Rapid Ethnography Research Articles

How stop smoking outreach works: a co-inquiry informed, complex intervention model

Abstract Background Across Europe, smoking prevalence is concentrating in underserved communities with high levels of deprivation. And yet, there is little research on how stop smoking services (SSS) can engage these communities. This study presents the findings of a 12-month collaboration involving an external public health research team and staff of an English SSS. Staff worked with community partners (e.g., schools) to raise awareness of the service, which included a newly introduced e-cigarette offer. Methods A complex intervention model was developed and refined through 6 facilitated co-inquiry sessions involving 13 SSS staff. Staff also completed 32 reflection forms on outreach events and rapid ethnography was conducted, by the research team, to evaluate staff’s working assumptions. This included 8 observations of outreach events and interviews with 10 SSS staff and 8 community members, from the service target groups. Data were organised into themes. Findings The model presents a picture of stop smoking outreach as challenging, unpredictable and resource intensive yet often having great impact. The themes enrich this to highlight 1) the appreciation for yet unpredictability of outreach referrals for people disconnected from health services; 2) the importance of staff adopting a person-centred approach; 3) the challenges and opportunities presented by e-cigarettes; and 4) the role of strategic community partnerships in optimising staff time on outreach. Conclusions Stop smoking outreach can generate considerable interest in SSS, particularly when delivered in combination with an e-cigarette offer. Future research should explore the economic and social return on investment in community outreach: while time consuming, referrals generated proactively may become more important for SSS as smoking concentrates in underserved communities. Key messages • Stop smoking outreach is an effective way to raise awareness and generate referrals but must be done non-judgementally and via effective community partnerships. • Staff’s careful discussion of an e-cigarette offer can change the perception of SSS without contributing to recreational normalization.

Intangible cultural heritage versus tourism: residents’ reactions to temporal overtourism during the Day of the Dead in Mixquic, Mexico

ABSTRACT Globalisation opens small communities and their traditions to temporal overtourism, causing adaptations in the local dynamics. This study investigates responses to overtourism during the Day of the Dead in Mixquic, a semi-rural community located in Mexico City. Employing rapid ethnography, semi-structured interviews, participant observation, and content analysis of social media, it delves into local perceptions and actions regarding temporary overtourism dynamics in a global patrimonialisation context. Results reveal a complex interplay between traditional practices, community resilience, and tourist dynamics. Despite challenges, residents show a positive attitude towards tourists, often incorporating them into ancient traditions while preserving cultural authenticity. Notably, symbolic representations of tradition persist amidst external pressures, showcasing the resilience of community identity. The study underscores the importance of embracing community-centric approaches – observing and considering the community – and innovative tourism strategies to mitigate negative impacts for a better preservation of cultural heritage. By prioritising resident values and needs, tourism can lead to practices that are beneficial to both communities and visitors. Furthermore, the research highlights the importance of observing and listening to local communities.

Mourning and orienting to the future in a liminal occasion: (Re)defining British national identity after Queen Elizabeth II's death.

In this paper, we conceptualize the days of mourning that followed the passing of Queen Elizabeth II. as constituting a liminal occasion, a moment of in-betweenness through which we can explore sense-making in times of transition. How do people navigate through liminal occasions, and are they always transformative? Through a rapid response ethnography (Ninterviews = 64, Nparticipants = 122), we were able to capture the raw moments within which a collective comes together, as part of a national ritual, to transition from 'here' to 'there'. In our data, liminality prompted participants to strategically define British national identity and its future by positioning the Queen as representative of Britishness, her loss as a national identity loss. No longer taken for granted, participants reasserted the value of the monarchy as an apolitical and unifying feature in an otherwise divided society, characterizing the continuity of the institution as an essential part of British identity and society. The analysis illustrates how liminality offers a useful conceptual tool for addressing how temporality and change are negotiated in relation to a shared identity, and how navigating transitional moments brings with it political implications for the future.

