Brief comment: Words and numbers in public health nutrition

By Gideon Lasco, MD, MSc

"In the field of global public health where well being is dominated by the numerical alchemy of measurement, the work of describing that which eludes measurement remains a challenge for anthropology." Complex carbohydrates - on the relevance of ethnography in nutrition education by Emily Yates-Doerr

In her short article about transporting a gift from Guatemala to New York, and reflecting on the significance of that gift - which happened to be some loaves of bread - Emily Yates-Doerr speaks in two levels, both of which are conveyed by the quote I chose.

The first is a call for ethnography in nutrition. People don't really think in terms of proteins, fats, and carbohydrates. There is more to food than what it is made of physically. Eating can mean remembering - as in the article, feeling happy, and many more emotions. Significantly, even the implementors of nutrition initiatives concede that the programs don't work. The limited resources make it difficult to. Though  Yates-Doerr doesn't offer anything concrete in terms of what might actually work (which would have been nice, but I also understand the limited goals of such a short article) - she hints at the right way to find out.

Secondly, she reflects on the relevance of ethnography itself, in general terms, and what it can contribute to fields such as global public health, development. What follows my chosen quote elaborates on this: "the challenge of representing aspects of life that will never be fixed is not small, but the value of complexity makes a case not only for the importance of ethnographic knowledge but also for its importance well beyond the field of anthropology."

This role of ethnography in describing complexity also surfaces in Robert Pool's work; in his case the complexity is that of sensation, what is felt, what is experienced. Annemarie Mol's more theoretical peregrination on the subject of taste - incidentally a fine example of an attempt to capture and convey complexity - has an epistemic concern that echo Doerr's anxiety over measurements: "in the act of testing, knowing and intervening intertwine." Finally, as I embark on my own research about height I am sensitized to the importance of meaning over measurements; and how certain physical measures may be magnified in its social construction. The small differences in height among humans, for instance, create difference, which are reproduced in various forms. Measurements are meaningful in ways beyond their power to indicate certain things,  and even when they are seen as such, they are still limited in their ability to express complexity.  Anthropology addresses these by foregrounding words over numbers, a "thick description" of what Malinowski calls the "imponderabilia" of life over a mathematical formula.

Looking at the quote again, I would like to refine its last sentence. It is not only a challenge for anthropology, it is the challenge for anthropology. But how can we anthropologists assert our voices in a world where numbers are more important than words?

Amsterdam
December 2013

Thoughts on Filipino words: Lakad (to walk)

Students walk outside  university campus in Palawan, Philippines (Gideon Lasco, 2014)

by Gideon Lasco, MD

Lakad, to walk, does not, in its common usage, evoke images of speed, yet in a nation where things are slow moving - or not moving at all - it has become a euphemism for getting into motion a number of things, from romantic relationships to bureaucratic procedures.

Among teenagers, 'ilakad' means to be a go-between between a boy and a girl. Usually, it is a person of influence who performs this act, by saying nice things about the boy, or creating opportunities for 'boy meets girl'. The performance of 'Lakad' is the antidote to one of the traits ascribed to Filipino males - torpe, which came from the term 'torpid': shy, slow, bashful. Of course, it does not always end up as intended: the boy may end up falling in love with the girl who performs the 'lakad', and that may have been her intent in the first place.

Then, there is another usage of 'Lakad', one that adults encounter more than teens: the facilitation of procedures in the face of a sluggish bureaucracy. There was a time when an application for a driver's license took a month; is it not possible for the application to walk instead of crawl? Same goes with petitions, lawsuits, job applications, and so forth. A way was found to circumvent this pace: ipalakad, to have someone 'walk through' the task at hand, that is, "to make things happen".

The term 'lakad' does not only imply speed, it is also implies access. The performer of the 'lakad' or the 'taga-lakad' can literally walk through the doors not accessible to the general public, and in so doing, facilitate things. He or she is, oftentimes, an insider, a creature who can not only walk (lakad) but also has many hands, a term which translates more vividly as 'maraming galamay', a metaphor for well-connected individuals.

On the other hand, he may just happen to be at the right place at the right time. When I used to work in a government hospital as a medical intern, it was very common for friends, family, family's friends and friends' family, to ask me if I can facilitate the admission of their sick. Amazingly enough, this facilitation - this special access - is sanctioned informally by the institutions themselves; in our case, the relatives of doctors, nurses, hospital staff are euphemistically termed 'extensions'.

What the performers of lakad have in common - among teenage social circles and institutions alike - is that it is people with influence who perform this act.

Possessive of speed and access, amid the backdrop of lethargic, opaque institutions, lakad is an all too convenient term that glosses over whatever illegalities or unethical practices that come with it. It offers not speed in the sense of a race car or a runner, but of speed only in relation to the norm. A government employee who sees himself as upright but has not been promoted for a decade, should he not act? Or in the case of benefits of a retired public school teacher who just died: Doesn't his widow have the right to speed things up if she can, in the name of her children and their future?

There is a whole moral economy in which the performance of 'lakad' is embedded. The beneficiary becomes indebted to the performer of the act and his debt is called utang na loob, a term pregnant with meaning. It will not be surprising if a doctor would return the favor to a lawyer who saved him from a lawsuit by waiving his professional fees in the future. My American brother-in-law wryly commented that Filipinos give each other too much gifts but in a nation where people rely on others to 'set things into motion', it is not too surprising.

We Filipinos have adapted to the bureaucracies and exigencies of life, and have become - wittingly or unwittingly - participants, or experts ourselves. If you get old enough, you'll have an entire ensemble of people to call on to for all sorts of things, from filing your taxes to registering your car. It becomes a way of life, as indispensable in being Filipino as Meralco bills and occasional typhoons.

It is not entirely a sorry state of affairs.

I know of one who needs 'lakad', and that is our nation. Diplomats, politicians, businessmen, people with influence, can advance our cause, and promote our nation's interest. The problem with lakad is that for every person who goes ahead, someone is left behind. But this is not true for larger schemes, such as national endeavors, where everybody benefits. Indeed, if all of us help to 'make lakad' our nation, then it is no longer a walk among shadows. It becomes a march to progress.