On a roll...

I finally feel like I am getting somewhere with the writing. In the last two weeks I have finished two chapters... just one and a half major chapters to go, plus the introduction and conclusion. And then of course is all the rewrites (I have three chapters back from my supervisors which will need more work). But for now I'm feeling pretty good about it.
The thesis has come to be based around the concept of Short Term Medical Missions (STMMs) as providers of health services in Honduras. In effect what they are doing is filling gaps in the health system. For whatever reason (and I've heard many) that Honduran health system appears unable to reach the entire population, and in particular there are huge issues with resourcing of clinics. Teams of western health professionals and lay people, donating their time and arriving with truckloads (in many cases literally!) of medication and supplies provide a service to Hondurans they may not be able to access otherwise. Of course this raises some very important issues about why this situation exists, about the appropriateness of using short term expatiate teams to meet health needs and about some even bigger issues such as dependency. These I will be exploring further as I get into writing the last couple of chapters.

An Update... finally

I guess the idea of having three journals was just a little too much! While doing the fieldwork it was enough effort to maintain one journal online, so I chose to keep a more personal blog of our travels- Which you can check out here. However I thought I'd update this page anyway- just in case anybody is actually still bothering to check it, and because I don't want to fill up our personal web pages with a lot of detail about the thesis.The thesis is now officially about 20000 words and 3 chapters long- oin other words about half way. Except its not half way... those 20000 words need some revision and rewriting, and I still haven't touched the major discussion chapters. I have more or less completed the methodology chapter, the usual discussion of the broad approach (qualitative), methods used (interviews, questionairres, observation) and data analysis (ongoing!). I have also completed a overview chapter on Health, Development and STMMs, which is more or less a literature review. I used some of the lit review I abandoned before the fieldwork, along with some new stuff. I am currently finishing a background chapter on health and Honduras, and have done some beginning work on a discussion chapter, looking at what the teams actually do and why. I continue to learn a lot as I write up my work of the past ten months- about Honduras, about health in developing nations, and about the role and consequences of outside intervention in development and health. I can see there are huge needs in Honduras, and big gaps in the health care system that these teams are attempting to fill. At present they do appear to provide a needed service, yet huge questions remain about the appropriateness of using outside teams, and the long term impacts they have on health and health care services. Maybe more answers will come as I get into the writing.

Rethinking

I have come to the conclusion that I cannot do this research the traditional way. I have tried to do a good review of the literature prior to fieldwork but just seem to get further and further away from the topic. There just isn't really anything much out there about Short Term Medical Missions, and while there is a lot on the larger context- NGOs and health, international health and so on, it doesn't really address my concerns. In fact my concerns have changed direction yet again. I am becoming more interested in Medical Missions as a symptom of larger issues. That sounds a little callous when discussing groups that are essentially doing "good", but it makes some sense to me. The larger issues I'm starting to see are dependency, paternalism and the dominance of western medicine and culture. These are all good development studies ideas but may prove to big to address in a Masters level thesis.
So the literature review is on ice until the feildwork is completed. I'm essentially going to do a slightly modified grounded theory type study, where the theory will come from the fieldwork. I need to hear what the people have to say- the patients and community, local health professionals and the teams themselves. Only then can I go back to the literature and see if there are any parallels. It's a challenging way to do it but since making this decision I feel a lot more excited about the research again.

It's Growing...

Things have been moving along very quickly over the past week or so, getting very exciting but also really quite scary. I have begun the process of contacting organisations and individuals in Honduras and the response has been- mostly- very positive. Very encouraging.
However it is now only 6 weeks until we leave and there is so much to do. I'm really not sure I will have the literature review done- I have a good grasp of it now (I hope) but it's getting larger and larger. I also need to spend some serious time getting to grips with the methodological aspects of the study, develop some questionnairres and think about how I'm going to manage the data as it accumulates.
But more than the workload, I'm starting to worry about the size of the study question itself... as I talk to more people and read more it just seems to grow. There is potential to take this beyond Masters level, and I have had some encouragement to do that. Its defintely something I would be interested in doing... but I'm really not sure how that would fit in my life plans- or my husbands- and whether I want to commit several years of my life to it. At this point I think I need to complete the Masters thesis. After the fieldwork I will think more seriously about where I will take this.

