Fogarty Fellow Uses Participatory Methods to Study Mental Health in Peruvian Amazon

Miranda Harris Martinez, center, presenting to a group during her Fogarty Fellowship.

Miranda Harris Martinez has roots in Latin America.

The fourth-year University of Minnesota Medical School student split her time between Ecuador and South Florida before making her home in the Twin Cities. That connection made her recent research as part of the Fogarty Global Health Fellowship even more meaningful.

Harris Martinez spent her fellowship in rural Peru studying the perceptions and expressions of mental health among Indigenous women of the Kukama tribe, who live in townships along the Marañón River, a tributary of the Amazon. 

“As an Ecuadorian-American, something that’s been so important to me since I arrived  at medical school is making sure I build a career in global health in Latin America,” said Harris Martinez. “The Fogarty Fellowship has allowed me to start that.”

The Fogarty Global Health Fellowship, known formally as the Fogarty LAUNCH Research Training Program, is a prestigious training program funded by the National Institutes of Health’s (NIH) Fogarty International Center that offers a year of mentored research training to postdoctoral trainees and doctoral students. 

The Center for Global Health and Social Responsibility is part of the Northern/Pacific Global Health Research Fellows Training Consortium, which operationalizes the fellowship program. 

Harris Martinez conducted her fellowship research through Mamás del Río, a local organization committed to improving women’s health in the rural Amazon by training and empowering community health workers. 

Collaborating with Dr. Magaly Blas, an epidemiologist and researcher of Lima’s Universidad Peruana Cayetano Heredia and director of Mamás del Río, who served as a principal investigator on the project, Harris Martinez used qualitative methods to determine how local women experienced and perceived emotional distress. 

Understanding these women’s experiences with mental health conditions will ultimately inform how community health workers can provide better support to those who need it, noted Harris Martinez.

“Disease is in part socially constructed, and illnesses like depression and anxiety are expressed within a social context,” said Harris Martinez. “Poor mental health is going to look differently depending on that context and Indigenous groups often have different conceptions and constructions of mental illness.”

Harris Martinez took a research year between her third and fourth years of medical school to complete the fellowship, which provides an opportunity for aspiring medical professionals to learn more about the research side of global health. 

Shailey Prasad, MD, MPH, is principal investigator for the University of Minnesota’s collaboration with the Fogarty International Center, which sponsors the fellowship. Prasad also served as Harris Martinez’s mentor during her fellowship. 

“The Fogarty Fellowship is a great opportunity for students like Miranda to gain hands-on experience in the field,” said Prasad. “Her research offers a prime example of the ethos of care and responsibility that the Center for Global Health and Social Responsibility prides itself on.” 

Harris Martinez’s research focused on female adolescents, pregnant women, and postpartum mothers. Women in the region have higher rates of mental illness than men; that statistic holds true globally as well.

Harris Martinez wanted her research to be participatory and collaborative, allowing participants to play an active role in the investigation. To do this, she used body mapping to understand how women in the region conceptualize their experiences with mental health.

This methodology has participants visually represent their symptoms of emotional distress within an outline of their body, which they draw on a life-sized canvas. The method was an important way for Harris Martinez to understand how the women’s emotional conditions manifested physically.  

An exhibit of the drawings was held in all of the eight communities where the research took place, allowing community members to discuss the images and engage in a conversation about mental wellbeing.

Participants drew sketches of anxiety-caused numbness, heart palpitations and dizziness. Harris Martinez also said many of the drawings represented pain in the uterus, which she found interesting.

“The piece about the uterus didn’t come up in the interviews. Verbal methods can be limiting, and this shows the importance of using a participatory, arts-based method,” she said.

“When you put things in people’s own terms, when you involve them in the process, you gain a much more expansive understanding of health.”

The data collected will help Mamás del Río expand their interventions to involve mental health and continue supporting all aspects of women’s wellbeing in these communities. But the experience also helped Harris Martinez develop as a researcher and an aspiring physician.

“As a researcher, this experience gave me a lot of confidence to conduct a rigorous, longitudinal study. I had never had the opportunity to do that on my own before. To do a project like this, you need that dedicated year,” she said. 

Harris Martinez added that her time as a fellow has also made her focus more on community-based health interventions. She believes that, as the U.S. healthcare system becomes increasingly privatized, doctors will have to play more of a role outside of the clinic walls and work alongside community members to develop health care solutions.

The year Harris Martinez had in Peru allowed her to take chances she might not have otherwise.

“I learned how to respond to my data and adapt my methods. The body mapping, especially, was a bit of a risk — I had never done it before, but it made my experience and project so much richer. The Fogarty Fellowship gives you the time and space to do just that,” she said.