Summer 2018 Fieldwork Reflections

Summer 2018 Field Researchers
2018 student researchers from left to right: Anna Freeman, Chadwick Dunefsky, Joanna Ramirez, Emmanuel Lee, Nick Allen, Maddy Kameny, and Caroline Efird


Nick Allen interviewed narrators in Orange County, North Carolina.

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These interviews are useful as documented perceptions of aging and “what comes next’ in adulthood. By studying our predecessors, we might become future generations that age even better than they have. Giving a public platform to a variety of worldviews increases the breadth and depth of our knowledge and understanding that points us towards a much better world. There were a few specific challenges of working with the older adults: technology, memory, and relationship rise to the surface:

  • Technology – it can be difficult to reach narrators through email, and sometimes over the phone.  The narrators I met with felt more comfortable meeting in person to discuss potential interviews. In some circumstances I had to meet with them twice during the interview process, and likely a third time after transcripts are processed. It is also important to have good gatekeepers to help negotiate these interactions, especially at first. Although this is a more time-consuming way to do oral history, it ultimately leads to strong rapport with the narrators and a relational bond as well.
  • Memory – while memories are rife with wonderful stories, at times details like dates, names, and other minute specifics can be lost or blurred. Memory in later adulthood is also a product of the life review process, wherein narrators have come to terms with their lives and made peace with their ghosts. For this reason, I often felt that there was little conflict or friction to uncover. Finally, older adults’ memories often function based off of key words or ideas that trigger stories. In this way, stories trigger other stories, sometimes creating an avalanche of yarns that can weave through time and subject matter without clear trajectory. It is difficult to interrupt a narrator, but especially an older one reminiscing. Nonetheless, this can become the interviewer’s job.
  • Relationship – hearing about the childhood stories of an older adult creates a kind of bond we’re all familiar with. For this reason, it is important, ethical, and humanitarian not to let the interview be the only interaction we have with older adults. The relationship between interviewer and interviewee necessitates a few logistical goals, but the relationship between two people goes beyond that. The strength of an intergenerational activity for a community lies not only in the potency of the activity, but its presence over time. As we age, relationships become the most important things to us.

I think that gathering stories based on disease types could be useful. From a medical humanities standpoint, analyzing how narrators make meaning of their various illness stories in an oral history format would be fascinating, perhaps we might even be able to observe how the life review process affected those stories. Bringing together stories of medical mysteries would also be interesting. We might like to know the instances when doctors were stumped or when they failed. That gestures towards a direction we could go to expand the vastness of our knowledge. I also wonder if there is a way to draw a link between a narrator’s younger years and their longevity or their health in later adulthood. Does emotional turmoil ever express itself as illness or disease?

Caroline Efird interviewed narrators in Stanly County, North Carolina.

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Over the summer, it was an honor to sit in people’s living rooms and listen to stories about everything from family recipes and home remedies, to what it was like to grow up where everyone knew your name and where you went to church. Most of the narrators that I had the pleasure of interviewing were residents of a rural community in Stanly County. As they described their family histories and healthcare experiences, I noticed some common themes. Stories about daily life in a rural community, access to healthcare, and interactions with healthcare providers were present in all interviews:

  • Experiences in a rural area: Many of the narrators expressed how much they valued raising children in a community where people knew each other, and where there was an abundance of social support. For example, one woman spoke of a time when she knew the owner of every car that drove down her road. During the era when many people in the community maintained their own farms, one narrator recalled that neighbors would always help each other harvest crops. Several narrators offered anecdotes about community members generously providing meals when they had a family member who was ill, or a newborn baby at home. Narrators also shared that faith and “family values” were important characteristics of their community. Some also spoke about the perceived difficulties of living in the area, such as a deficit of employment opportunities after local mills and factories closed.
  • Access to health care: Given that primary care providers are the only physicians located relatively close to their community, several narrators mentioned that it was a burden to drive into Mecklenburg County and Cabarrus County for medical specialists. However, there were some differing perceptions about the quality of care they received from the hospital in Stanly County as opposed to the hospitals in neighboring counties.
  • Experiences with healthcare providers: Some narrators remembered when there was a local doctor who made “house calls” and cared for their family for decades. At present, the narrators expressed the feeling that they had to get to know new primary care physicians on a regular basis because of frequent physician turnover in the area. They consistently expressed appreciation for providers who knew them on a personal level, listened attentively, and took time to answer their questions during office visits. Conversely, narrators did not appreciate when providers were dismissive, careless, or did not listen well.

Additionally, conducting interviews in narrators’ homes seemed to be a positive experience for both the narrators and for me. Apart from the occasional dog bark, ticking clock, or telephone ring, it worked quite well to record the oral histories in the place where the narrators felt the most comfortable. Furthermore, being in each narrator’s home offered me the privilege of getting to know them better, given that we could chat before and after the recording device was in the “on” position. Once the recorder was turned off I had delightful opportunities to view family photos, tour gardens, or meet great-grandchildren. These narrators provided many insights into their lived experiences, and they gave detailed descriptions about life in their community. They shared information that their healthcare providers would never know from simply looking at a medical chart or discover during a brief office visit. Perhaps these interviews could give the healthcare community a better understanding about the social, emotional, and physical “ups and downs” this community has experienced over the years, and thus provide them with better care. While rural culture varies from region to region, the stories these narrators shared could offer invaluable perspectives about the social determinants of health for white Americans in a rural part of the North Carolina.

