, to burn garbage daily, to
    control house flies, to report cases infectious diseases, and to boil
    drinking water. These innovations involve major changes in thinking and
    behavior for Peruvian villagers, who do not understand the relationship
    of
    sanitation to illness. Water boiling is an especially important health
    practice for villagers in Peru. Unless they boil their drinking water,
    patients who are cured of infectious diseases in village medical clinics
    often return within a month to be treated again for the same disease.

    A two-year water boiling campaign conducted in Los Molinas, a peasant
    village of 200 families in the coastal region of Peru, persuaded only
    eleven
    housewives to boil water. From the viewpoint of the public health
    agency,
    the local health worker, Nelida, had a simple task: to persuade the
    housewives of Los Molinas to add water boiling to their pattern of daily
    behavior. Even with the aid of a medical doctor, who gave public talks
    on
    water boiling, and fifteen village housewives who were already boiling
    water
    before the campaign, Nelida's diffusion campaign failed. To understand
    why,
    we need to take a closer look at the culture, the local environment, and
    the
    individuals in Los Molinas.

    Most residents of Los Molinas are peasants who work as field hands on
    local
    plantations. Water is carried by can, pail, gourd, or cask. The three
    sources of water in Los Molinas include a seasonal irrigation ditch
    close to
    the village, a spring more than a mile away from the village, and a
    public
    well whose water most villagers dislike. All three sources are subject
    to
    pollution at all times and show contamination whenever tested. Of the
    three
    sources, the irrigation ditch is the most commonly used. It is closer
    to
    most homes, and the villagers like its taste.

    Although it is not feasible for the village to install a sanitary water
    system, the incidence of typhoid and other water-home diseases could be
    greatly reduced by boiling the water before it is consumed. During her
    two-year campaign in Los Molinas, Nelida made several visits to every
    home
    in the village but devoted especially intensive efforts to twenty-one
    families. She visited each of these selected families between fifteen
    and
    twenty-five times; eleven of these families now boil their water
    regularly.

    What kinds of persons do these numbers represent? We describe three
    village
    housewives--one who boils water to obey custom, one who was persuaded to
    boil water by the health worker, and one of the many who rejected the
    innovation--in order to add further insight into the process of
    diffusion.

    Mrs. A: Custom-Oriented Adopter.

    Mrs. A is about forty and suffers from a sinus infection. The Los
    Molinas
    villagers call her a "sickly one." Each morning, Mrs. A boils a potful
    of
    water and uses it throughout the day. She has no understanding of germ
    theory, as explained by Nelida; her motivation for water boiling is a
    complex local custom of "hot" and "cold" distinctions. The basic
    principle
    of this belief system is that all foods, liquids, medicines, and other
    objects are inherently hot or cold, quite apart from their actual
    temperature. In essence, hot-cold distinctions serve as a series of
    avoidances and approaches in such behavior as pregnancy, child-rearing,
    and
    the health-illness system.

    Boiled water and illness are closely linked in the norms of Los Molinas;
    by
    custom, only the ill use cooked, or "hot" water. Once an individual
    becomes
    ill, it is unthinkable to eat pork (very cold) or drink brandy (very
    hot).
    Extremes of hot and cold must be avoided by the sick; therefore, raw
    water,
    which is perceived to be very cold, must he boiled to make it
    appropriate to
    consume.

    Villagers learn from early childhood to dislike boiled water. Most can
    tolerate cooked water only if a flavoring, such as sugar, cinnamon,
    lemon,
    or herbs, is added. Mrs. A likes a dash of cinnamon in her drinking
    water.
    The village belief system involves no notion of bacteriological
    contamination of water. By tradition, boiling is aimed at eliminating
    the
    "cold" quality of unboiled water, not the harmful bacteria. Mrs. A
    drinks
    boiled water in obedience to local norms, because she perceives herself
    as
    ill.

    Mrs. B: Persuaded Adopter.

    The B family came to Los Molinas a generation ago, but they are still
    strongly oriented toward their birthplace in the Andes Mountains. Mrs.
    B
    worries about lowland diseases that she feels infest the village. It is
    partly because of this anxiety that the change agent, Nelida, was able
    to
    convince Mrs. B to boil water.

    Nelida is a friendly authority to Mrs. B (rather than a "dirt inspector"
    as
    she is seen by other housewives), who imparts useful knowledge and
    brings
    protection. Mrs. B not only boils water but also has installed a
    latrine
    and has sent her youngest child to the health center for a checkup.

