Quotes from a Poet (Mary Between Parasites and Planets: Science - - PDF document

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Quotes from a Poet (Mary Between Parasites and Planets: Science - - PDF document

Quotes from a Poet (Mary Between Parasites and Planets: Science Oliver) in the Muggled Middle To pay attention, this is our endless and proper David Waltner-Toews Community of Practice for Ecosystem Approaches to Health Canada work.


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Between Parasites and Planets: Science in the Muggled Middle

David Waltner-Toews Community of Practice for Ecosystem Approaches to Health – Canada CoPEH-South and Southeast Asia Veterinarians without Borders/ Vétérinaires sans Frontières Network for Ecosystem Sustainability and Health Population Medicine, University of Guelph Dirk Gently Gang

Quotes from a Poet (Mary Oliver)

To pay attention, this is our endless and proper work. Look, I want to love this world as though it’s the last chance I’m ever going to get to be alive and know it

At the one end there is At the other end there is In the middle there is

Dog Ruminant with cyst Tapeworm Death

An example: the parasitic cycle of echinococcosis (Hydatid Disease)

Person with cyst Canine behaviour Access to infected offal Causes and places of death Cultural and dietary habits Economics Infection rate Feces disposal Hygiene Human-Dog Relationships Occupation

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SLIDE 2

Actual size

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SLIDE 3
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SLIDE 4

1991- 1994: Intensive Conventional Investigations

  • Estimated infection rates in dogs & people
  • Identified risk factors
  • Suggested certain possible solutions &

controls (controlling risk factors)

  • Provide information for public education

program (television)

Proposed solutions

  • Build new slaughterhouses (Denmark)
  • Animal Safety & Inspection Act &

regulations (Denmark & Nepal)

  • Ensure garbage collection & clean the

streets (GTZ)

  • Treat house dogs and kill street dogs

(Various Health Agencies)

1991-1994 - Nothing Changed - Why?

Problems with our approach

  • Inappropriate theory
  • Inappropriate action
  • Inappropriate goals

Outdoor Butchering Dogs Eat Offal Dogs Defecate In House People don’t Wash hands People Get Sick Reducing the problem to fit the models: An Epidemiological Risk Factor Model Of Hydatid Disease in Kathmandu

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SLIDE 5

An alternative to linear models: Thinking in Systems

  • Everything is of course connected

– Therefore everything we do has unintended consequences

  • Not all things are connected in the same

way (strength, directness, time & spatial lags)

– Therefore not all consequences are worth paying attention to

Simple Systems

  • Simple systems: linear, stable equilibrium, cause

& effect, predictable systems. Respond with expertise: If you are in a car accident, you want experts who know what to do for your broken leg, and others who know how to fix the broken car!

  • Scholarly Response: modeling
  • Practical response: good education and training.

Hierarchy of command. Efficiency is good.

Complicated Systems

  • Complicated: big or messy simple systems – you can

create quantitative models. Still expert-reliant but need more checks and balances as the math is difficult: epidemic modeling (?), sending a landing craft to Mars.

  • Scholarly Response: Modeling
  • Practical Response: Good education and training.

Build redundancy into the system – lots of checks and

  • balances. Effectiveness is better than efficiency.

Complex Systems

  • Complex systems: complex systems are descriptions of
  • complexity. There are many such descriptions possible –
  • bserver dependent. Raising children and managing

sustainable food systems are activities for which one would invoke complex systems of practice.

  • Complexity Issues (all contentious): Feedback loops

(uncertainty); Scale (boundaries, stakeholders); Multiple Perspectives (whose version counts?)

  • Scholarly Responses: Scenarios, Principles, Narratives
  • Practical Responses: Expand the peer group. Iterate across

temporal and spatial scales.

Drug and alcohol abuse Awareness in Human health Stray dogs Slaughter House hygiene Water availability literacy garbage management Family planning Squatter areas Urban immigration Population density Water quality Open drains Street vendors Air pollution Noise pollution Land availability

A influences B only Bi-directional influence, A -> b and b-> A

Figure !

A different simplification

International Community Regional Landscape Geographic Community Individual Household Nation

Scale - a nested hierarchy

Who are the key Actors? What are the Key Issues?

The World Body is not Flat!

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Whose Story Counts More? Who decides? Who decides who decides?

  • Some perspectives may

be privileged reasons of gender, values, power, wealth, sustainability.

  • Some perspectives are

based on fear, fantasy and ideology and absence of evidence.

