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In Conversation: Mother Tongue Education and Civic Engagement amongst Ga Youth
No full textThe role of language in education policies and the importance of civic engagement are well documented. What is less clear is how they converse with one another to inform how to develop active citizens who are empowered in their mother tongues. Building on a conceptual framework of civic engagement and linguistic injustice, this article asks: After the implementation of the 1971–1994 and 2004 medium of instruction education policies in Ghana, what language did Ga youth learn in, in practice? What are the intersections between Ga youths’ relationship to language and civic engagement participation? Together, these questions inform understanding of youth educational experiences, Ga people’s perception of the vitality of their language, and their responsibility to the community. In interviewing 22 Ga people in Ghana during the summer of 2022, I find that despite policy encouraging mother tongue instruction, most participants learned in English during primary school. Additionally, contrary to the notion that there is a disinterest in civic engagement amongst Ghanaian youth, findings show Ga youth find part of their civic responsibility to lie in passing on the Ga language to preserve their culture, land, identity, and the future of their community
Signing the Unspeakable: On Trauma, Recovery, and Drive My Car
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The world as I know it has dissolved.
“All trauma is preverbal,” writes Bessel van der Kolk (43). In The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, he examines current scientific knowledge about the nature of PTSD and catalogues possible treatments for the disorder. “Victims of assaults and accidents sit mute and frozen in emergency rooms . . . photographs of combat soldiers show hollow-eyed men staring mutely into a void” (43). In 1994, van der Kolk and a team of researchers identified the neural substrate of this phenomenon: when patients were dissociating, Broca’s area—a portion of the brain that is necessary for generating language—was deactivated (43). Trauma, from this perspective, is a neurochemical response, not an external event, and the response is one of dissociation—what van der Kolk terms “the essence of trauma” (66). Some who experience potentially traumatic events don’t dissociate at all; others dissociate so severely that their memory of the event is obliterated along with the language they could use to describe it (192).
I clutch at words that crumble as I struggle to scramble out of this preverbal void.
Traumatized people fall silent for many reasons: some are rendered speechless during flashbacks; others become frustrated when they find that their speech is consistently disorganized (van der Kolk 43). Maya Angelou, famously, resigned herself to “muteness” (88). In her autobiographical novel I Know Why the Caged Bird Sings, she recounts that after her testimony against the man who raped her when she was a child led to his murder, she felt that her voice was too dangerous to be heard: “I had to stop talking” (87).
It is unsurprising, then, that in a film about the lead-up to and aftermath of a traumatic event, a non-speaking person should serve as the spiritual anchor. Ryusuke Hamaguchi’s Drive My Car tells the story of Yusuke Kafuku, an actor and director whose love for his wife Oto is matched only by his dedication to his red Saab 900. Oto, a screenwriter, dies suddenly after learning that Yusuke has discovered her affair with Koji Takatsuki, the young star of one of her films. In the wake of his wife’s death, Yusuke, who is starring in his own production of Waiting for Godot, finds himself speechless and unable to proceed with the performance. However, despite losing his ability to act, he keeps directing, and two years later he finds himself in Hiroshima staging a multilingual production of Chekhov’s Uncle Vanya. A phlegmatic perfectionist, he proceeds as methodically as ever: he travels from the island where he is lodged to Hiroshima each day in his precious Saab, reading lines from the play along with a tape his wife recorded for him. But instead of playing Vanya himself, he casts the brash and impulsive Takatsuki in the role. The evolution of their relationship, and Yusuke’s burgeoning friendship with Misaki, the driver that he is forced to accept for liability reasons—someone who, it is revealed, has suffered significant losses herself—are the focus of the remainder of the film.
Against this backdrop, the character Yoon-a, a non-speaking former dancer who turned to acting after being traumatized by a miscarriage, can seem extraneous. A cursory Rotten Tomatoes search reveals that only five out of forty-five top critics used the keywords “Yoon-a” or “sign language” in their review, and most of the few that did portrayed the use of the language as one of the film’s many idiosyncrasies. Worse yet, because she is a “mute” character played by a speaking actor, Yoon-a could be construed as merely a metaphor for silence, trauma, and exclusion. However, a closer examination of her silences, and of the contradictory nature of silence itself, reveals that her role in the film is more than symbolic: her character arc traces the full path to recovery from trauma, a path on which her inability to speak is revealed to be an asset in disguise.
