Joseph J. Simoni ,3 Luis Albert0
Vargas,” and Leticia
Casillas5
Merolicos, Mexican medicine ‘showmen, ” use techniques ranging from ventriloquism to snake-handling to sell medicinal products. The research re- ported here indicates that merolicos are effective communicators, and that thy can make an important contribution to ongoing public health communica- tion eflorts.
Introduction
Merolicos are Mexican medicine showmen whose counterparts can be found in many other developing countries. Merolicos frequent marketplaces and other common meeting places, such as town squares and areas near subway stations, but they also work spots where crowds are not usually found. With ventriloquism, mental “telepathy,” snake- handling, clown acts, medicinal “recipes,” and other kinds of crowd-pleasing perfor- mances, they attract the public and in the end always offer some medicinal product for sale. How did research on merolicos get started? Some time ago, in 1968, one of the authors
‘Based on a paper prepared for presentation at the XXXIX Annual Meeting of the United States-Mexico Border Health Association held at Scottsdale, Arizona, on 31 May-4 June 1981. Also appearing in Spanish in the Boletin de Ia Oficina Sanikaria Panamericana, 94(5), 1983.
kesearch for this paper has been supported by the following organizations: The Inter-American Founda- tion, The Mexican National Council of Science and Technology (CONACYT), The National Autonomous University of Mexico (UNAM), and West Virginia University.
3Associate Professor, Department of Sociology and Anthropology, West Virginia University.
4Researcher and Academic Secretary, Institute for An- thropological Research, National Autonomous Universi- ty of Mexico.
5Head, Office of Medical Anthropology, Medical Sciences Administration, National Autonomous Univer- sity of Mexico.
(Simoni) spent a year in Oaxaca, Mexico. While visiting that city’s famous open-air market, he often watched merolicos with their audiences and heard many of their sales pitches. However, it was not until close to the end of his stay, while walking through the marketplace one day, that he came to grasp what was occurring and began to understand its social meaning. Facial expressions and un- divided attention indicated a seriousness of thought, and purchase of the merolico’s “medi- cines” indicated a commitment to his pro- posed solutions. It appeared that the merolico knew how to effectively communicate health information to the members of his audience, and in some way was satisfying their health- related needs. So here was a public scene in which someone was quite possibly doing what public health personnel around the world, at great expenditure of time and money, had been trying to do with very limited success- that is, to effectively communicate health in- formation to those who need it most. The idea suggesting itself was that maybe this type of street presentation could be used for positive public health purposes, and that maybe re- search on merolicos could provide valuable in- formation for public health communication programs.
Once the results of a literature survey had firmly established the scholarly need for re- search on Mexican medicine showmen, plans
for the first field phase of a study were devel- oped. Preliminary observations had indicated that many people seemed to trust merolicos to the extent of asking them for advice. People seemed to believe what merolicos said about health and illness. Merolicos seemed to be effec- tive communicators of health information, and to be viewed as valuable sources of health information. It was fairly clear, however, that any initial research effort should be directed at confirming the merolicos’ effectiveness as com- municators of health information. Therefore, the major questions became: (1) Were memli- cos actually effective communicators of health information? and, if so, (2) Why were they ef- fective? In order to answer these questions and learn more about the work and lifestyles of merolicos, the first field phase of the study was executed in 1974.
This initial research into the relationships between medicine showmen and their patrons suggested that communications on the medi- cine show model might not only be favored by many of the poor, but might be especially ef- fective in combining the persuasive advan- tages of mass media and interpersonal com- munication. The results (I) disclosed that the patrons of medicine showmen often return again and again, and are not just passers-by stopping to be entertained for a few mo- ments. They regard the showmen as honest and credible, and they value very highly the showmen’s ability to explain things clearly. Showmen were observed talking to as many as 250 people and selling to as many as 70 people in a period of two-and-a-half hours.
Although the initial field research data demonstrated the potential for using medicine show-style communications as part of com- munity health programs, we were not yet in a position to propose specific measures for any particular organized approach. And although the initial study explained some of the reasons why poor Mexicans sought health information and satisfaction of health needs through con- tact with medicine showmen, we still knew lit- tle about poor Mexicans who did not patron-
ize such showmen. So it seemed worth asking whether the health-related beliefs and illness- related decisions of poor Mexicans who pa- tronized medicine showmen were different from those of others who did not, and was there any relationship between health and illness-related beliefs and patterns of patron- age? Such empirical questions had to be an- swered before any attempt could be made to successfully employ medicine show-styled lo- cal media (2,3) for the communication of pub- lic health information. Answering these and related questions became the major objective of a second field research phase in 1976.