  • Take ownership!

Multiple Perspectives

Dogs were a source of disease, but also community police and companions Butchers were providing a service, but also carrying on family, caste and cultural traditions Garbage collection is the responsibility of multiple jurisdictions, and all are under-funded

Whose story is this? Why isn’t she in school?

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SLIDE 7

Pass an Animal Health act?

I think I found the Problem !

Neither

I’d better go back to school

  • Systemic, participatory

approaches to understanding and promoting health and wellbeing in the context

  • f complex social-

ecological interactions.

  • Encompass concerns for

both systemic outcomes and appropriate process.

Ecosystem approaches to health AMESH

David Waltner-Toews

Entry point

Presenting Issues The Given History Governance Issues Stakeholders

Analysis of: People and Their Stories Understanding Social-Ecological Systems Collaborative Learning and Action Monitoring and Evaluation: Implementation Design of an adaptive approach Trade-offs & Solutions. Where do people want to go

Understanding Culture Understanding Nature

1 2 3 4 5 6 7

What are the options: constraints and

  • pportunities

Presenting Situation: Entry point and initial description - Why are you here?

  • Guiding Questions

– How did the current situation come about? Interactions among social, economic, and political developments? – Who have been the agents of change? At what scale?

  • Methods – Government Documents,

Literature

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SLIDE 8

Stakeholder analysis

  • Guiding Questions – Stakeholder identification &

analysis

– How do we identify the stakeholders? Who are they? – What are the relationships among and between stakeholder groups (coalitions, conflicts)? – Who is making the key decisions? – Who benefits from the system as it is? Who loses? Who is excluded? – What happens if you exclude one stakeholder group? – How does gender affect people’s roles and opportunities to participate? – What are the roles of researchers? How are they viewed by the community? What kind of power do the researchers have?

Analysis of the relationships among stakeholders, issues and governance: Issues

  • Guiding Questions

– What are the critical issues, and how to the relate to each other? – At what spatial and temporal scales do these occur? – For which stakeholder groups are these issues critical?

Analysis of the relationships among stakeholders, issues and governance: Policies

  • Guiding Questions

– What are the important rules and policies that influence the various issues? – Which of these are explicit (published, formal) and which are implicit (gender, economics, cultural). – Do these enable or hinder the development of solutions? – Who creates those rules and policies? Are they local, national, international?

  • Methods: Mixed methods – literature, focus groups, key

informants

Multiple narratives: a more complex history

  • Guiding Questions

– What stories do the different groups tell about how the current situation came to be? These include stories by virologists and economists as well as farmers and village animal health workers, and both men and women. – What is the main purpose of the system from each stakeholder group’s perspective?

  • Methods: Interviews, key informants,

stakeholder-specific focus groups, literature Systems analysis

  • Guiding Questions

– What are the key ecological and social processes that define the system? – What are the important spatial and temporal scales of

  • bservation? (individuals? Households? Landscapes?

Measured over a week? A year? Ten years? – eg climate change takes many decades to discern; rainfall and nutrition might be over years; disease patterns over months). – How do the variables related to each other?

  • Methods: Multiple qualitative and quantitative

models, rich pictures, influence diagrams, GIS, Complex Systems Models

Systems Synthesis

  • Guiding Questions

– What are some possible scenarios and visions for the future, what are the conditions under which they might occur, and what are the trade-

  • ffs?

– What are some feasible and desirable management actions

– Methods: scenario development, looking at how subsystems related to each other

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Butchers (employees) Retailers Customers (ward citizens) Street Sweepers (women) Street vendors Vegetarian hotel Non - vegetarian hotel Water availability - low quantity

  • f tap water

Water availability - low quantity tube well water Water quality - low quality tube well water Hygiene of slaughter houses Level of shop hygiene Quality

  • f meat

sold Water availability Hygiene of riverbed Cleanliness Of streets Quality of meat served Quality of tube well water (poor) Quality of tap water (poor) Quality of Dhungedhara water (poor) Quality of hotel hygiene (poor) Water availability quantity of water

What do Stakeholders identify as needs and goals - water, food and waste

Garbage container Regular garbage collection Training refrigerator storage Protective nets

  • ver meat

Training Protective clothing Garbage containers Improved slaughterhouse garbage management Protective equipment (gloves, masks, shoes) Hygiene training Bell system (does not work) Awareness needed at household level Need time to collect garbage Time and money to boil water Interested in forming a mother’s group to manage drinking water, garbage, slaughterhouses & awareness raising All other actors ( Wholesalers, Squatters, etc.)