    Mrs. B is marked as an outsider in the community of Los Molinas by her
    highland hairdo and stumbling Spanish. She will never achieve more than
    marginal social acceptance in the village. Because the community is not
    an
    important reference group to her, Mrs. B deviates from village norms on
    health innovations. With nothing to lose socially, Mrs. B gains in
    personal
    security by heeding Nelida's advice. Mrs. B's practice of boiling water
    has
    no effect on her marginal status. She is grateful to Nelida for
    teaching
    her how to neutralize the danger of contaminated water, which she
    perceives
    as a lowland peril.

    Mrs. C: Rejector.

    This housewife represents the majority of Los Molinas families who were
    not
    persuaded by the efforts of the change agents during their two-year
    water-boiling campaign. In spite of Nelida's repeated explanations,
    Mrs. C
    does not understand germ theory. How, she argues, can microbes survive
    in
    water that would drown people? Are they fish? If germs are so small
    that
    they cannot be seen or felt, how can they hurt a grown person? There
    are
    enough real threats in the world to worry about--poverty and
    hunger-without
    bothering about tiny animals one cannot see, hear, touch, or smell.
    Mrs.
    C's allegiance to traditional village norms is at odds with the boiling
    of
    water. A firm believer in the hot-cold superstition, she feels that
    only
    the sick must drink boiled water.

    Why Did the Diffusion of Water Boiling Fail?

    This intensive two-year campaign by a public health worker in a Peruvian
    village of 200 families, aimed at persuading housewives to boil drinking
    water, was largely unsuccessful. Nelida was able to encourage only
    about 5
    percent of the population, eleven families, to adopt the innovation.
    The
    diffusion campaign in Los Molinas failed because of the cultural beliefs
    of
    the villagers. Local tradition links hot foods with illness. Boiling
    water
    makes water less "cold" and hence, appropriate only for the sick. But
    if a
    person is not ill, the individual is prohibited by village norms from
    drinking boiled water. Only individuals who are unintegrated into local
    networks risk defying community norms on water boiling. An important
    factor
    regarding the adoption rate of an innovation is its compatibility with
    the
    values, beliefs, and past experiences of individuals in the social
    system.
    Nelida and her superiors in the public health agency should have
    understood
    the hot-cold belief system, as it is found throughout Peru (and in most
    nations of Latin America, Africa, and Asia). Here is an example of an
    indigenous knowledge system that caused the failure of a development
    program.

    Nelida's failure demonstrates the importance of interpersonal networks
    in
    the adoption and rejection of an innovation. Socially an outsider, Mrs.
    B
    was marginal to the Los Molinas community, although she had lived there
    for
    several years. Nelida was a more important referent for Mrs. B than
    were
    her neighbors, who shunned her. Anxious to secure social prestige from
    the
    higher-status Nelida, Mrs. B adopted water boiling, not because she
    understood the correct health reasons, but because she wanted to obtain
    Nelida's approval. Thus we see that the diffusion of innovations is a
    social process, as well as a technical matter.

    Nelida worked with the wrong housewives if she wanted to launch a
    self-generating diffusion process in Los Molinas. She concentrated her
    efforts on village women like Mrs. A and Mrs. B. Unfortunately, they
    were
    perceived as a sickly one and a social outsider, and were not respected
    as
    social models of appropriate water-boiling behavior by the other women.
    The
    village opinion leaders, who could have activated local networks to
    spread
    the innovation, were ignored by Nelida.

    How potential adopters view the change agent affects their willingness
    to
    adopt new ideas. In Los Molinas, Nelida was perceived differently by
    lower-
    and middle-status housewives. Most poor families saw the health worker
    as a
    "snooper sent to Los Molinas to ply for dirt and to press already
    harassed
    housewives into keeping cleaner homes. Because the lower-status house
    wives
    had less free time, they were unlikely to talk with Nelida about water
    boiling. Their contacts outside the community were limited, and as a
    result, they saw the technically proficient Nelida with eyes bound by
    the
    social horizons and traditional beliefs of Los Molinas. They distrusted
    this outsider, whom they perceived as a social stranger. Nelida, who
    was
    middle class by Los Molinas standards, was able to secure more positive
    results from housewives whose socioeconomic level and cultural
    background
    were more similar to hers. This tendency for more effective
    communication
    to occur with those who are more similar to a change agent occurs in
    most
    diffusion campaigns.

    Nelida was too "innovation-oriented" and not "client-oriented" enough.
    Unable to put herself in the role of the village housewives, her
    attempts at
    persuasion failed to reach her clients because the message was not
    suited to
    their needs. Nelida did not begin where the villagers were; instead she
    talked to them about germ theory, which they could not (and probably did
    not
    need to) understand. These are only some of the factors that produced
    the
    diffusion failure in Los Molinas. Once the remainder of the book has
    been
    read, it will be easier to understand the water-boiling case.

    This case illustration is based on Wellin (1955).

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