In the United States, speech is often associated with agency, personhood, and connection. Silence, as the absence of speech, is equated with powerlessness and disconnection. As prominent feminist Rebecca Solnit succinctly puts it, “words bring us together, and silence separates us” (18). In her essay “A Short History of Silence,” she reflects on the role that silence has played in the ongoing struggle for women’s rights and concludes that it is inextricably bound up with oppression. Because their cries for help have not been heard, she laments, people who have been abused and subjugated stop talking, stop listening, and ultimately “hear no one, not even themselves . . . [they] have repressed, forgotten, buried the knowledge and thereby buried themselves” (Solnit 38).
I am left alone with only an echo of myself. The voices of others arrive as a sub-marine mumbling, as if resonating through the plexiglass barriers of an aquarium tank.
When oppression is presented as the only alternative, it seems reasonable and even admirable to demand speech. That is precisely what “black, lesbian, mother, warrior, poet” Audre Lorde did in her address “The Transformation of Silence into Language and Action” (“Audre Lorde”). Following a surgery that could have marked the beginning of the end of her life, she implored her listeners to tell their stories: “In becoming forcibly and essentially aware of my own mortality . . . what I regretted most were my silences . . . I have come to believe over and over again that what is most important to me must be spoken, made verbal and shared” (Lorde 41).
This urgent need to speak spurs many traumatized people to assume what Delker et al. call a “survivor identity” (4). In their analysis of social perceptions of trauma in the aftermath of the #MeToo movement, they identified three types of endings to trauma stories: negative, redemptive, and survivor identity. Survivors, in a modern American context, are those who tell their stories even and especially in the face of scorn and disbelief. In yet another example of speech as a form of connection, their choice to do so is often motivated by their desire to serve others who have endured similar traumas (Delker et al. 4). As Solnit observes, “speaking up is . . . often an act of empathy” (38).
But telling difficult stories is more than just a service we provide to others. Rather, it is regarded as both the catalyst for and the proof of healing. Our cultural preference for people who speak, and speak with conviction, entices us into believing that despite the ineffability of trauma, verbalizing one’s feelings about traumatic events should lead to healing and reintegration. This belief, for which there is compelling but incomplete evidence, undergirds all traditional treatments for the disorder. The oldest and most famous of these treatments, of course, is psychotherapy, invented by Sigmund Freud and Josef Breuer in the late 19th century (van der Kolk 183). Talk therapy was invented when these two pioneers realized that recollecting the details of a traumatic event could relieve their patients’ “hysterical symptoms” (183).
Hand around throat, head against concrete, my roommate Simón spits poppy flowers that sprout crimson as they spatter my white clothes…
Undoubtedly, it is necessary to recall the specifics of a traumatic event in order to determine its lingering effects. But where does this leave Yoon-a? There has been no room for her in the conversation about Drive My Car up to this point. Even if she signs her story, she will usually need someone to translate and speak for her. Won’t the immediacy, and therefore the transformative power of telling, be lost?
The answer is a resounding no. We first hear Yoon-a’s backstory during a scene in which she and her husband Gong Yoon-soo, the dramaturg for the production of Uncle Vanya, host Yusuke and Misaki for dinner to apologize for the fact that they had concealed their marriage when she auditioned. Dressed in white, Yoon-a is initially presented as a symbol of fertility. The potatoes on the table, Yoon-soo is proud to note, were grown by her, and Yoon-a even jokes that one of the potatoes looks like him (1:22:45-1:23:05). But soon, the illusion is shattered: when Yusuke asks why she auditioned, she responds with a series of signs that concludes when she brings both hands before her womb, pushes one down and away, and solemnly bows her head. Her husband, after declining to translate her last sentence, reluctantly translates this one: “I got pregnant and took time off from dancing, but had a miscarriage.” She confesses that she turned to acting because her body “refused to dance.” Finally, she relaxes, and she joyfully shares that acting is bringing life to her body again. Her guests sit spellbound, clearly moved that someone could share such a story so forthrightly (1:25:05 – 1:27:53).
But Yusuke and Misaki also share their stories, and until those two stoic characters finally show emotion during the film’s closing scenes, they’re not transformed in the process. On the contrary, they seem to be stuck in cycles of repetition and self-hatred: Yusuke listens to his dead wife’s voice repeat the same lines in the same car on the same roads every single day; Misaki, in search of a way to escape the literal and figurative wreckage of her personal life, flees to Hiroshima, of all places. The more they try to leave their pasts behind, the more their pasts define them.
I run, insensate, through the vibrating danger of boarded-up districts. Fear brings me back to life; adrenaline outraces memory.
“Freud,” writes Van der Kolk,
had a term for such traumatic reenactments: “the compulsion to repeat.” He and many of his followers believed that reenactments were an unconscious attempt to get control over a painful situation and that they eventually could lead to mastery and resolution. There is no evidence for that theory—repetition leads only to further pain and self-hatred. In fact, even reliving the trauma repeatedly in therapy may reinforce preoccupation and fixation (32).