?

Linking Stakeholder Concerns - food and waste system

Temporary Doko sellers produce garbage Sweepers do not sweep regularly enough Sweepers should not get weekends off Street sweepers are responsible for poor garbage management Community leaders Sweepers only collect paper & vegetable waste leave other garbage e.g. dead animals Ward committee does not properly enforce rules and regulations People, esp. from disadvantaged groups w/ low literacy are not aware of garbage mgt Lack of efficient and regular sweeping exacerbates garbage mismanagement People throw garbage out window as soon they see tractors Massive amounts

  • f garbage from

slaughterhouses Street vendors Expect Sweepers to clean waste Citizens ignore request to not carelessly throw garbage everywhere ‘sweepers’ Other vendors Retailers Do no perceive any environmental problems Wholesalers (owners) Squatters (ward citizens) Slaughter houses waste & smell Butchers yell & throw bones at them Feel intimidated by employers Butchers (employees) Feel they receive bad media coverage Not enough time to collect garbage Customers produce garbage when they purchase from vegetable vendors Doko vendors Sense of

  • wnership

Better management All vendors should pay rent for space - facilitate

  • rganisation

Temporary Doko sellers cause traffic fams & sell too cheap Vegetarian hotel Non - vegetarian hotel Police - HMG Small Meat Market Association KMC Customers (ward citizens)

?

Figure 14: Issues and influences - sweeper stakeholders

Actors Needs Activities Resource states Concerns Cleanliness Of streets

Lack of efficient and regular sweeping exacerbates garbage mismanagement

Expect Sweepers to clean waste Not enough time to collect garbage Citizens ignore request to not carelessly throw garbage everywhere People throw garbage out window as soon they see tractors Massive amounts

  • f garbage from

slaughterhouses Illiteracy helps upper caste keep domination

  • ver them

Lack of opportunity for education & employment for children Health impacts

  • f handling

garbage Garbage containers Need time to collect garbage Awareness needed at Household level Bell system (does not work) Improved slaughterhouse garbage management Literacy training Money to send children to day care or school Protective equipment (gloves, masks, shoes) Hygiene training Dispose garbage into containers Dispose fecal matter in plastic bags in street Dispose garbage in street Sweep streets (garbage into piles) Unblock drains Pick up piles Set rules and regulations for street sweeping Empty containers into tractor (once a week) Transport waste to Teku landfill Dispose vegetable waste in street Sweeper Help fund (loans) Households KMC sweepers Street vendors Ward Committee Inspectors (men) Captain (men) Tractor Driver (men) Drain Unblockers (men) Street Sweepers (women)

Sweeper Hierarchy

Collaborative action and learning - Seeking Solutions

  • Guiding Questions

– What kind of a story do stakeholders want their grandchildren to tell about them? – Is there a shared vision of the future? – How can stakeholders make this story come true (How can they achieve their goals)? – What kinds of institutional arrangements are necessary? – What are the barriers, and how might these be overcome? Workshops, town hall meetings, formal governance institutions

Implementation, Monitoring, Evaluation

  • Guiding Questions

– What are the steps required for implementation, and who is responsible? – How can people be motivated to adopt suggested changes? – How can this be sustained? – What are the relevant indicators of performance? Who “owns “ them? Who will measure them? Who will use them? – How will the system “learn”, that is, use the indicators to develop new strategies and policies?

  • Methods: Political, organizational and bureaucratic
  • engagement. Foresight methods. Natural Step.

Entry point

Presenting Issues The Given History Governance Issues Stakeholders

Analysis of: People and Their Stories Understanding Social-Ecological Systems Collaborative Learning and Action Monitoring and Evaluation: Implementation Design of an adaptive approach Trade-offs & Solutions. Where do people want to go

Understanding Culture Understanding Nature

1 2 3 4 5 6 7

What are the options: constraints and

  • pportunities
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What Changes in a Complex Systems Approach?

! Our understanding of the world (Complexity, uncertainty) ! The roles of experts and investigators (Facilitators in an expanded peer group – Communities of Practice and networks of trusted colleagues and friends ! Decision-making, governance, management, monitoring (Innovative) ! Measures of quality or “success” : What are we trying to achieve? - principles (equity, sustainability, adaptability) – cf The Natural Step, Ecohealth, MDGs

What would a successful ecohealth project look like?