The Battle for Urban Space: Dynamics of Spatial Change In Siak, Riau, Indonesia

This study aims to examine the implications of changes in urban space as a result of the implementation of government policies in the development and expansion of the city of Siak on the existence of community space and how the community seizes and utilizes spaces of the industry and government to maintain their subsistence economic life. This study uses a rapid ethnography approach. Researchers conduct a desk study before fieldwork to obtain an initial research report. Researchers stayed in Siak District for 40 days to conduct observations, in-depth interviews, informal conversations, and stakeholder discussions. We conducted Focus Group Discussions (FGD) in the four research villages. The event was attended by 28 participants from four villages, comprising village heads, homemakers, peasants, small traders/street vendors, freelance workers, and NGOs at the district level. The study shows that the four research villages have changed from subsistence community spaces to industrial and government spaces. In this research, the community space is becoming increasingly limited, so people carry out two strategies in seizing industrial and government spaces, namely using government spaces to become places for work and business and controlling industrial spaces, Even though this can give rise to latent and manifest tenure conflicts, corporate and society's urban space becomes an arena for struggling for the means of production represented through control and ownership of space. Society must adapt to these conditions to obtain space for them. Government policies in developing and expanding the city of Siak have not taken the community's interests as the primary goal.

Innovation and adaptation: The rise of a fentanyl smoking culture in San Francisco.

Illicitly manufactured fentanyls and stimulants are implicated in the escalating US mortality from drug overdose. San Francisco, California (SF) has seen declining fentanyl injection while smoking has increased. Beliefs and behaviors surrounding this development are not well understood. The study used rapid ethnography to explore fentanyl and methamphetamine use in SF. The team conducted semi-structured interviews (n = 34) with participants recruited from syringe service programs. Video-recorded smoking sequences (n = 12), photography and daily field notes supplemented interview data. Difficulty injecting and fear of overdose motivated transitions from injecting to smoking. Fentanyl was extremely cheap-$10/gram-with variability in quality. Foil was the most commonly used smoking material but glass bubbles, bongs and dabbing devices were also popular. No reliable visible methods for determining fentanyl quality existed, however, participants could gauge potency upon inhalation, and developed techniques to regulate dosage. Several participants reported at least hourly use, some reporting one or more grams of daily fentanyl consumption. Smoking was also very social, with people sharing equipment, drugs and information. Participants raised concerns about hygiene and overdose risk to others arising from shared equipment. Reportedly potent fentanyl 'residue' accumulated on smoking materials and was commonly shared/traded/stolen or consumed accidentally with diverse preferences for its use. Our data highlight fentanyl residue as a new overdose risk with potential mismatch between the potency of the residual drug and the recipient's tolerance. Further, large doses of fentanyl are being consumed (estimated at approximately 50 mg of pure fentanyl/day). Smoking fentanyl has potential health benefits over injecting and may be protective against overdose, but substantial uncertainty exists. However, SF overdose mortality hit a record high in 2023. Recommendations to reduce fentanyl smoking overdose risks through pacing, greater awareness of dosages consumed and checking tolerance of residue recipients are potentially viable interventions deserving further exploration.

Implementation Barriers Encountered During a Universal Suicide Screening Program in Pediatric Emergency Departments.

Because understanding barriers to universal suicide risk screening in pediatric emergency departments (PEDs) may improve both identification and management of suicidal behaviors and ideation, this study assessed barriers to a quality improvement initiative examining the use of a novel computerized adaptive test (CAT), the Kiddie-CAT, in 2 PEDs. Research assistants (RAs) trained in Rapid Assessment Procedures-Informed Clinical Ethnography methods documented barriers related to the environment, individuals, and workflow as encountered during screening shifts, categorizing the barriers' impacts as either general to a screening shift or related to screening an individual youth/caregiver dyad. Using thematic content analysis, investigators further categorized barriers based on type (eg, workflow, language/comprehension, clinician attitudes/behaviors) and relationship to the limited integration of this initiative into clinical protocols. Reasons for refusal and descriptive data on barriers are also reported. Individual screen barriers were most often related to workflow (22.9%) and youth/caregiver language/comprehension challenges (28%). Similarly, workflow issues accounted for 48.2% of all general shift barriers. However, many of these barriers were related to the limited integration of the initiative, as RAs rather than clinical staff conducted the screening. Although this study was limited by a lack of complete integration into clinical protocols and was complicated by the COVID-19 pandemic impacts on PEDs, the findings suggest that considerable attention needs to be directed both to physician education and to workflow issues that could impede universal screening efforts.