Neuroscientist Ethan Kross captures this “preoccupation and fixation” in a single word: Chatter. In his 2021 book of the same name, he discusses some ways in which our thought patterns hold us in thrall and offers evidence-based strategies to help readers use their inner voices to their advantage. One of the findings he discovers most consistently in the scientific literature is that, paradoxically, repeatedly sharing negative experiences with others can actually intensify feelings of isolation (Kross 31).
Why, then, is Yoon-a’s story so transformative—not just for her, but for Yusuke and Misaki as well? One clue can be found in the nature of sign language itself: unlike speech, it demands full-body awareness and communication.
Breathing in, I know I’m breathing in … Breathing out, I know I’m breathing out.
A fascination with the physicality of sign language led anthropologist Stephen C. Fedorowicz to a series of workshops at the Japanese Sign Language (JSL) Atelier in Hirakata. Knowing that deaf children in Japan were often forced to learn to speak by hearing teachers rather than taught sign language by Deaf ones, Fedorowicz was curious about the role that JSL played in initiating deaf people—that is, people who are clinically deaf—into the Deaf cultural community. The result was his 2019 paper “Performance, Sign Language, and Deaf Identity in Japan,” in which he argued that the performative aspect of sign language played a crucial role in the development of Deaf personal and cultural identity. In one workshop, many deaf participants were actually criticized for signing a story in a way that too closely mimicked Signed Japanese, a derivative language that is considered inauthentic and unimaginative. The instructor, on the other hand, “stressed the importance of imagery and everyday experience” when using JSL and used a variety of facial expressions to keep his viewers engaged (Fedorowicz).
And it turns out that being physically connected to the emotional content of a painful story is far more important from a therapeutic perspective than simply telling the story out loud. “Recollection without affect,” note Freud and Breuer, “invariably produces no result” (van der Kolk 184). Paradoxically, then, Yoon-a’s “muteness” forces her to tell her story in a more productive way. Instead of recounting the events stone-faced, her communication has to be grounded in physical awareness.
As I sit, aware of my body, I stop trying to find the words to tell my story. And all of a sudden, the words appear: my roommate went off his medications and attacked me; I was trapped with him for the rest of the term. Nothing less, and nothing more. Breathing in, I know I’m breathing in; breathing out, I know I’m breathing out.
In order to understand Yoon-a’s significance in Drive My Car, we must understand Japanese cultural attitudes toward silence. In a now-published talk entitled “A Deep Sense of Human Value,” Zen master Katagiri Roshi employed a word that expresses the essence of those attitudes: mokurai (63). “Moku” he said, “means silence, and rai means thunder . . . So you are silent, but simultaneously there are many words, many explanations, and many representations there . . . there is an enormous voice like thunder there” (63).
Submerged in silence, sensations alone are now enough. As I stop running from my memories and trying to return to my former self, I surrender to a much larger sense of self, one that is by nature in flux, impermanent, and insubstantial, ready to change at any instant.
During a scene in which the cast of Uncle Vanya rehearses outside in a shady grove, we witness how acting is revitalizing Yoon-a. After weeks of forbidding his actors to show emotion, Yusuke finally allows them to perform, at which point Yoon-a does something radical: she improvises. In a scene between Sonya, played by Yoon-a, and Yelena, played by Chinese-American cast member Janice, Yelena confesses her misery and bemoans, “Happiness, for me, doesn’t exist in this world.” Then, upon seeing Sonya’s reaction, she stops short. “Why are you laughing?” she asks. “I’m happy,” Sonya signs. “I’m just so happy.” Yelena grins, turns away, and shakes her head, bemused; “I want to play the piano now,” she pines. Suddenly, Yoon-a picks up a leaf from the ground and presents it to Janice. “Do play,” she urges, wrapping her arms around her from behind (1:53:10-1:53:50). This small gesture, a gift of vitality and presence, breathes new life into their performance, and the monotony of the film is finally broken.
The veil that separated me from reality has been lifted: before, I felt that the wind was blowing; now, I feel the wind blowing; I relax and feel its coolness against my skin.
So far, all of our attempts to understand Yoon-a’s transformative power have required an analysis of language, whether voiced or unvoiced. But because trauma is preverbal, communication between traumatized people must ultimately transcend language.
What does this look like in theory? It entails, to borrow a phrase from film theorist Trinh T. Minh-ha, “speaking nearby.” “‘Speaking nearby,’” according to the description from a museum exhibition on the topic, “sets itself apart from ‘speaking about;’ it refers to an indirect form of speaking that does not objectify topics and subjects but reflects upon itself and is capable of approaching topics and subjects from up close” (“Migration: Speaking Nearby”). Just as when resting in physical awareness, when speaking nearby, the distinction between subject and object—those interlocking gears that set all language in motion and give rise to the notion of the “other”—can fade away. In other words, it is unnecessary to speak about trauma in order to “speak” nearby it.
