Perceiving Threats to Health in the Field: Researching Zoonotic Diseases at the Human–Animal Interface

Introduction

While there are inherent risks in all fieldwork, there are unique dangers posed by particular research questions, methods, and field sites. In discussing research in conflict environments, Professor Jenny Pearce highlights several themes regarding danger – to herself and others – that both resonate and provide points of contrast with my experience of undertaking doctoral fieldwork. My research broadly examined the experiences, risk perceptions and behaviours of people who sell and slaughter poultry at live bird markets in Indonesia – respectively, a demographic considered to be at an elevated risk for exposure to zoonotic pathogens, and a location identified as the source of many human infections with avian influenza and other pathogens. This fieldnote builds on three overarching issues that arise in Professor Pearce’s reflections on her extensive work in Latin America; namely, the different types of danger that can exist in fieldwork, how different types of danger shape the methodological approach of a study, and how perceptions of danger can differ significantly between researchers and their respondents.

Ambiguous and Invisible Dangers

Danger in fieldwork, as Professor Pearce suggests, is relative. It can be influenced by a broad range of factors across diverse political and social contexts, and at different times. In this way, she underscores the fact that danger is not static, but dynamic, shifting with place and person, as well as with perspective. Professor Pearce talks about the ambiguities and uncertainties involved in assessing threats of violence and other dangers, saying, ‘They’re just [Page 178]around you, and you don’t quite know the limits’ (see Chapter 14). This resonated with my own experience, as danger in my field sites – the potential for one to be exposed to, and infected with, avian influenza (A H5N1) – was also ambiguous and changeable.

Unlike the very visceral experiences of seeking shelter from a bombing campaign or running away from armed forces that Professor Pearce discusses, the primary threat in my fieldwork was essentially invisible and undetectable without proper diagnostics or, at the very least, the presence of sick or dead animals. Live bird markets are identified as the source of many human infections with avian influenza viruses that have resulted in death. Without clear physical evidence of the virus in the field sites, I relied upon external scientific data to establish danger in the field, and drew on these data in developing and conducting safety training for my research assistants prior to beginning fieldwork. I thought I had a firm grasp of where the danger lay and what we could do to mitigate it. And yet, once in the field, I found the process of navigating epidemiological concerns to be more complicated. As Professor Pearce says about her own experience, ‘It was all very well when I thought about the potential threats, but now that I’m in the midst of an actual threat it’s a different matter’ (see Chapter 14). For me, even though I paid close attention to detail during my preparations for fieldwork, it became quite apparent that the realities of the field are such that little is as certain or as fixed as presented in external representations.

Figure 15.1 Choosing a chicken in an Indonesian bird market

Unforeseen events and dangers can arise at any moment, as I found out towards the end of my fieldwork. Following a few weeks of intensive research in two live bird markets – one in Southern Sumatra and one in West Java – my research assistant and I returned to Jakarta, where she lived. I was readying to leave for Singapore to renew my visa, while she was preparing to spend some much-deserved time with family before we returned to the field for [Page 179]one last round of research. Towards the end of this fieldwork stint we both started to feel fatigued from the long days and consecutive weeks of work, and as we parted ways in Jakarta I reminded her to frequently keep in touch about her health status should anything change. At the airport the next morning, I received a call from her – my stomach dropped when she said she was feeling unwell. I knew the potential severity of the situation: from officially diagnosed cases, the mortality rate of people infected with avian influenza in Indonesia is believed to exceed 80%. All ambient noise disappeared as I zeroed in to listen to her symptoms: ‘sore throat, gastrointestinal issues, fatigue, muscle aches’. There was no question that she had to go to the hospital immediately.

I was consumed with worry for her well-being as she sought medical assistance. For me, this was the worst-case scenario and, after I knew that she was headed for help, I was flooded with questions and doubts about my fieldwork practices. Had I become too complacent? Had I neglected to remain vigilant about hygiene? Maybe we should not have spent that extra day in the market – or that extra week in Lampung? From the outset, remaining safe in the field was always top priority, regardless of the research agenda. Had my desire for data trumped our own safety? I had difficulty sleeping, concentrating or eating as I awaited updates from her and her husband. After many concerned communications, an incredible burden was lifted upon hearing that she was feeling better, receiving therapeutics, and not infected with avian influenza. For the remainder of our time in the field we were both extra vigilant. This experience served as a reminder that danger does not always disappear upon leaving the field. Indeed, as the latency period for avian influenza (the time after infection and before symptoms appear) can be several days, it was only after some time following fieldwork that I truly felt that my assistants and I were clear from danger. In this, I empathize with Professor Pearce’s concerns regarding the threats that one’s fieldwork can impose on others, such as family members and research assistants. Moreover, as this episode reflects, there can be serious ethical obligations involved in working with others during fieldwork.