From the 1976 field research results, it was concluded that the most meaningful differ- ences between patrons and nonpatrons of Mexican medicine showmen did not depend on their health orientations (scientific, mixed, or folk-traditional), but on their curiosity, their eagerness for information regarding “scientific medicine,” and their belief in the showmen. For example, the results indicated that 25 per cent of the patrons and 50 per cent of the nonpatrons exhibited folk-traditional health orientations. However, the patrons dif- fered markedly from their nonpatron counter- parts in terms of their interest in hearing more about “scientific medicine” from the medi- cine showmen (4).
The basic political decisions clearing the way for further investigation were made in 1977 and 1978. At first, various traditional objections were encountered. Merolicos were sometimes derided as deviant types and even sociopaths. These deep-seated prejudices ini- tially prevented objective consideration of the fact that the merolicos’ methods might prove useful.
the National Autonomous University of Mex- ico (UNAM) to Mexico’s National Council of Science and Technology (CONACYT).‘j That proposal was approved by CONACYT, and funding through CONACYT began in January 1979. That funding, along with fi-
nancial support from the Inter-American Foundation, UNAM, and West Virginia Uni- versity, permitted implementation of the project.
The main object of the pilot project was to confirm that the “medicine-show” method of communication could make a valuable con- tribution to public health programs. Specif- ically, we wanted to know if medicine show- men were able to bring about changes in the knowledge, attitudes, and behavior patterns of their audiences.
Methods
Selection of Communities
Six test and six control communities were included in the project. All were located in the Federal District, the state of Michoacan, or the state of Oaxaca, six being rural commu- nities and six being settlements on the urban outskirts of Morelia (in Michoacan), Oaxaca (in the state of Oaxaca), and Mexico City (in the Federal District). These three regions were chosen for the project because (a) they provide a reasonably representative sample of much of the Mexican population, (b) the research team had extensive research experience in all three areas, and (c) the research team had estab- lished good rapport with merolicos in all three areas.
The twelve communities were selected on the basis of the following criteria: (a) each of them had to be more or less self-contained and small enough to permit effective project im- plementation and evaluation; and (b) each had to have no history of previous exposure to
6The M &can counterpart of the U.S. National Science Foundation.
localized interpersonal attempts at the kind of nutrition education to be employed as part of the project.
Selection of Merolicos
Five merolicos were selected to work with the project. They were chosen on the basis of (a) their observed expertise, (b) their experience in the regions to be covered, (c) their past honesty in dealings with one of us (Simoni), and (d) their apparent interest in working to improve public health education.
Message Content
Partly because 1979 was the International Year of the Child, and partly because two of us (Vargas and Casillas) possessed expertise in the general area of growth and nutrition, we decided to focus our message on the nutrition of infants up to one year of age. During prep- aration of this message, we instructed the me- rolicos to emphasize the following:
1) The value of breast-feeding until a baby is at least one year of age.
2) Th e name and function of the first breast se- cretion, colostrum.
3) The fact that it is beneficial for mothers to cleanse their breasts with camomile tea before breast-feeding,
4) The desirability of early supplementary feed- ing for infants combined with continued breast- feeding. Indicated supplementary foods included: (a) fruit juices (orange, apple, tomato) at 15 days; (b) fruit at two months; (c) a “magic meal” (a pu- ree of beans, the juice from the beans, and some other product such as tortilla or crackers) at three months; (d) vegetables at four months; (e) egg yolks at five months; and (f) meat at six months.
5) The value of vitamin drops for babies. 6) The functions of vitamins A, C, and D.
oriented organizations that attempt to dissem- inate information utilizing both mass media and interpersonal channels of communica- tion. This posed a problem for the project, because it was necessary to have some way of discerning the specific impact of the merolicos’ activities.
This problem was dealt with in three ways. To begin with, two items of information not being disseminated through any other chan- nels were incorporated into the merolicos’ message-these being the recommendation that mothers cleanse their breasts with cam- omile tea and the concept of the “magic meal.” In addition, the name and function of the first breast secretion, colostrum, was em- phasized. (It was felt that even though a small percentage of the public would be aware of colostrum, it was not an item of information greatly stressed by other health communica- tion efforts, and so this emphasis would help identify the results of our project.) Finally, plans were made for incorporating questions about respondents’ sources of information or knowledge into the evaluation survey instru- ments.
Preparing the Message
This phase of the project, to be described in more detail elsewhere, proceeded essentially as follows: The merolicos spent three weeks working with us in Mexico City. The first week, which was very relaxed, gave everyone a chance to get acquainted and gave fellow academics an opportunity to learn from the merolicos about communicating with the pub- lic.