What does it look like in practice? Yoon-a demonstrates best. With Misaki in the audience, she delivers the monologue we have heard Yusuke’s wife repeat so many times during his long, monotonous drives. In it, Sonya encourages Vanya—played, in the end, by Yusuke himself—not to lose hope.
Fig 1. “Drive My Car (2021) Theater.” YouTube.
I watch this scene tranquil and whole, once more at a loss for words, but this time free from fear. Yoon-a is not signing for Yusuke, nor is she signing to him; she is signing with and nearby him. At once, five dimensions are collapsed into none: the distance between Yoon-a, Sonya, Yusuke, Vanya, Misaki, and us is dissolved. In a film that chronicles the collective isolation of its speaking characters, we finally have preverbal communion: characters, actors, and audience merge in a shared experience, a oneness that exists beyond words, beyond signs, beyond stories; now safe, we can reclaim the void.
WORKS CITED
Angelou, Maya. I Know Why the Caged Bird Sings. New York, Bantam Books, 1997.
“Audre Lorde.” Poetry Foundation, Poetry Foundation, https://www.poetryfoundation.org/poets/audre-lorde.
Delker, Brianna C., et al. “Who Has to Tell Their Trauma Story and How Hard Will It Be? Influence of Cultural Stigma and Narrative Redemption on the Storying of Sexual Violence.” PLOS ONE, edited by Whitney S. Rice, vol. 15, no. 6, June 2020, https://doi.org/10.1371/journal.pone.0234201.
Drive My Car. Directed by Ryusuke Hamaguchi, performances by Park Yu-rim, Hidetoshi Nishijima, Tōko Miura, Jin Dae-yeon, Masaki Okada, Reika Kirishima, and Sonia Yuan, C&I Entertainment, 2021.
“Drive My Car (2021) Theater.” YouTube. Uploaded by Nameless Fox, 4/1/2022, https://www.youtube.com/watch?v=ghP5fgUVU-E.
Fedorowicz, Steven C. “Performance, Sign Language, and Deaf Identity in Japan.” Anthropology News, vol. 60, no. 3, May 2019, https://doi.org/10.1111/AN.1182.
Katagiri, Dainin. Each Moment Is the Universe: Zen and the Way of Being Time. Shambhala, 2008.
Kross, Ethan. Chatter: The Voice in Our Head, Why It Matters, and How to Harness It. Crown, 2021.
Lorde, Audre. “The Transformation of Silence into Language and Action.” Sister Outsider: Essays and Speeches. Trumansburg, 1984. ProQuest, https://www.proquest.com/books/sister-outsider-essays-speeches/docview/2138588223/se-2.
“Migration: Speaking Nearby.” e-Flux Announcements, e-Flux, https://www.e-flux.com/announcements/305194/migration-speaking-nearby/.
Solnit, Rebecca. The Mother of All Questions. Haymarket Books, 2017, ProQuest Ebook Central.
Van der Kolk, Bessel A. The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma. Penguin Books, 2015
AREN’T I A WOMAN DESERVING OF JUSTICE? RESTRUCTURING VAWA’S FUNDING STRUCTURE TO CREATE RACIAL AND GENDER EQUITY
Get PDFThis Note analyzes the funding priorities of the Violence Against Women Act (VAWA), and how the law’s egregious funding of prosecutors, enforcement agencies, officers, and courts directly impacts Black female survivors of intimate partner violence (IPV). Although VAWA was passed in 1994 to serve as a federal remedy for women subjected to IPV, over 85% of current VAWA’s funding supports law enforcement, prosecutors, and the overall criminal legal system. This directly harms Black women due to this community’s historically negative relationship with the legal system. Additionally, Black women subjected to abuse are also uniquely impacted by VAWA’s emphasis on punitive measures and enforcement due to their overrepresentation amongst IPV survivors. This Note will advance the argument by investigating three grant programs under VAWA
The Thinking Classroom in a College Setting: A Case Study
No full textDeveloping and Supporting Teachers' Mathematical Pedagog
Protective Factors that Yield Empowerment for Black Girls’ Mathematical Brilliance: Black Girls Protective Factors of Empowerment
No full textBlack girls are marginalized and often experience barriers to accessing advanced mathematics, which affects their socialization and identity. Little is known about the experiences of Black girls who have gained access to advanced mathematics programs. The participants in this study were 11 middle school Black females enrolled in advanced mathematics, a course with a curriculum at a higher grade level and a faster pace compared to their same-age peers. Using a qualitative methodology, we use collective memory writings, individual and focus group interviews, and the researcher’s journal data to examine how girls’ perceptions of societal messages work to impact and empower Black girls enrolled in advanced mathematics coursework and extend current research on this topic. We conclude that Black girls have various protective factors--innate characteristics that yield positive outcomes, influencing their self-efficacy. The themes uncovered as a result were that Black girls are motivated by engaging in valuable mathematics that is meaningful to them; their perceived mathematical identity represents a protective factor. This research study illuminates that Black girls are brilliant, but only those with prominent protective factors are often recognized in educational institutions for their merit.