SHIVARAPATNA STONE CRAFT IN KARNATAKA - EXPLORING THE TRANSFORMATIVE ROLE OF INNOVATION IN TRADITIONAL HANDICRAFT AND CULTURAL IDENTITY

Handicraft sector is one of the most sustainable product sectors, because of the consumption of untreated raw materials received unswervingly from the nature. In many developing countries like India, there are a large number of livelihoods depending on handicraft business with an anticipated 17.79 million artisans associated with the sector in the year 2022. The previous studies indicate the relation between the handicrafts and innovation is both controversial and imperative. It is suggested that the sector must undergo incremental innovation for growth and survival in the present times. On contrary there are studies which dispute, considering cultural traditions as barriers to innovation. Innovation may be introduced in the technologies aiding to create the craft. While bringing innovation within the craft techniques and product creation might hinder its cultural identity. Innovation being one of the prime keyword of the 9th goal of the SDGs, the goal of this research is to study how introducing innovation in cultural craft production affects the identity of the traditional handicraft. For the findings, rapid ethnography was performed for the exquisite Shivarapatna stone craft. The craft uses ancient knowledge of Shilpashashtra to hand-craft the intricate Hindu idol statues from granite, and the associated community and the craftsmen are situated in the Kolar district of Karnataka, India. An experiment will be conducted to diversify the stone made craft products to analyse the outcome. The representational difference of the traditional craft products and the innovative craft products are then compared and presented with images. In addition to the comparative analysis, methodology also focuses on the descriptive approach in the handicraft.

Impact of automated dispensing solutions in long-term care facilities and closed-door pharmacies: A mixed methods study of medication management

BackgroundFinancial, operational, and clinical workflow impacts of deploying an automated dispensing cabinet (ADC) in long-term care (LTC) facilities based on actual observations have not been documented in peer-reviewed literature. ObjectivesTo evaluate the impact of a closed-door pharmacy (CDP) implementing an ADC with unique secure, removable, and transportable locked pockets in an unstudied setting (LTC facilities) for management of first and emergency dose medications. Practice DescriptionThis study was conducted in 1 CDP and 2 LTC facilities. Practice InnovationEnhancing emergency medication management and inventory tracking in an unstudied setting through implementation of an ADC system featuring unique electronically encoded medication storage pockets that can be prepared in the CDP, locked and securely transported to the LTC, and when inserted into ADC it informs staff of its presence, position, and contents. Evaluation MethodsMixed methods, pre- and poststudy to assess the impact of replacing manual emergency medication kits with an ADC. Outcomes were evaluated using rapid ethnography with workflow modeling; inventory and delivery reports; a nursing perception survey; and transactional data from the ADC during postimplementation phase. ResultsPharmacy technician preparation time and pharmacist checking time decreased by 59% and 80%, respectively, and standing inventory was reduced by more than $10,000 combined for the CDP and 2 LTCs by replacing emergency medication kits with the ADC. In the LTCs, this change led to a 71% reduction in emergency medication retrieval time, an increase in emergency medication utilization, and a 96% reduction in the cost of unscheduled deliveries. Over 70% of the nurses surveyed favored replacement of the emergency medication kits with the ADC system. ConclusionReplacing manual emergency medication kit with the described ADC system improved workflow efficiency in the CDP and LTC. It also significantly reduced unscheduled (STAT) deliveries and standing inventory and increased the availability of medications commonly used.