Maddy Kameny interviewed narrators who are providers and patients at CommWell Health in Harnett County, North Carolina.

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The questions that resulted in the most interesting and unexpected answers for me were about home remedies and parenting – both experiences parenting and being parented. In general, people seem to remember things about being cared for and those memories snowball to remind them of other things about their childhoods. The questions that were not as successful were those that people felt they “had” to answer in certain ways, or that there were just a few possible answers to. In my last interview, I asked [my narrator] what she was most proud of, and I wish I’d added that one earlier. It ends the interview on a good note without seeming patronizing.

I definitely saw themes of home remedies, lack of biomedical healthcare in childhood, concerns about cost in healthcare, value of owning land, challenges of rural communities, and negative experiences with the healthcare system. I had three narrators allude to negative experiences with dentists, and several discussed lack of trust due to physician mistakes. People talked about having pride in rural communities and pride in having been there for generations. They talked about their towns being different now than it was then; demographic changes like migrant workers moving in and then out again; factories closing. Buying land was a big life milestone. Health literacy was a big one, though the term itself didn’t surface much. The employees talked a lot about their patients and often brought notions of their communities back to the patients, demonstrating that the patients are intertwined within the community. 

I think a lot of these findings can be useful for healthcare providers who work in clinics that aren’t as accepting and motivated to have employees understand social determinants of health as CommWell Health is. Hearing the experience as the patient as provider, and vice versa, can tell us a lot about the way people conceptualize their own experiences, and on what areas we can focus our efforts when training employees to bring more of themselves into their practice. I feel like CommWell Health can benefit from these and learning more about their own employees.

Collecting oral histories in a clinical setting is very difficult, and I imagine it would be more so having patients as the primary narrators. Time was always an issue; it was always in the back of my and/or the narrator’s mind and sometimes that was clear in the interview. I rarely had the opportunity to get to know the narrator first. Ultimately these were a hybrid of oral histories with some other qualitative interviewing methods, since they did not fulfill all the requirements of a traditional oral history.

Chadwick Dunefsky interviewed narrators from Orange County, North Carolina.

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Exploring the topic of medical health seemed accidental and unintentional. Before starting the interview process, I was worried about how I could talk about medical health without it interrupting the flow of the interview. However, doing these interviews, I realized how normal it was to have a deep entanglement with some sort of health issue over the course of a life span. Health feels interwoven into our lives and I realized that it was a lot easier to let the interview go at its own pace.

Health is integral to living. Undergoing an ailment is one of the experiences that nearly every human has at some point in their life. For some individuals, it is larger and becomes part of their story for who they are. Exploring how central medical health can be to an individual and how individuals turn stories into their character can be useful in considering a typical visit to a doctor or the hospital. How do individuals adopt medical issues into their character and how they define themselves? This question is useful for the medical world because it allows for insight into this way of describing ourselves while using medical terminology. Although the two might seem disparate and disconnected, medical health is core to how individuals define themselves and using that can be used to further enhance a connection individuals have to the medical world.

I am a soft-spoken person and many of the individuals I interviewed turned deaf in one ear or lost a lot of their hearing at this stage in their life. I was not used to shouting and hearing myself at that volume so I scared myself a lot over the summer.  I did not fully realize how delicate health issues were at a later stage in life until I conducted these interviews and it was humbling to see these individuals exude presence and strength when they were able to do the interviews.

Anna Freeman interviewed narrators in Warren County, North Carolina.

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Speaking with people from Warren County was an experience I won’t soon forget. The kindness and generosity of its residents struck me. While many interviews collected by my research partner and I were strong and could be improved for different reasons, I found questions about traditional foods and eating habits, questions about home remedies, and questions about how the local community had changed to yield full responses. I think the interview guide could include more questions pertaining specifically to diet and exercise because those are the foundations of healthy behavior. Some distinct themes began to emerge over the course of collecting interviews. Those themes include a lost or changing community, diet changes over the years that stem from changes in availability or gardening practices, changing community demographics as well as themes regarding the infrastructure of Warren County.

Materials found in these interviews could be useful to a myriad of people for a similarly large number of reasons. There are some anecdotes about diet or home remedies that could be useful to groups involved with this project with an interest in gardening. There are materials about community practitioners in the past that could be useful to practitioners in and around Warren County. now. There are materials regarding structural boundaries to medical care that could potentially be useful to researchers and policy makers. Some challenges with conducting interviews were to be expected with a project about health and medical care in a small community. People were faced with somewhat personal questions from people they didn’t know, which understandably led to some apprehension. Some people were very friendly, but private.