Immunizing Roe: How Court Treatment of COVID-19 Vaccine Mandates Supports Reproductive Freedom
Get PDFImmunizing Roe: How Court Treatment of COVID-19 Vaccine Mandates Supports Reproductive Freedo
International Research and Philanthropy: Ethical Concerns with Malaria Research
No full textPhoto by Erik Karits on Unsplash
ABSTRACT
This paper analyzes ethical issues arising from malaria research. These issues stem from the use of human landing catches, the medical treatment provided to human landing catch participants, participants misunderstanding their role in research, the conflicts of interest between the Gates Foundation and its evaluation policy, and the genetically modified mosquito release. This paper reviews the relevant ethical issues and recommends ways to prevent these problems from re-occurring and similar issues from arising.
INTRODUCTION
Malaria research poses complex ethical issues. The potential for unanticipated and anticipated harm to research subjects is high, and the areas of research are often where the general population is socioeconomically disadvantaged. The type of data collection and the role of human research subjects are problematic. Issues concerning the release of genetically modified mosquitoes include participants misunderstanding their role in the research, community consent, mosquito migration, and the cost of re-occurring release. This paper reviews these ethical concerns and uses a rule utilitarian approach to provide recommendations to prevent ethical problems from recurring. Policies and protocols surrounding international research and philanthropy as a primary funding source need to be strengthened and further developed; otherwise, unethical research practices in low-income resource-poor settings will likely continue.
l. Rule Utilitarianism
John Stuart Mill’s work is part of classical utilitarianism, which describes the principle of utility.[1] The principle of utility states, “actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness.”[2] Rule utilitarianism, a contemporary form of utilitarianism, still seeks to produce the most happiness for the most people. It considers the consequences that would occur during the implementation of an act as a general rule where everyone in similar circumstances did the same thing.[3] It judges whether an action is good by asking whether it conforms to a rule that consistently maximizes utility or happiness. Applied rule utilitarianism demonstrates how some of Target Malaria and the Gates Foundation’s current practices could not be implemented as general rules for similar circumstances.
ll. Human Landing Catches
Human landing catches are a mosquito collection method for research involving studying behaviour and physiology, and population.[4] Human landing catches use human subjects as bait to attract mosquitoes, which are then caught as they land on an exposed limb. Medical treatment for human landing catch participants is inadequate.
Human landing catches are a mosquito collection method used in research settings. Human subjects are placed in an area with an exposed limb to catch mosquitoes as they land.[5] When participating in a human landing catch, researchers may expose subjects to roughly 70 mosquito bites per night.[6] When conducting these catches in areas with malaria, repeated mosquito bites put participants at risk of contracting malaria or other mosquito-borne diseases. Furthermore, the individuals recruited to be human landing catch subjects frequently come from financially disadvantaged backgrounds, with limited or no other means to generate an income.[7] Senior researchers often do not participate in catches because they understand the associated risks.[8]
A mosquito electrocuting trap, which electrocutes and kills the mosquitoes, was explicitly designed as a safer alternative to human landing catch.[9] The continued use of human landing catches when other methods of collecting mosquitoes are available may place participants at undue risk. Under rule utilitarianism, it would not be possible to implement a generalizable rule that allows human subjects to be placed at undue risk when safer alternatives are available. Therefore, the use of human landing catch should not continue.
lll. Medical Treatment for HLC Subjects
Malaria is a parasitic disease spread by the Anopheles species of mosquitoes.[10] Four parasites cause malaria, P. vivax, P. ovale, P. malariae, and P. falciparum, the latter causing the most severe form of the disease.[11] The incubation period for malaria is usually 7 to 30 days. However, symptoms can first show as late as one year after exposure.[12] Two parasites, P. vivax and P. ovale, can cause a relapse of illness because they can remain dormant in the liver, with relapse occurring up to four years after infection.[13] Recurrent malaria infections can have severe consequences: recurrent P. falciparum and P. malariae infections can lead to severe anemia and nephrotic syndrome, respectively.[14] Human research subjects must be monitored and given adequate treatment for any illnesses or complications of human landing catches.
lV. Terms: Gene-Drive and Genetically Modified
Gene drives are self-replicating DNA. In male mosquitoes, they would spread infertility with the potential to wipe out the entire species. As male mosquitoes do not bite, the research assumes that using gene drives will shrink female mosquito populations in areas with high malaria rates, reducing the incidence of the disease.