Using Design Thinking to break social barriers: An experience report with former inmates

AbstractDesign Thinking techniques have been widely used in software requirements elicitation to understand the necessities of stakeholders and end‐users. However, there is a lack of evidence of their effectiveness when applied to guide the development process of a system targeting vulnerable populations. What are the implications of using Design Thinking techniques to elicit requirements in a community of former inmates—and what would be the benefits of and challenges in this deployment? In this paper, we report our experience of using Design Thinking for requirements elicitation of a mobile application customized for the former inmates of the Brazilian prison system and their families. We applied techniques such as Brainstorming, Stakeholder Mapping, Personas Creation, Rapid Ethnography, and Interviews to obtain relevant data and create several prototypes. These techniques contribute to the development of an uncommon application that aims to help the reintegration process of former inmates into society. Our results validate the initial hypothesis that such techniques, when applied to a sensitive context, assist product development that meets the end‐users' needs by creating a higher quality product. The main limitation of the research was the lack of access to low‐literacy end‐users and/or former inmates without previous experience using mobile devices.

A Rapid Ethnography to Inform a Biobehavioural HIV Preventions Study Among Venezuelan Migrant Sex Workers in Peru: A Protocol of Formative Multidisciplinary Methods

The Venezuelan refugee crisis has triggered Latin America’s largest mass migration, displacing over a fifth of the country’s population. A significant number of migrants have sought refuge in neighboring countries like Peru. Within this context, Venezuelan migrants confront an array of vulnerabilities, including xenophobia and economic hardship, which have compelled some to sex work for their livelihoods. Venezuelan sex workers (VSWs) in Peru face amplified challenges, including heightened risks for HIV and sexually transmitted and blood-borne infections (STBBIs) and exposure to various forms of violence. Addressing the urgent need to comprehend and enhance HIV and STBBI preventive services tailored to this marginalized group in Peru’s capital is paramount. Our biobehavioural HIV prevention study combines sequential mixed methods: we start with a rapid ethnography, followed by semi-structured interviews and finally incorporate cross-sectional surveys with HIV and STBBI testing. The present study protocol presents the integrated and initial rapid ethnographic component of the study which explores the dynamics of street-based sex work in Lima and the sociocultural narratives surrounding VSWs. Data collection will involve systematic fieldnote taking including non-person photos during in-person and virtual participant observation. This comprehensive approach will provide a nuanced understanding of the complex landscape of sex work and HIV/STBBI vulnerabilities among VSWs in Lima. The rapid ethnography endeavors to offer valuable insights that can underpin evidence-based healthcare interventions, specifically tailored to cater to the unique requirements of this marginalized population.

Study protocol: Novel Methods for Implementing Measurement-Based Care with youth in Low-Resource Environments (NIMBLE)

BackgroundFor youth receiving care in community mental health centers, comorbidities are the rule rather than the exception. Using measurement-based care (MBC), or the routine evaluation of symptoms to inform care decisions, as the foundation of treatment for youth with comorbid problems significantly improves the impact of psychotherapy by focusing care and building engagement and alliance. MBC increases the rate of symptom improvement, detects clients who would otherwise deteriorate, and alerts clinicians to non-responders. Despite its demonstrated utility, MBC is rarely implemented with fidelity; less than 15% of providers report using MBC per recommendations. Previous efforts to support MBC implementation have yielded suboptimal outcomes, in part, due to organizations’ challenges with identifying and prioritizing barriers and selecting and developing strategies to overcome them. New methods are needed for identifying and prioritizing barriers, and matching strategies to barriers to optimize MBC implementation and treatment quality to improve youth mental health outcomes in community settings.MethodsPragmatic implementation methods will be piloted in four diverse community mental health centers. Methods include (a) rapid evidence synthesis; (b) rapid ethnography; (c) design kits (e.g., kits with disposable cameras, journals, maps); (d) barrier prioritization, and (e) causal pathway diagramming. These activities will generate actionable barriers; subsequently, we will use facilitated group processes to prioritize barriers and develop causal pathway diagrams to match strategies to barriers to create implementation plans that optimize MBC fidelity (Aim 1). We will track strategy deployment for 6 months, then compare MBC fidelity for another 6 months post-implementation with data from 2 years of historical controls (Aim 2). Finally, we will co-design a toolkit for design kit methods with youth and the practice and scientific communities (Aim 3).DiscussionOptimizing MBC implementation in community mental health centers could transform youth mental health care by ensuring the most pressing symptoms are targeted early in treatment. The discussion section highlights expected challenges and limits to using the five methods, including recruitment and engagement given the high pressure on community mental health settings.Trial registrationClinicaltrials.gov. NCT05644756. Registered on 18 November 2022. This trial was retrospectively registered.