The second week was much more struc- tured. The merolicos attended class-like ses- sions, were instructed about the message we wanted them to communicate, and learned the reasons (including the scientific rationale) for the importance of each segment of the message. At the end of the second week, each of the merolicos was asked to develop a medi-
cine-show routine incorporating all segments of the message. It was emphasized that the routines should be developed according to each merolico’s individual style, and that we only sought uniformity regarding the correct- ness of the message content. For example, all the merolicos were instructed to recommend commencing the “magic meal” at three months, rather than at any younger or older age.
During the third week each merolico made an initial presentation of the routine, incorpo- rated changes based on constructive criticism from the authors and other merolicos, and prac- ticed the routine repeatedly until he felt com- fortable with it and ready to present it to the public. At the end of the third week each mero- lice practiced the routine near a subway sta- tion in Mexico City.
Communicating the Message
After a one-month waiting period, the three-month field phase of the project began the week after Easter, in late April of 1979. In Oaxaca and the Federal District the merolicos worked in pairs. In MichoacLn the fifth meroli- co worked alone. As already mentioned, two test sites (a marginal area near a city and a ru- ral village) had been chosen in each of the two states and the Federal District. The merolicos worked each site only once a week for a period of about three hours. At each site they moved around, working three different locations within the site on each visit. (This limited the total time spent in each test community to a maximum of 40 hours.)
Evaluation
After completion of the merolicos’ work, two months were allowed to elapse before the field segment of the evaluation phase was begun. This phase involved administration of survey interview instruments by social workers and nurses trained for that task. At first, 20 per cent of the households in both the test sites and control sites were surveyed for the purpose of assessing the medicine shows’ impact upon mothers. All those interviewed initially were mothers, preference being given first to moth- ers of babies less than a year old, next to mothers of preschoolers over a year old, and so forth. In all, interviews were obtained with 400 mothers in test communities and 344 mothers in control communities. The ages and educational levels of these subjects are shown in Table 1.
In addition, after observing the merolicos working in the six test communities, we real- ized that many adolescents were paying some attention to the medicine shows. Since many of the young girls listening would soon be mothers, we felt it important to learn whether
Table 1. Ages and educational levels of 744 mothers interviewed during the field evaluation phase of
the medicine-show project.
% of 400 % of 344 mothers in test mothers in con-
communities trol communities Age group:
15-19 years 7 8
20-39 ” 71 79
40-59 ” 21 13
No data 1 0
Total 100 100
Educational leuel:
Third grade or less 64 58 Fourth, fifth, or
sixth grade 27 33
Beyond primary 8 8
No information 1 1
Total 100 100
their thinking about infant nutrition was being affected. Therefore, steps were taken to inter- view unmarried, childless females between 11 and 19 years of age. These respondents were not members of the households where mothers had been interviewed. In all, this childless seg- ment of our sample included 180 respondents from test sites and 183 respondents from con- trol sites. The ages and educational levels of these respondents are shown in Table 2. All of the interviews, in every test and control com- munity, were completed between 60 and 75 days after the merolicos’ work ended.
Table 2. Ages and educational levels of 363 unmarried and childless teenage girls interviewed during the field evaluation phase of the medicine-show project. % of 180 girls % of 183 girls in test in control communities communities Age:
11 years 12 ” 13 ” 14 ” 15 ” 16-17 ” 18-19 ” Total Educational level:
Third grade or less Fourth, fifth, or
sixth grade Beyond primary No information
Total
0 0.5
1 1
36 35
22 24
38 37
2 2
1 0.5
100 100
23 23
57 43
19 34
1 0
100 100
Findings
The results reported here are based on a preliminary analysis of data gathered during the interviews. Tape recordings of all the medicine shows, as well as field notes about many of the shows that were observed during the course of the project, are available to sup- port these findings.
colostrum provide a clear indication of the medicine-shows’ impact and permit changes in the knowledge, attitudes, and behavior pat- terns of the respondents to be assessed. Data on mothers’ responses to these questions are presented in Table 3, while data on the re- sponses of unwed and childless teenagers are shown in Table 4.
Regarding the “magic meal,” 24 per cent of the mothers and 18 per cent of the unmar- ried, childless females retained knowledge about its content. Also, the data indicate that the merolicos were able to cause a 17 per cent increase in the share of mothers knowing the name or function of colostrum. In sum, then, the surveys showed that the results regarding new knowledge were impressive.