Target malaria does not use gene-drive mosquitoes outside of labs at all. This paper refers to d the release of non-gene-drive genetically modified mosquitoes in Burkina Faso. (Gene drive mosquitoes are genetically modified mosquitoes,[15] but not all genetically modified mosquitoes are gene drive.) There is no evidence that any researcher has released any gene-drive mosquitoes.
V. Target Malaria in Burkina Faso
Target Malaria is a non-profit research consortium that aims to limit malaria incidence in sub-Saharan Africa by reducing populations of malaria-transmitting mosquitoes. Target Malaria, based at Imperial College London, is researching gene-drive mosquitoes (only in labs in the UK and Italy) and non-gene drive mosquitoes to reduce mosquito populations and the incidence of malaria in high-burden areas.[16] Target Malaria has released mosquitoes, although those released were sterile, do not bite, and do not carry malaria. Currently, Target Malaria is using non-gene drive genetically modified mosquitoes in its research. Target Malaria’s goal is to eventually use gene drive genetically modified mosquitoes engineered with a genetic mutation designed to reduce the number of female offspring. Target Malaria receives its primary funding from the Gates Foundation.[17] Researchers at Imperial College London develop genetically modified mosquitoes and ship the eggs to partner institutions which carry out the research.[18] For example, in one instance, mosquitoes were developed at Imperial College London and shipped to Italy and Atlanta, where researchers test them; eggs were then shipped from Italy to Burkina Faso.[19] According to Target Malaria, the partner institution's research in Burkina Faso aims to determine the species of mosquitoes located in the area and the seasonal dynamics and behaviour of these mosquitoes.[20] Target Malaria and its partner institution in Burkina Faso use human landing catches and the release of genetically modified mosquitoes in their research.[21]
Target Malaria uses several methods to collect the mosquitoes used for research. The methods include human landing catches, swarm collections, and spray catches.[22] The collection method used depends on the type of research.[23] Target Malaria uses mosquitoes caught through human landing catches in various ways, including creating eggs for their insectary, studying insecticide resistance, and studies involving mosquito releases.[24] During human landing catches, the research team collects the mosquitoes before they bite. Swarm collections are conducted using a net in areas where mosquitoes swarm; this method captures live adult mosquitoes.[25] Spray catches are used inside and involve insecticides; this method collects dead mosquitoes.[26] Target Malaria’s release of genetically modified mosquitoes used swarm collection and spray catches as the methods of recapturing mosquitoes.[27]
According to Target Malaria, individuals participating in human landing catches are monitored for symptoms of malaria for 21 days after participating in a catch.[28] As the incubation period for malaria can be much longer, Target Malaria’s current policy for medical treatment of human landing catch participants does not adequately protect them. Burkina Faso has a fee-based healthcare system that uses out-of-pocket payments, although pregnant women and children under five receive free health care and medications.[29] As a result, human landing catch participants diagnosed with malaria after the 21-day period observed by Target Malaria would be responsible for paying for healthcare and medications themselves.
Furthermore, Target Malaria provides treatment only once a participant shows symptoms of malaria;[30] there is no mention of preventative treatment in its guidelines. As part of an unrelated study on malaria, human landing catch participants were given Malarone as a preventative treatment.[31] According to the authors, not providing the treatment would have been unethical.[32] If preventative treatments are available, human landing catch participants should receive those treatments, as withholding preventative treatments put participants at undue risk of catching malaria. Following rule utilitarianism, a formulated rule would state that researchers should give human landing catch subjects preventative medicine and medical treatment that aligns with incubation periods.