Stepped collaborative care versus American College of Surgeons Committee on Trauma required screening and referral for posttraumatic stress disorder: Clinical trial protocol

BackgroundEach year in the US, approximately 1.5–2.5 million individuals are so severely injured that they require inpatient hospital admissions. The American College of Surgeons Committee on Trauma (College) now requires that trauma centers have in place protocols to identify and refer hospitalized patients at risk injury psychological sequelae. Literature review revealed no investigations that have identified optimal screening, intervention, and referral procedures in the wake of the College requirement. MethodsThe single-site pragmatic trial investigation will individually randomize 424 patients (212 intervention and 212 control) to a brief stepped care intervention versus College required mental health screening and referral control conditions. Blinded follow-up interviews at 1-, 3-, 6-, and 12-months post-injury will assess the symptoms of PTSD and related comorbidity for all patients. The emergency department information exchange (EDIE) will be used to capture population-level automated emergency department and inpatient utilization data for the intent-to-treat sample. The investigation aims to test the primary hypotheses that intervention patients will demonstrate significant reductions in PTSD symptoms and emergency department/inpatient utilization when compared to control patients. The study incorporates a Rapid Assessment Procedure-Informed Clinical Ethnography (RAPICE) implementation process assessment. ConclusionsThe overarching goal of the investigation is to advance the sustainable delivery of high-quality trauma center mental health screening, intervention, and referral procedures for diverse injury survivors. An end-of-study policy summit will harness pragmatic trial data to inform the capacity for US trauma centers to implement high-quality acute care mental health screening, intervention and referral services for diverse injured patient populations.Trial Registration:Clinicaltrials.govNCT05632770

Naming Diseases in Children by the Sidrap Bugis Ethnic

This research aims to reveal the value of naming diseases in children by the Bugis ethnic group in Sidrap Regency. The type of research is qualitative with a Rapid Ethnography approach. The selection of informants used the snowball technique. Data were collected through in-depth interviews with seven traditional birth attendants, 2 parents of toddlers, two families of toddlers, two health workers, and one traditional leader, as well as focus group discussions with five health workers. Data is analyzed using content analysis, then interpreted and presented as narratives, matrices, and schemes. Test the validity of the data using triangulation of sources and methods. The research results showed that the Bugis ethnic group in Sidrap Regency gave 18 names of diseases to children. The values associated with naming illnesses in children are Jamali, the makkatenni sanro tradition, and mappallesso. Health workers should provide outreach regarding the equivalent names of diseases by the Bugis ethnic group so that errors can be minimized in handling and treating conditions in children.

The motives and methods of methamphetamine and ‘heroin’ co-use in West Virginia

BackgroundOpioid and methamphetamine co-use is increasing across the USA with overdoses involving these drugs also rising. West Virginia (WV) has led the US in opioid overdose death rates since at least 2013 and rising co-use of methamphetamine with opioids has played a greater role in deaths over the last 5 years.MethodsThis study used rapid ethnography to examine methods and motivations behind opioids and methamphetamine co-use from the viewpoint of their consumers. Participants (n = 30) were people who injected heroin/fentanyl also using methamphetamine who participated in semi-structured interviews.ResultsWe found multiple methods of co-using opioids and methamphetamine, whether alternately or simultaneously and in varying order. Most prioritized opioids, with motives for using methamphetamine forming three thematic categories: ‘intrinsic use’, encompassing both inherent pleasure of combined use greater than using both drugs separately or for self-medication of particular conditions; ‘opioid assisting use’ in which methamphetamine helped people manage their existing heroin/fentanyl use; and ‘reluctant or indifferent use’ for social participation, reflecting methamphetamine’s low cost and easy availability.ConclusionsMethamphetamine serves multiple functions among people using opioids in WV. Beliefs persist that methamphetamine can play a role in preventing and reversing opioid overdose, including some arguments for sequential use being protective of overdose. ‘Reluctant’ uptake attests to methamphetamine’s social use and the influence of supply. The impact on overdose risk of the many varied co-use patterns needs further investigation.

