Bridges and Barriers: The Ins and Outs of Strategic Storytelling

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© 2016 University of North Carolina at Chapel Hill School of Medicine

Dr. Raúl Necochea is currently an assistant professor in the Department of Social Medicine at the UNC School of Medicine as well as an adjunct assistant professor in the Department of History. Inspired by stories from his OB/GYN mother and questions of unethical sterilizations in his native Peru, Necochea wrote A History of Family Planning in Twentieth Century Peru, which was published in 2014. His book tries to capture the different lived experiences of people regarding family planning. Each chapter represents a different vantage point including those of clinicians, intellectuals, feminists, the Catholic church, and men and women who were seeking abortions. At stake were notions of individual autonomy, the future of gender relations, and national prosperity.

“When I went in to write this book about the history of family planning in my home country of Peru,…I had some vague idea of what it was going to be about; it was going to about family planning and it was going to involve Peru and it was going to involve the 20th century…Once I had that figured out, [I thought] okay, I have all this now, [so] what is the best story that I can tell with all this?”

Grabbing a copy of his book, A History of Family Planning in Twentieth Century Peru, from his office’s book nook, Raúl Necochea settled in his desk chair and briefly sifted through the pages. When reflecting on his role as a historian, Dr. Necochea knew he was tasked with telling and uncovering yet “another story of abuse and negligence of people” who shouldn’t have been susceptible. Although Dr. Necochea recalls always having a particular interest in family planning, his research journey began at the start of his grad career, which was situated within the plight of a Peruvian scandal.

“Right around the mid 1990s, there was a scandal in Peru over some surgical sterilizations that were performed on women seemingly without their consent. They were mainly poor women, indigenous women, mainly women who lived in rural areas, traditionally the women who had always been the last to [be] served by the government and the medical profession.”

Representing a repetitive pattern of victimization, Dr. Necochea was challenged with revitalizing an old tale. Why were the same people still vulnerable and victimized? How were the same trends regarding contraceptive access reproduced? What actors were consistently involved? These probing questions guided Dr. Necochea’s role as an active historian, researcher, and storyteller.

When talking about projects, Dr. Necochea believes creating research projects is a valuable tool to experience. He views it as a bridging opportunity between professors and students to experience the value and importance of research and allow students to explore their interests deeper. “I think that the experience of writing and doing research on your own is really valuable…I mean, oftentimes the way in which we present research to students sort of makes it seem as though our expertise…is there for you to simply accept and consume, but the experience of actually producing the knowledge that goes into books or articles, that’s a very different process.” Dr. Necochea’s advice to students who hope to create their own research project encompasses the idea of producing knowledge through passion. He demonstrated his passion by drawing attention to the needs of the community in Peru. He also spoke about his identity as a Peruvian and the role it played in navigating the exploration of his research. Dr. Necochea stated that being Peruvian “opened a lot of doors for [him], not only speaking the language but being able to navigate and understand the people there. There’s nothing like being a local to open those doors and get others to say what you understand.”

“Beyond [ethnicity], there’s other markers that make you into the right or wrong messenger for some stories. The whole time that I wrote this story for example, I was always worried about the fact that I was a man studying a topic that is primarily about contraception for women”

In addition to his ethnicity, other aspects of his identity played a pivotal role in his research on sexual and reproductive health, especially with regard to gender. Conflicted about the role of men in conversations regarding modern contraceptives and family planning, concepts primarily marketed for women, “being a man was always in the back of [his] mind as a barrier to negotiating some of these conversations that [he] had to have.”

Alongside his identity, Dr. Necochea’s upbringing helped bridge the barrier of potential ideological differences between himself and his research participants. “Another thing that sort of played in my favor is who I am, which is not only a man but also a man who has been educated at a fairly conservative high school [in Lima]” he explained. This high school was a Catholic institution that was very renowned in Lima. Many of the participants in Dr. Necochea’s research had conservative viewpoints and were strong activists of the Catholic church, so his educational background provided a common ground, a sense of trust, and a bridge for critical dialogue. Ultimately, “it created sort of a level of confidence that [he] would not have had otherwise.”