  • Improved/ enriched understanding by researchers and

decision-makers (citizens)

  • Improved “patient” - eg better water quality, less disease,

better sharing of wealth (less disparity between rich and poor), how many women are in positions of leadership, what are the men doing now, is there better education, - depends on the goals of the stakeholders and the constraints of the system

  • Community is able to continue and adapt to new

circumstances long after the researchers are gone - they have learned how to learn

Parks Composting Houses for Squatters Public Bathrooms and Riverside Plants

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SLIDE 11

Urban Gardens Enclosed Slaughtering Areas

Stabilized River Banks New Leadership

There are always unresolved issues Resilience, Scale & Humility: The Berlin Wall, 9-11 and disappearing vultures

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It is about values: but not JUST about values

You’ll miss more for not looking than for not knowing. What you see isn’t always what is there (you could be projecting). Listen to everyone around you. Use THEIR eyes Compare notes: No one can figure this out alone Ask why why why – a good scientist and public health worker never gets past 5 years old

Who cares if we make a difference?

The Challenge of Space

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International Community Region/Landscape Community Individual Household Nation Key Issues Research Variables Peru: Nested hierarchy of the key issues and research variables

  • Malnutrition
  • Gastro-intestinal infections
  • Food Insecurity
  • Poor hygiene and sanitation
  • Diverse seasonal livelihood strategies
  • Intra-household food allocation
  • Gender dynamics
  • Poor water quality
  • Little social capacity
  • Flooding cycles affect livelihood systems
  • Sectoral approaches that fail to take into account

linkages between health and the environment

  • Centralized health policy
  • Unregulated commercial extraction
  • Priorities for health aid programs determined

internationally

  • Little baseline data and follow-up to evaluate

national interventions

  • Nutritional status
  • Parasite loading
  • Diarrhoeal incidence/prevalence
  • Anaemia
  • Anthropometry
  • Production levels/diversity
  • Income levels/diversity
  • Time allocation
  • Hygiene practices
  • Ecoli counts
  • Access to health services
  • Community organization/social capital
  • Internal migration
  • Diversity of ecological resources
  • Seasonal changes in available

ecological resources

  • Access to food aid programs
  • Access to health and nutrition

programs

Efficient Poultry Production

Water Manure Feed Imports Travel

Happy Consumers

Energy: labour, fossil fuel, technology

Quick Snow Melt Unusually Heavy Rainfall High Temperatures Food Exports

Offal, Deadstock

Happy Farmers Climate Change Political Decentralization’ Deregulation U N

WHAT IS EFFICIENCY? WHERE IS THE BOX?

Systemic Feedbacks

Narratives: Relating Complexity to Evidence

  • A narrative is … a series of elaborate

scaling operations that allows different things of different sizes to be made commensurate (TF Allen).

  • The point of models is to improve the

quality of our narratives.

  • The point of scholarly evidence is to

improve the quality of our models.

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SLIDE 14

Outcomes change from fixing to facilitating, medicine to health Biomedical Ecosystem

Scientific base Normal science Post-normal science Theoretical concern Analysis Synthesis Clinical concern What’s the problem? (Specific Dx) What are the issues? (Systemic Ux) Source of Credibility Professional authority Stakeholder negotiation Context Hierarchy Holonocracy Implementation issue Compliance Conflict resolution Goals Disease Px or Tx Ecological integrity/ sustainable livelihoods/ health Systems Perspective Px Disintegration Promote SOHO

Some responses to Complexity

Focusing on Outcomes

  • Ecological integrity
  • Conservation medicine
  • One medicine
  • One health
  • Sustainable livelihoods
  • Resilience
  • Ecosystem health
  • Complex systems
  • Healthy Communities
  • MDGs

Focusing on Processes

  • Systems Design Engineering
  • Soft Systems Methodology
  • Participatory Action

Research

  • Collaborative Learning
  • Adaptive Environmental

Management

  • Appreciative Inquiry
  • Operations Research
  • Interactive Planning

The Roles of Researchers or Interveners

  • Initiate, facilitate, communicate - systemic views, broader

understanding.

  • Be the helpful “outsider”

– Help identify important scientific, economic, social & cultural issues – Help identify missing stakeholders and facilitate their entry into the process – Help measure outcomes

  • Normal research into causal linkages
  • Evaluate the process
  • Acknowledge our own role as change agents - do we have a

right to do this?

The Challenge of Values: Chickens