Methodological Challenges and Limitations

This experience also highlights another challenge that Professor Pearce speaks of in relation to doing fieldwork in dangerous environments, namely, that extensive time in such environments and in close proximity to some respondents, may pose an increased risk for researchers. There is, therefore, a constant tension between the amount of time a qualitative researcher can safely spend undertaking fieldwork, and the amount of time required to collect a sufficient amount of in-depth data. Qualitative research can hinge upon whether research teams abide by social and cultural norms, and whether respondents accept researchers, both of which relate to how much time researchers spend in the company of their respondents building trusting relationships. During her fieldwork in Latin America, Professor Pearce found that it was not always possible to remain safe in a certain location for a long period of time. This was also the case in my field sites, where the more time spent in close proximity to live and dead poultry meant a potentially greater likelihood of being exposed to pathogens. Therefore, like Professor Pearce, I had [Page 180]to think carefully about how to proceed with my data collection, and ultimately determined that utilising a focused ethnographic1 approach would enable me to balance the competing demands of an in-depth qualitative inquiry into the experiences and behaviours of people at the human–animal interface, with the imperatives of limiting my time in the field to keep my assistants and myself safe.

In addition to considering the length of time we spent in the field, I also had to reflect on the behaviours that my assistants and I engaged in while in each field site. Although transmission routes for emerging diseases are not always known, the most common routes of avian influenza transmission – physical contact with infected animals or contaminated environments and materials – can be highly social, and driven in part by human behaviour. My research assistants and I discussed whether we should try to limit physical contact with some respondents by not shaking hands or sharing food. From an epidemiological perspective, shaking hands with people who slaughter and sell birds may lead to viral exposure. However, from a cultural perspective, not shaking hands with informants may be viewed as impolite or arrogant. After my research assistants and I had discussed this dual reality together on separate occasions, we made the decision that we would never refuse an informant’s hand that was first offered to us, but we would not pre-emptively shake people’s hands. In practice this meant that we routinely shook people’s hands, as sellers would often greet us each day with an open palm. While at some point after this contact we would attempt to apply hand sanitizer discreetly, away from public gaze, this was not always possible.

This dilemma was even more delicate for my research assistants as they were acutely conscious of cultural expectations and did not want to be perceived as arrogant by their fellow Indonesians. When I asked my research assistants to reflect on certain aspects of the fieldwork process, one of them wrote to me saying that she ‘tried to reduce the possibility to shake hands with people in the markets. But this is not common in Indonesian culture. I mean, maybe it’s okay for Scott [to avoid shaking people’s hands] because people will understand that he is from another culture, but for me, as an Indonesian, I may be called sombong (arrogant). If I think about it, I would probably think that somebody is sombong if they avoided shaking my hand’.

Differing Perceptions of Threat

This issue was further complicated by the fact that perceptions of the threat posed by the disease differed significantly between my respondents and myself. This is a point of contrast with Professor Pearce’s experience, in that she suggests there was a reasonable amount of consensus regarding the dangers present in the conflict sites where she was working. In my experience, however, my respondents’ perceptions of danger were very different from the ways that danger had been presented in the biomedical literature. In particular, many respondents believed that avian influenza can only infect birds, and thus did not consider [Page 181]the virus to be a potential danger to human health. None of my respondents, for example, routinely wore masks or gloves to protect themselves from infection. A primary focus of my study was exploring risk perceptions and behaviours among people who raise and sell birds, making it important to conduct data collection in as neutral and non-judgemental a way as possible. Those infected and affected by infectious diseases are often othered, as part of a process where they are labelled as diseased, dirty, or potential vectors. Had my research assistants or I worn personal protective equipment to prevent exposure to pathogens, it may have appeared to presuppose environmental contamination, a process which may, in turn, have potentially stigmatised respondents and negatively impacted their business, or jeopardised my access to the field sites. This conflict – between remaining safe in the field while avoiding stigmatising respondents – remained a constant tension throughout fieldwork, and, ultimately, underscored the dynamic conceptualisation of risk across place and population.

Conclusion

Dangers involved with doing fieldwork are neither uniform nor static. In each site, and on any given day, the threats presented to researchers may be unique. Consensus on the type and severity of dangers present may be limited. With conflicting accounts regarding the extent and nature of threats, Professor Pearce reminds us that ‘The spectrum of threats, from human to viruses, they’re distinct in different contexts, and you have to be aware of all of them’. Looking back on my fieldwork, it has become clear that there is only so much that you can do in preparation – only so much that you can learn from the extant literature. Determining the risks and dangers of fieldwork requires presence on site, and continued vigilance and reflection while in the midst of research. Yet, even this might not be enough. Indeed, it may be only after the fact that you realise the nature of certain threats to yourself or others. And in this way, it is important to recall that fieldwork – and avoiding threats and dangers – always requires an element of good luck.