By Kristina Arvanitis / Staff Writer
Wednesday, August 20, 2003

How do you get an African woman to go to hospital during childbirth when she has heard nothing but horror stories about health care workers from her family and friends? And how do you motivate an overextended hospital staff to become more culturally competent toward their patients?

These are just two of the questions that Astier Almedom, a Tufts University professor and Washington Street resident, is attempting to answer. Like a lot of researchers in the post-Sept. 11 era, she has devoted much of her time to studying the effects of emergencies and disasters. But Almedom's studies have taken her as far as the war-torn communities on the Eritrean and Ethopian border.

Almedom, a mother of two, is the Henry R. Luce Professor in Science and Humanitarianism at Tufts and has conducted research in Eritrea during periods of unrest and war in newly independent West African nation. She noted that the Luce professorship is often involved in a "cutting edge kind of work" that combines disciplines and crosses boundaries.

"It was a big transition for all of us," Almedom said, adding that she moved to town both for the quality of schools and the ease of commute to the university.

Last summer, Almedom and her team in Eritrea concluded that mothers rely more heavily on local customs and social networks than traditional medical science and primary care physicians. The results of Almedom's research have been published in a recent issue of the Bulletin of the World Health Organization and were featured in the spring edition of Tufts Nutrition Magazine.

Conducting interviews with both male and female participants about the quality of maternal healthcare, Almedom concluded that Eritreans have a negative view of nurse midwives, who often "reportedly treated their patients harshly," asking derisive questions while the women delivered their babies. In contrast, traditional birth attendants with no ties to the formal health care system were well-respected and treated their patients well.

One of the tools that Almedom used in her research was to veer away from the traditional model of viewing participants as having "post-traumatic stress syndrome." She instead uses a model that relies more on gauging the "mental well-being" of participants rather than adopting a method that already assumes that the participants have experienced some sort of trauma.

According to Almedom, her method of mental health evaluation in Eritrea, also known as a "sense of coherence" model, has also been used in studying the "life transitions" of Holocaust survivors, veterans, retirees and the unemployed across different cultures.

"We were moving away from that [post-traumatic stress] model. It really doesn't measure accurately how people are able to maintain strong and able," Almedom said.

And after gathering information on her first trip to Eritrea last summer, she was able to make a second trip this summer to begin interpreting the data that they collected and studying its policy implications for the Eritrean government.

"It does make sense to work with the government," Almedom noted, adding that she worked well with the nation's Ministry of Health, and that the government is not corrupt like other African nations. "The humanitarian agencies cannot replace the government. They cannot be alternatives to the government."

And Almedom has the experience in government research, working for the British government's National Health Service for a year before she moved to Winchester. She also completed both her undergraduate and graduated studies at Oxford University and has worked in public health and applied research for over 15 years.

"We were involved in getting business and health services together to remedy exclusion and inequality in South London," she said of her work in Great Britain.

The results of this summer's research should be published sometime next year, and just days after returning from second research trip to Eritrea for Tufts, Almedom is already in her office hard at work parsing her data.

"We know how to interpret the data now because we have the context," she said. "You know who the people are that you are going to study and how they are going to react. Now we know the quality of health care services, the participants' mental well-being and gender differences in the perception of medical services."