A quick update

My apologies to anyone out there who actually reads this- I've obviously not been very good at keeping it up to date. So here's a quick update-
1. Tickets are booked and partially paid for thanks to the department graduate research fund and student loans. No thanks to study link who will cut my student allowance if I get my scholarship paid now, which means I have to wait until the end of the academic year (November) for that, meaning more loans and a growing overdraft.
2. The literature review is progressing... slowly. searching the internet for information about Honduras and what organisations are at work there is much more interesting than reading and making notes from dry academic articles about NGOs and development theory. Which brings me to...
3. Locating and contacting agencies. I've done some searching around and have drawn up a list of people and organisations to contact to set up fieldwork sites... many thanks to projecthonduras.com! Unfortunately the job of actually making contact has been put off yet again until my information sheet is approved and I've had a departmental ethics review meeting. So maybe next week?
4. Reading Reading Reading. Which is what I am going back to now...

Why I'm here (on Saturday afternoon)

Saturday afternoon and I'm at the university in front of my computer and wondering why I'm here. The excitment of finally starting the thesis seems to be getting lost in a pile of books, articles and notes. I have three more months before we fly away (tickets were booked yesterday!), it seems plenty of time but the last month has gone so fast I'm beginning to worry.
I'm trying to work on a literature review but things are going slowly. As there is little literature specifically regarding short term medical missions the literature review is ending up much wider- in particular I am looking generally at the role of expatriate medical professionals in developing countries, and at the role of NGO's in health care provision. This is leading me up all sorts of interesting pathways and diversions- International Health and NGO's both being rather large areas.One thing I am really starting to wonder about is who should be responsible for providing health care. NGOs and expatriate professional teams may provide a great service (of course whether they do or not is an entirely different thesis question!) but should they be "doing" or should it be the responsibility of the State? If it's the States responsibility then what is the role of non-State agencies? The reality is that in this market-driven world we live in State responsibilty is obviously decreasing, and private health care providers have become increasingly important. This does leave an important stop-gap role for NGOs who can provide free or cheap services the private companies don't want to do and the government can't or won't provide. Perhaps this is precisely the reason both long-term NGOs and short term medical missions are an increasingly common feature of health care provision in the world today. Whether or not this is the way things should be I'm really not so sure. Of course thats what research is all about- exploring that which you are really not sure about. As Einsten is reputed to have said- "if we knew what it was we were doing, it wouldn't be called research"!

Scholarships, computers and methodology

The pace of life and study seems to have picked up quite significantly this past week. The most significant event was notification that I have been awarded a Masterate Scholarship . Now I can really get into this knowing I will have the money to get to Latin America and carry out the research. Very exciting!
I have also recently acquired a laptop (to be more specific a second-hand IBM Thinkpad). Although I've been getting by on reams of paper and shared computers I now feel I can really get going- I just have to figure out how get it hooked up to the university network.
As far as the research itself goes I am currently wrestling with the methodology, specifically my role as a researcher and/or nurse. I had thought I would perhaps work with the teams while collecting data however I'm now wondering (prompted by some readings from the nursing research literature) that in fact that taking a dual role may well be confusing for community participants, not to mention that it may possibly bias the research. If I was studying the teams themselves then full partipation would probably be appropriate but I'm becoming more interested now in the researching medical missions as they relate to the commnuity and local health services so I am now defintely moving away from the idea of doing any nursing at all.
While all this is going on in my head my supervisor has reminded me it is time to start making contacts in Honduras. I am using the internet to start compiling a list of teams planning trips and organisations I might contact. I probably should also look at sending emails to various organisations and contacts. However if there's anybody actually reading this who is aware of medical teams who will be in Honduras between Nov. 04 and Feb. 05 I'd love to hear from you- click the comments link below to post me a message!