Dr. Sara Kauko
I joined Dr. Lesser’s research team in Sao Paulo as a research assistant and photographer in June 2016. I had never set my foot in the city before and spoke Portuguese on the level of a six-year old. Nevertheless, as an anthropologist and Latin Americanist, I found it fascinating to be able to participate in the Bom Retiro research project.
I accompanied the task team from Bom Retiro’s health center a few times a week as they attended to patients in their homes. Wearing my anthropologist’s hat, I was drawn to learning more about the patients’ backgrounds and present lives. Wearing my photographer’s hat, I documented these patient rounds and at the same time, the life in the neighborhood.
As a Spanish speaker, I learned Portuguese rather easily. My camera often mediated my interactions with people, which helped me to learn more. The time I spent in Bom Retiro eventually turned into an archive of hundreds of images and a photographic exhibition on one of the health center’s walls.
I wrote my doctoral dissertation on the relationship between socioeconomic mobility, race, and entrepreneurialism in northern Argentina, and graduated in the spring 2020. The difference between the vertical megalopolis of Sao Paulo and the flat provincial city in Argentina where I conduct research is colossal. Yet in both places, the human experience of ethno-racial exclusion and aspirations for upward mobility can be remarkably similar. Those similarities intrigue me. I hope to go back to Argentina’s Portuguese-speaking neighbor someday to explore them further.
I never imagined that I would fall in love with São Paulo. Having grown up in Appalachia, big city life felt intimidating. But from the moment that I set foot in the Bom Retiro health post, I knew a journey of sorts had begun.
With the support of a Fulbright Research Award, a Boren Fellowship, and the Bom Retiro community health team, I conducted an ethnographic study of how patient care unfolds across sociocultural and linguistic difference. I explore how health professionals – including community health workers, doctors and nurses – construct racialized understandings of patients based upon their membership in ethnoracial groups that in turn shape their approach to patient care. I also investigate the everyday organizational practices of community health workers as they seek meaning in their work while laboring within a neoliberal approach to health management.
My research employs participant observation – both within the clinic and out in the neighborhood – alongside in-depth semi-structured interviews with patients and providers. I am currently analyzing these data for my dissertation, entitled “Primary Care and the Reproduction of Health Inequity in a Central São Paulo Neighborhood” which I will defend in early 2021 in Emory University’s Department of Sociology.
To learn more about my work, please visit my academic homepage.
Far from Brazil, in the heart of North America, lay the eighteenth-century Spanish colony Louisiana, stretching from the Gulf Coast northward until present St. Louis. The few colonial towns along the Mississippi River were inhabited by French, English, Spanish, German, and Irish settlers, as well as free and enslaved people of African and indigenous descent. Most of the territory claimed by Euro-American empires however was controlled by powerful indigenous nations like the Osage or Quapaw.
My research investigates indigenous communities and Anglo-American settlers who moved from the Trans-Appalachian West across the Mississippi River into Spanish claimed territory. I’m interested in the conflicts that arose among officials and immigrants who were steeped in different legal cultures, had diverging ideas about race and property, and practiced different religions.
I have set up and currently maintain the website for the Lesser Research Collective.
My honors thesis explores the topic of accessibility to health services in Brazil. The thesis is a case study of the UBS Bom Retiro, a health post/clinic in the neighborhood of Bom Retiro located in São Paulo, Brazil. The neighborhood is home to multiple immigrant groups such as the Bolivians, Koreans and Paraguayans.
This thesis aims to better understand how accessibility barriers work in this neighborhood and what initiatives has the staff taken to reduce these barriers. Another aim of this thesis is to analyze the level of access to health services by patients who do not speak Portuguese as a first language. Lastly, this thesis contains possible health policy suggestions that could provide solutions to accessibility barriers in UBSs that are located in neighborhoods with a similar demographic profile as Bom Retiro.
My research was supported by the Fox Center Undergraduate Humanities Honors Fellows Program.
I had the pleasure of working in Team Lesser in the Bom Retiro neighborhood last summer. While in the Bom Retiro neighborhood, I joined physicians and nurses during medical appointments with pregnant patients (prenatal care) and women who had recently given birth. The physicians and nurses described their prenatal cases as either “planned” or “unplanned” on daily activity logs and the women’s medical files.
This led me to my research question, how do patients and healthcare providers of the clinic (physicians, nurses, and community agents) conceptualize family planning? In other words, what makes a pregnancy “planned” or “unplanned” for patients and providers? I spoke with women during their medical appointments to understand how they describe their own pregnancies and their definitions of a planned pregnancy. I then spoke to community agents, physicians, and nurses to ask about their own conceptualizations and whether they perceived differences in cases with women that stated planning their pregnancies and women that did not plan.
This information, along with demographic information found in women’s medical files, demonstrated that patients and providers did indeed conceptualize family planning in different ways. This gap between patient and provider must be closed to improve family planning services within the clinic. To do so, providers must acknowledge these conceptual differences and engage their patients in more conversations on family planning and contraception use.
I wrote about this in my thesis.
Over two summers in Brazil, I compiled four types of sources from 1924 to 2018: (1) literary sources, (2) visual sources, (3) medical records, and (4) oral narratives. Using literary analysis of themes and representations, I analyze visual and literary sources of Leprosy in Brazil.
I gathered oral narratives of healthcare workers and patients through snowball sampling in two leprosaria, a state reference hospital, and local clinics. I used medical records (1920s-1980s) from the Emilio Ribas Public Health Museum’s archives in São Paulo that show a narrative of the patient’s lives in the leprosaria, detailing runaways, removed children, etc. and clinical treatment. The pool of sources helps understand life when labelled a “leper” in Brazil.
Through the diversity of sources across time and intended fields (literature, art, public health), I show the continuity of stigma and fear despite leprosy’s curability since 1941. In my thesis analyze the diverse origins of the stigma of leprosy and suggest that the cultural phenomena surrounding leprosy has a longstanding impact on patient’s quality of life.