Vl. Burkina Faso
Burkina Faso is one of the world’s poorest nations,[33] and it is part of a group of seven African countries which account for roughly half of all yearly malaria deaths globally. [34] The village of Bana in Burkina Faso is where Target Malaria conducts much of its research.[35] Bana consists of mud huts with no electricity or sewage system; significant health concerns in the village include malaria and water pollution.[36] While indigenous populations reside in Burkina Faso, the country's constitution does not recognise indigenous persons as existing.[37]
Burkina Faso may not have an ethical code or straightforward regulations for human research. There is limited information on the country's research regulations. The council on Health Research for Development noted in a 2008 document that there were no regulations at the time of publication.[38] Attempts to find new documents or ethical codes since the 2008 publication has been unsuccessful, partially due to difficulties in accessing websites such as Burkina Faso’s governmental sites. Burkina Faso initially drafted an ethical code in 2005; however, Burkina Faso does not appear to have implemented the code.[39] Burkina Faso utilizes Research Ethics Committees for determinations on research projects. An order was implemented in 2004 to guide the organization and function of ethics committees but does not include any regulations on research ethics.[40] The Health Research Ethics Committee, created in 2002, primarily follows International ethical guidelines, combined with guidelines from various medical professions due to the lack of a research code of ethics.[41] All health research projects conducted within Burkina Faso must receive approval from the Health Research Ethics Committee; when a project is approved, the committee issues an ethics certificate, researchers cannot conduct research.[42] Yet, gaining the ethics certificate does not mean the research can initiate: once the certificate is issued, researchers are required to gain ethics approval from a regional department.[43] The reasoning for this is that the higher-up officials serving on the national ethics committee cannot authorise the operational aspects of a project; representatives from these regional departments believe that their authorisation is more determinate than the national ethics committee concerning ethical standards.[44] The requirement of a project to receive two different levels of approval raises the question of whether the initial guidelines approved will still be implemented in research projects if the regional department believes they are not feasible from an operational standpoint. The Health Research Ethics Committee does not have the resources available to oversee the research activities it approves.[45] Although the status of Burkina Faso’s ethical codes is currently unknown, international codes of ethics, such as the Declaration of Helsinki and the Nuremberg Code, should protect international research subjects if followed.
Vll. Informed and Community Consent
The elements required for informed consent to be valid are disclosure, understanding, voluntariness, and capacity.[46] The researcher must ensure that subjects have a sufficient understanding of the study information prior to signing the consent forms.[47] In low-resource settings, it may be beneficial to determine the potential subjects' willingness to participate in the study prior to disclosing financial incentives. This may help to alleviate the issue of subjects agreeing to participate in research studies only because of financial incentives. Under rule utilitarianism, if outside motivation such as free treatment or financial compensation biases consent in one situation, it is biased in all similar situations.
The element of disclosure could be expanded in international research to further protect research subjects. Disclosure agreements should include information about the study, including risks and benefits, the right to withdraw, and the reason for consent.[48] But, suppose Target Malaria had been required to disclose to potential participants that human landing catches would likely not be approved in a high-income country. Even if they would be approved, they could not be ethically done without providing participants with a preventative treatment.[49] Such disclosure would make the potential subjects aware that they were not getting the same protections as their counterparts in other countries. This information would have allowed them to make a more fully informed decision.
Rather than using the same individual consent-based model that researchers used with human landing catch participants, Target Malaria decided to develop a community agreement model for the release of genetically modified mosquitoes in Bana.[50] Target Malaria seemed to believe that consent did not apply to their work because the organization does not work in areas with recognised indigenous peoples.[51] However, in previously published research, Target Malaria stated that indigenous populations reside in and around the village of Bana.[52] The decision not to use a consent-based model may have been because Burkina Faso does not recognize indigenous peoples.[53] However, by definition, an indigenous person is indigenous regardless of whether their government recognizes them as such. Under rule utilitarianism, disregarding a population as indigenous and using community agreement in place of free and prior informed consent implies a general rule that this could apply in similar circumstances. This would likely result in the rights of officials disregarding indigenous persons in many instances.
Vlll. Participants Misunderstanding Their Role in Research
Researchers from Target Malaria conducted a qualitative study in Bana to determine what factors motivated individuals to participate in their research activities. There is an apparent conflict of interest with the researchers conducting the study themselves. While Target Malaria attempted to reduce potential bias by using a researcher who was not part of the primary research team in Bana to conduct the qualitative study,[54] it may not have been enough. The study participants were aware that Target Malaria was conducting the study; the researcher gathering the qualitative data spent three months in Bana.[55] Target Malaria felt that this would allow the residents to trust the researcher and limit the potential of participants tailoring responses based on what they thought the researcher would want to hear.[56] However, because the participants knew the researcher was from Target Malaria, they may not have given the same information they would have given to a researcher not affiliated with Target Malaria. A study conducted by a researcher unaffiliated with Target Malaria may have yielded different results.