Snapshot of Necochea's archival adventures. Reflective of one of his practical research challenges, "being indoors reminded [him] of how resource-poor archives can be." Pictured

Snapshot of Necochea’s archival adventures. Reflective of one of his practical research challenges, “being indoors reminded [him] of how resource-poor archives can be.” Pictured is one of the buildings of the Regional Archive of Puno, in southern Peru, 4000 meters above sea level.

During his time in Peru, Dr. Necochea faced many unexpected research challenges. He gave us interesting insight into navigating practical and ethical barriers while in the field. On the practical side, he learned that accessing archives would be much more difficult in Peru than in the US or Canada; but, in order to pursue the study, he would have to adjust.

“What I would find is that people were not returning my calls…or the facilities would be closed arbitrarily, or the materials that were supposed to be there were not there…Materials would be scattered around in different places. Archives would close, as in ‘we no longer have the possibility of serving the public because, [we’ve] run out of money’…It [was] a situation I encountered very often and it’s not a situation that is uncommon in developing countries– archived materials [that] ought to be available for public education and research often suffer from lack of funds.”

Dr. Necochea also discussed some of the ethical dilemmas he faced while in the field. He often had to interview individuals with whom he disagreed on the issue of family planning. Sometimes he was able to “make bridges [with individuals] when there [was] a respectful understanding of difference.” Other times, it was not so simple. In one example, he had conversations with physicians who flippantly recalled forced sterilizations they had performed and a pharmaceutical representative who ended up going on an anti-indigenous rant.

“Sometimes not everything can be planned in those situations, and you can be surprised in a bad way…you start to question your own sense of composure. Like, did I really do the right thing in not telling this guy he’s an ass and that I’m out of here or something like that? Or do I just finish my drink and then be on my way? Do I stay in touch with these people, all of whom want to stay in touch? “I mean, what do you do? It becomes a little bit of an ethical conundrum too about how do you stay connected to the field, which is another anthropological thing.”

In order to overcome his own biases, which could also act as barriers to his research, Dr. Necochea found that it was important “[to be] comfortable being sort of alien in a different cultural space. That’s a mainstay of anthropological work and it’s one of the things that has happened to [him] often by having to travel to different places for archives.” Despite being “mainly in archives, you have to be in situations in which you are the odd person out because of the nature of the different archives where [he] was. That attitude of being comfortable with uncertainty helps make you a good observer when you’re on the edge of a different culture.”

Through his research, Dr. Necochea was able to overcome barriers and create powerful bridges by telling a story that ensured voices were heard on a research topic in which he was extremely invested in. Yet, the story does not end here and Dr. Necochea’s research will continue on. Looking towards the future, he plans to write his next book on the “history of cervical cancer in Peru and possibly Latin America.” He “came across a couple of sources from the 1950s of physicians with ties to the government who were speaking out against the use of intrauterine devices for women…[and] started to get very curious about how this particular fear sort of became articulated at different levels — [specifically] at the level of government experts and also at the level of lay people.”

“More needs to be done to end social problems that have health implications, and a law is not gonna change that. We need something more–community participation in changing people’s minds like minds were changed earlier in the 20th century about birth control. That takes a great deal more work than just saying ‘Oh that’s wrong.'”

Now it is our turn. Now is the time to turn the page and bookmark the innovated projects of the future. Now is the time to research our own stories that encompass our passions, our interests, our backgrounds, and our various identities. Each story will bring its own barriers and challenges, however, it will also build bridges and enable us to make connections to the world around us. Dr. Necochea told his story, which story will you tell?

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Gems about Dr. Necochea

Tar Heel Bred: “I’m a big fan of this place [and] organizationally what UNC is and stands for. I mean, public education for one — I’m very proud of the fact that I can contribute to training of people who are so grounded in this space of this state and who get some kick ass education and experiences and opportunities to go as wide as they can.”

Elements of Anthropology: “I really enjoy ethnographic tales where anthropologists sort of reflect on their position of being on the edge of something and being able to understand its differences and similarities with other places.”

Favorite Quote: “The restricted use of anovulatories* […] does not infringe on the terms of the [Humanae Vitae] Encyclical, according to the judgment of authorized experts in morality” – Juan Landázuri, Archbishop of Lima (1955-1990) and Cardinal (1962-1990)

* – contraceptive pill

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