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Public Interest Ethnography: Women's Prisons and Health Care in California
RACHAEL STRYKER
Summary In this article, Rachael Stryker describes how ethnography can be used to affect public policy. With government sponsorship, she and a group of her undergraduate students interviewed a number of inmates incarcerated in two California state prisons for women. Their goal was to learn about the provision of health care from the prisoner's perspective. Armed with the "insider's" point of view, they produced recommendations for changes, some of which were adopted by prison authorities.
Public interest ethnography (a branch of applied anthropology) involves ethnographic research among people who are affected by policy. It brings a human face to the impact of policy and often seeks to empower those affected by it. The study of health care provided in California's women's prisons is a good example. The researchers discovered that to receive care, an inmate had to fill out a request, pay a five-dollar copay, receive a ducat (something like a hall pass), and then see one of three people: an MTA (medically trained correctional guard), a nurse, or a doctor. The process could take weeks and was complicated by the fact that inmates had little money, were often treated by unqualified health providers, and were frustrated by an inability to speak English (many inmates spoke only Spanish). Inmates often feared medical procedures and felt that doctors treated them with disrespect. They also told about instances of sexual harassment. Other factors related to inmate health included poor sanitation caused by overcrowded cells, and lack of cleaning and personal hygiene supplies. AIDS patients were housed in the general inmate population. Food was also a problem, especially for diabetics and those with food allergies. Finally, inmates did not get enough exercise. Inmates often responded to these problems by treating themselves or ignoring symptoms.
The ethnographic study produced a list of recommendations. It advised the state to simplify the process required of inmates to receive health care, reduce or eliminate the copay because inmates had little money, eliminate the MTA position, hire more qualified nurses and doctors, provide translators, reduce overcrowding, and improve nutrition and sanitation. In response to these recommendations the state increased translation services, eliminated the MTA position, and started a process to reduce overcrowding. Other recommendations were taken under advisement.
According to Stryker in "Ethnography in the Public Interest," public interest ethnography looks at public policy from the perspective of those who are affected by it.

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