Nineteen per cent of the surveyed mothers and 15 per cent of the unmarried, childless females recommended camomile tea for cleansing the breasts before breast-feeding. Considering the responses given by their con- trol counterparts, one can safely assume that before their exposure to the medicine shows these subjects would have recommended some other form of hygiene or none at all. There- fore, these responses (made at least two months after exposure to the medicine shows) indicate that the merolicos can indeed change attitudes or ways of thinking about breast- feeding.
Regarding the merolicos’ potential for chang- ing behavior, mothers breast-feeding at the time of the interviews were asked what they were then using to cleanse their breasts before breast-feeding their children. Whereas not even one individual in the control group in- dicated she was using camomile tea, 8 per cent of the breast-feeding mothers in the test com- munities said they were using camomile tea. This is an unambiguous illustration of the merolicos’ ability to change behavior. Further- more, as the Table 3 data indicate, this ability seems about equally strong in urban and rural areas.
Regarding the merolicos’ credibility, respon- dents in the six test communities were asked
“DO you believe the things that these merolicos said?” If the answer was “yes,” the inter- viewer then asked “Specifically, did you be- lieve what they said about the nutrition of children?” Of all the test community respon- dents, 60 per cent gave an affirmative re- sponse to the first question, and 86 per cent of the latter gave an affirmative response to the second. Among urban test community re- spondents the respective percentages were 65 and 90, and among rural test community re- spondents they were 55 and 82.
Discussion and Conclusions
Earlier research results, combined with the data from this pilot project, have led us to en- thusiastically endorse the idea of using medi- cine shows as part of public health programs. In the project just described, Mexican medi- cine showmen clearly demonstrated an ability to effect changes in the knowledge, attitudes, and behavior patterns of their audiences. Fur- thermore, the test was rigorous and the hur- dles overcome were imposing. Among those hurdles:
1) Previous unwillingness of test communities to cooperate with government-sponsored programs. The state health agency had withdrawn its pro- grams from one of the rural test sites, and one of the urban test sites was a squatter settlement not legally recognized by the local government.
2) Low levels of education. Ninety-one per cent of the mothers interviewed, and 80 per cent of the unmarried, childless females interviewed had not gone past primary school. Sixty-four per cent and 23 per cent, respectively, had not gone past third grade.
3) The requirement that the merolicos commu- nicate a rather lengthy message consisting of more than 10 parts.
4) The requirement that they change attitudes and behavior patterns steeped in tradition. (Infant nutrition is a subject about which everyone has an idea or opinion.)
5) The need to work during the rainy season. This circumstance made it necessary at times to change work schedules, to work in the rain, etc.
Table 3. Responses to key survey questions of mothers interviewed in test and control areas. The number of mothers interviewed* (in parentheses) and the
percentage giving a positive response to each question Urban mothers in: Rural mothers in: Total mothers in,
Test CO”tld Test Control Test Control areas areas areas areas areas area.3 Qwstum: Speaking again about breast-milk, have
you heard what you call (name) the first breast- milk, and do you know what function it serves?
Number interviewed
Per cent indicating knowledge of name and/or function
(201)
44%
(165) 23%
(199)
20%
(179) 8%
Question: Where did you hear about the name or function of this first breast-milk?
Number interviewed
Percent indicating medico as SOUPX of knowledge
(85) (36) 29% 0%
(41) 49%
(1‘4
0%
QuAon: (For mothers breast-feeding at the time of the interview) What do you use to cleanse your breasts before breast-feeding your chid?
Number interviewed
Per cent indicating use of camomile tea Question: (For mothers not breast-feeding at the
time of the interview) What would you advise nursing mothers to use for cleansing their breasts?
(46) 9%
(29) 0%
PJ)
8%
(58) 0%
Number interviewed
Per cent indicating camomile tea Question: How did you know what a woman
should use to cleanse her breasts before breast-feeding?
(151) (129) (123) (105) (274) (234) 15% 1.5% 24% 0% 19% 1%
Number interviewed
Per cent indicating merolico as source of knowledge
(164) (120) 1%
(129)
(98)8% 23% 0%
Question: Some people speak about a famous “magic meal” for infants less than a year old. Would you be able to tell me how that is pre- pared?
(201) (165) (199) (179) 26% 1% 22% 0% *Where appropriate, subjects giving an inapplicable answer or no answer were discounted.
Number interviewed
Per cent knowing how to prepare the “magic meal”
(400) 32%
(126)
36%
(106)
8%
(344) 15%
(48) 0%
(87) 0%
(293)
15%
(218)
0%
(400) (344) 24% 0%
period; as a result, the time spent in each test com- munity never exceeded 40 hours.