Leveraging identity to overcome temporal and financial limitations in rapid ethnography in criminological research

With limited time and funding, scholars who deploy qualitative methodologies to examine deviance and criminogenic contexts, such as ethnography, must leverage sources of capital which reduce time-arcs and costs needed for qualitative research. Traditional ethnographic projects require both significant time and funding; accordingly, several authors have indicated the utility of “rapid ethnographies”, which require less time in the field and funding. By reflecting on three rapid ethnographies, we show how identity is simultaneously a property that informs how research unfolds and a capital that can be leveraged to compensate for temporal and financial deficits. In short, we show that rapid ethnography can be conducted ethically and that identity can counterbalance deficits in monetary and temporal capital when identity is carefully considered in the pre-planning and execution of a rapid ethnographic project.

Rapid ethnography and participatory techniques increase onchocerciasis mass drug administration treatment coverage in Benin: a difference-in-differences analysis

BackgroundOnchocerciasis, a neglected tropical disease (NTD) that causes blindness, is controlled via mass drug administration (MDA) where entire endemic communities are targeted with preventative chemotherapeutic treatment. However, in many settings, MDA coverage remains low. The purpose of this project was to determine if engaging communities in the development of implementation strategies improves MDA coverage.MethodsThis study took place in an intervention and a control commune in Benin, West Africa. We conducted rapid ethnography in each commune to learn about community member perceptions of onchocerciasis, MDA, and opportunities to increase MDA coverage. Findings were shared with key stakeholders and a structured nominal group technique was used to derive implementation strategies most likely to increase treatment coverage. The implementation strategies were delivered prior to and during onchocerciasis MDA. We conducted a coverage survey within 2 weeks of MDA to determine treatment coverage in each commune. A difference-in-differences design was used to determine if the implementation package effectively increased coverage. A dissemination meeting was held with the NTD program and partners to share findings and determine the perceived acceptability, appropriateness, and feasibility of implementing rapid ethnography as part of routine program improvement.ResultsDuring rapid ethnography, key barriers to MDA participation included trust in community drug distributors, poor penetration of MDA programs in rural or geographically isolated areas, and low demand for MDA among specific sub-populations driven by religious or socio-cultural beliefs. Stakeholders developed a five-component implementation strategy package, including making drug distributor trainings dynamic, redesigning distributor job aids, tailoring community sensitization messages, formalizing supervision, and preparing local champions. After implementing the strategy package, MDA coverage increased by 13% (95% CI: 11.0–15.9%) in the intervention commune relative to the control commune. Ministry of Health and implementing partners found the approach to be largely acceptable and appropriate; however, there was mixed feedback regarding the feasibility of future implementation of rapid ethnography.ConclusionsImplementation research conducted in Benin, and indeed throughout sub-Saharan Africa, is often implemented in a top-down manner, with both implementation determinants and strategies derived in the global North. This project demonstrates the importance of participatory action research involving community members and implementers to optimize program delivery.

Design for Impact: Wake Wadho, A Cultural Branding through Collaborative Design Model in Ngada Regency, East Nusa Tenggara

Wake Wadho is a trans-sectoral and interdisciplinary collaborative model that combines design thinking and rapid ethnography implemented in three traditional villages in Ngada, Middle Flores, East Nusa Tenggara, Indonesia. This collaborative model was born from a pilot program (IKKON) run by the Indonesia Creative Economy Agency (BEKRAF RI). This collaboration involved people from various backgrounds, such as design, art, and anthropology. The three traditional villages in Ngada Regency required more comprehensive action involving facilitation and empowering activities to develop a sustainable and creative ecosystem. The program activities were reviewed based on social, cultural, economic, and geopolitics aspects. This paper illustrates the usage of design as a tool to create sustainable livelihoods. It describes a collaborative design model that combines anthropological and design approaches to create an ‘Experience Journey’ (EJ) consisting of two categories: a service design recommended as a tourism scheme and a sustainable lifestyle product as a tangible product design. This output aimed to emphasize the part of empathy within the design process by considering the sociocultural aspect of the community’s everyday life. Furthermore, the products have authentic and inspiring stories behind them. The initial output was wrapped up in Wake Wadho as a cultural brand.