The study also showed participants misunderstood their role in the research. One of the more prominent misconceptions was that they thought they were learning how to do a trade;[57] this belief indicates that they did not understand their role as research subjects. The issue was further confused because participants were paid, making them believe that it was their job.[58]
Another misconception concerned the responses of individuals who participated in indoor spray catches. The common misconception in the participant responses was that indoor spraying offered malaria protection and a direct benefit to health by reducing the number of mosquitoes in the home.[59] The researchers mention that even after repeatedly explaining that these methods were purely scientific, were not meant to control mosquitoes, and were not methods that would give long-term protection, subjects continued to believe that indoor spraying offered malaria protection and a direct health benefit.[60]
The researcher's concluded that residents of Bana had better knowledge of malaria and how transmission occurs because of Target Malaria’s work.[61] Mosquito collectors listed the skills they gained through the projects and believed that entomological research could be a long-term job prospect because of other local research groups; they welcome the chance to earn income through the project.[62] The researchers do not discuss the gravity of the misconceptions or their implications on the informed consent to Target Malaria’s main project activities. Researchers have a duty to ensure that study participants give fully informed consent. Their gaining what they believed to be skills and work experience may have affected participants’ perceptions and judgments and led them to consent when they otherwise would not have.
lX. Available Research on Participant Misunderstanding
The conflict of interest may become more apparent considering one of the researcher's previous publications, which, after reviewing a study that had issues similar to Target Malaria’s qualitative study, still reached differing conclusions. One of the Target Malaria researchers involved in the qualitative study had previously reviewed malaria research involving participant misunderstanding. The research in this instance was a clinical study comparing two malaria medications in children.[63] The study found that parents decided to enroll their children in the study prior to receiving any information from the researchers conducting the study.[64] The parental motivations to enroll their children included free medication.[65] The study also shows that parents did not understand the research being conducted or its procedures.[66] The researchers concluded that lack of understanding and motivations, such as free treatment to participate, might compromise the informed consent.[67] In areas with socioeconomic vulnerability, the decision to participate may be strategic: participants receive access to health care that otherwise would be unattainable.[68] Strategies to ensure voluntary informed decision making are needed.[69] Furthermore, sometimes when an individual’s main reasoning for participation in a research project is financial compensation, they have not made an autonomous choice because the financial compensation is a controlling influence that determines their decision to participate. This conclusion is quite different from the one provided in Target Malaria’s qualitative study, which emphasized the benefits to the participants, such as improved knowledge about malaria.
X. Financial Backing: The Gates Foundation Evaluation Policy
The Gates Foundation provides an evaluation policy; however, the policy may not adequately cover scientific research. The foundation designed the policy to assist the foundation and its partners in determining what needs evaluation.[70] In most circumstances, the foundation works with prospective partners within the grant proposal process to determine measurable outcomes, progress and success indicators. The foundation believes this will allow partners to work instead of constantly needing to measure and report.[71]
The Gates Foundation has set priorities for evaluation. Projects are a "high priority for evaluation when outcomes are not easily observable, and a low priority when the results are easily observed.”[72] In these cases of low priority for evaluation, the foundation believes that the “partners' self-reported progress data and existing protocols (such as for clinical trials) provide sufficient feedback for decision making and improvement.”[73]
Aside from the context of Target Malaria, the Gates Foundation has funded ethically questionable research projects, including cheaper cervical cancer screening in India that left some women in the control group without any screening,[74] and a demonstrational study giving HPV vaccines to adolescent girls, and failing to provide medical care to those participants who experienced severe adverse effects.[75]
By not evaluating the protocols, the Gates Foundation is at continued risk of funding research that does not adequately protect research subjects. Relying on existing protocols is insufficient, primarily when researchers are conducting the research in low
Beyond Language and Culture: A Qualitative Exploration of Mental Health Barriers for Chinese International Students Seeking Therapy in the U.S.
Get PDFThis qualitative study explores the experiences and attitudes of Chinese international students in the U.S. towards psychotherapy, with an emphasis on identifying potential barriers and facilitators to their mental health treatment. Data were drawn from individual experiences of undergraduate and graduate Chinese international students who had engaged in therapy in the U.S. A grounded theory approach was employed to dissect these experiences and assess their attitudes towards psychotherapy. The grounded theory identified several themes from the students’ therapeutic experiences, such as: the inconsequential role of language barriers, the significant yet not prohibitive impact of cultural differences, the critical role of health insurance, the influence of therapists’ professional demeanor, and the correlation between mental health knowledge and attitudes towards therapy. Interestingly, the study also unveiled an emergent theme concerning professional boundaries within therapy. These findings suggest that while language and cultural differences might not be direct obstacles to therapy, factors such as therapists’ backgrounds and attitudes, insurance coverage, and accessibility can pose substantial challenges to Chinese international students seeking mental health treatment. Importantly, a heightened level of mental health knowledge was associated with more positive attitudes toward therapy. As a culmination of these findings, we formu- lated a triadic model emphasizing cultural understanding within the therapeutic setting, service accessibility, and mental health knowledge as key influences on the psychotherapy experiences of Chinese international students