An ethnography of nonadherence: Culture, poverty, and tuberculosis in urban Bolivia

Research output: Contribution to journalReview articlepeer-review

45 Scopus citations


The author conducted a focused descriptive ethnographic study of nonadherence with tuberculosis (TB) therapy among Aymara-speaking residents of the city of La Paz, Bolivia. A cohort of patient-informants was identified from the District III TB Control Registry of La Paz as having been nonadherent with their TB medication protocol. From June to August 1998, ethnographic material was collected through participant-observation and repeated interviews and visits in homes, workplaces, clinics, and the community. Ethnographic analysis revealed structural barriers to be more important than cultural differences in the production of nonadherence. Though informants maintained a variety of beliefs and practices related to Aymara medicine, the majority of patients were comfortable with a biomedical model of tuberculosis and maintained belief in the efficacy of antituberculosis chemotherapy and desire to finish treatment. Patients overwhelmingly cited hidden costs of treatments, poor access to care, ethnic discrimination, and prior maltreatment by the health system as reasons for abandoning treatment. These data suggest that overemphasis of cultural difference without exploration of other social dimensions of health care delivery can obscure a more practical understanding of nonadherence in marginalized populations.

Original languageEnglish (US)
Pages (from-to)401-425
Number of pages25
JournalCulture, Medicine and Psychiatry
Issue number3
StatePublished - Sep 2004
Externally publishedYes


  • Anthropology
  • Aymara
  • Bolivia
  • Ethnography
  • Patient nonadherence
  • Tuberculosis

ASJC Scopus subject areas

  • Health(social science)
  • Anthropology
  • Arts and Humanities (miscellaneous)
  • Psychiatry and Mental health


Dive into the research topics of 'An ethnography of nonadherence: Culture, poverty, and tuberculosis in urban Bolivia'. Together they form a unique fingerprint.

Cite this