Exploring resident experiences of person-centred care at mealtimes in long-term residential care: a rapid ethnography

IntroductionPoor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life. Previous research has concluded that the content of the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal. However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking. We aimed to understand the mealtime experience in long-term residential care by exploring (missed) opportunities for person-centred care in different settings.MethodsAs part of the TRANS-SENIOR research network, rapid ethnographies, were conducted across multiple sites (including interviews, observations and informal conversations), in a long-term residential care home in the UK, Switzerland and the Netherlands between October 2020 and December 2021. ResultsFollowing analysis and interpretation of observations, interviews and informal conversations, the following themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed: 1) considering the setting, 2) listening to and implementing resident choice, 3) enabling residents to help/care for themselves and others, 4) providing individualised care in a communal setting, and 5) knowing the person in the past and present. Residents experienced moments of participatory choice, interaction, independence and dignity, but opportunities for these were often missed due to organisational or policy constraints.ConclusionsThere are opportunities for person-centred moments during the mealtime, some of which are taken and some missed. This largely depended on the setting observed, which includes the overall environment (size of dining area, seating arrangements etc.) and allocation of staff resources, and the level of resident involvement in mealtimes, from preparation to the actual activity.

The Guerrilla Gallery: A Rapid Ethnography about a Collaborative Public Art Installation in East Harlem

In the heart of East Harlem, New York City, a collective of artists called the Harlem Art Collective created the “Guerrilla Gallery”: A collaborative public art installation on a construction fence, to give residents a place to express themselves through art and messages. While East Harlem is characterized by murals depicting Puerto Rican flags and political causes, these symbols were absent in the Guerrilla Gallery, which instead exhibited predominantly Mexican cultural and political symbols. Was a territorial contestation taking place through art, a sort of identity negotiation to determine who “belongs” in the neighborhood? (Zukin, 1995) This article presents an ethnographic and photographic narrative of the Guerrilla Gallery and what it means to the people who live in the neighborhood. Using rapid ethnographic assessment procedures (Low et al., 2005), coupled with photographic cartography (Ulmer, 2017), this study presents the findings of interviews and the Guerrilla Gallery. The analysis revealed that, although there were instances of aesthetic conflict occurring in the gallery, these were not exclusively related to national cultures; gender and racial conflicts were also observed. Strong expressions of aesthetic empathy were also identified in the artwork. The Guerrilla Gallery became a meaningful space for the community in East Harlem, who not only appreciated it because of its aesthetic value and the possibility of expression it offers, but also because residents were able to connect with their roots, strengthen their local identity and pride, express empathy and solidarity with other social groups in the neighborhood or in faraway places, and resist changes or policies that affected their everyday lives.

Professional competition amidst intractable maternal mortality: Midwifery in rural Pakistan during the COVID-19 pandemic

Low-income countries with intransigent maternal mortality rates often follow WHO guidelines that prioritize access to skilled, or professionalized, prenatal and birthing care. Yet the impact of these initiatives in areas still suffering high maternal mortality is opaque. Despite heavy and long investments, the professionalization of midwifery in Pakistan is incomplete, and declines in maternal mortality have plateaued. Traditional midwives have lost status, but they continue to see clients and have influence in their rural communities. We conducted a rapid ethnography among traditional midwives (Dais) and trained Lady Health Workers (LHWs) in two communities of Attock, Pakistan from May to July of 2020. Our findings underscore the importance of long-term presence and trust to maternal care, especially in conditions of resource scarcity or fear (e.g., fear of COVID). We provide evidence of overt disparagement of Dais by LHWs; (2) illustration of the conflicts between gender norms and biomedical priorities of hospitalized births; and (3) exacerbated fear of hospitals during COVID, which served to highlight the advantages of Dai care. Professionalization programs for midwifery must include structures and training to ensure collaborative communications across the country's midwives. Failure to respect the rational decisions of traditional midwives and their patients in circumstances of scarcity, high stress, and isolation only ignores the material and cultural conditions of these vulnerable communities.