The idea that merolicos can contribute to
7) The time-lapse before evaluation. Because no
community health programs is now supported
evaluation interviews were conducted until at least by seven years of research and experience. two months after the last medicine show, respon- That idea makes sense in terms of (a) our
dents had to remember relevant portions of the knowledge of certain target subcultures and
Table 4. Responses to key survey questions of unmarried and childless teenage females (11-19 years of age)
interviewed in test and control areas.
The number of subjects interviewed* (in parentheses) and the per- centage giving a positive response to each question Urban subjects in: Rural subjects in: Total subjects in:
Test Control Test Control Test Control areas areas areas areas areas areas Question: What would you advise nursing
mothers to use for cleansing their breasts? Number interviewed
Per cent indicating camomile tea Question: How did you know what a woman
should use to cleanse her breasts before breast-feeding?
Number interviewed
Per cent indicating merolico as source of knowledge
Qu&‘on: Some people speak about a famous “magic meal” for infants less than a year old. Would you be able to tell me how that is pre- pared?
Number interviewed
Per cent knowing how to prepare the “magic meal”
(87) (91) (91) (92) (178) (183)
6% 0% 23% 1% 15% 0.5%
(61) (64) (63) (41) (124) (105)
18% 0% 25% 0% 22% 0%
(84) (91) (86) (91) (170) (18‘4
17% 0% 20% 0% 18% 0%
*Where appropriate, subjects giving a” inapplicable answer or no answer were discounted.
communication media and their potentials for communicating health information to those targets, and (c) the relatively low potential cost compared to both the cost of other health communication efforts and the potential bene- fits.
Of course, information about infant nutri- tion is just one kind of information that could be conveyed. Information about venereal dis- eases, gastrointestinal disorders, heart dis-
ease, or virtually any other health-related top- ic could be disseminated by medicine show- men. We know that people listen to these showmen, that people believe them, and that their presentations can transmit knowledge and change both attitudes and behavior. For all of these reasons, we have concluded that medicine showmen should be integrated into ongoing public health programs.
SUMMARY
Merolicos are Mexican medicine “showmen” tion of one sort or another to the kinds of people
with counterparts in many other developing coun- who are apt to need such information most.
tries. Frequenting marketplaces, town squares, and The research reported in this article sought to other areas where crowds can be attracted, they use determine whether medicine shows should be inte- techniques ranging from snake-handling to clown grated into public health communication programs. acts for the purpose of selling medicinal products. For that purpose five merolicos were selected. Each
mation about infant nutrition, which was ultima- tely presented at various sites in six communi- ties (three urban and three rural) in the states of Michoacan and Oaxaca and in the Federal District.
Mothers in the six test (exposed) communities and in six control (unexposed) communities were then interviewed, as were unwed and childless girls 11-19 years of age. These interviews, conducted about two months after the merolicos’ work was com- pleted, generated data which indicated that a sig- nificant fraction of the women remembered things the merolicos had said and in some cases had put
them into practice.
This ability to achieve positive results in the face of obstacles ranging from established community noncooperation with government programs and low educational levels to inclement weather and severe time limitations was quite impressive. Over- all, the results confirmed that many people listen to the merolicos, believe them, and modify their health- related behavior according to what they say. All this provides a compelling argument for supporting the integration of medicine shows, in Mexico and other countries, into ongoing public health programs.
REFERENCES
(1) Simoni, J. J., and R. A. Ball. Can we learn from medicine hucksters? Journal of Communication 25:174-181, 1975.
(2) Menzel, H. Quasi-mass communication: A neglected area. Public Opinion Quarterb 35(3):406- 409, 1971.
(3) Lin, N., and R. S. Burt. Roles of D$erential Information Channels in the Process of Innovation Dzi& sion. International Center for Social Research, Albany, New York, 1973.
(4) Simoni, J. J., and R. A. Ball. Huckster- Styled Communication: Its Potential Role in Com- munity Health Programs. Paper presented at the Annual Meeting of the Rural Sociological Society
held on 2-5 September 1977 in Chicago, Illinois, U.S.A.
(5) Simoni, J. J., and R. A. Ball. La difusion de information sobre la salud: Lo que 10s merolicos nos pueden enseiiar. Salud Pu’blica de Mixico 19(2): 273-279, 1977.
(6) Simoni, J. J., and R. A. Ball. The Mexican medicine huckster: He must be doing something right. Socioloy of Work and Occupations 4(3):343- 365, 1977.
(7) Simoni, J. J., and R. A. Ball. Institutional- ized exploitation: The case of the Mexican medi- cine huckster. Sociological Symposium, Number 23, pp. 27-40, Summer 1978.
POLIOMYELITIS IN ARGENTINA
Fourteen cases of paralytic poliomyelitis resulting in two deaths have been reported in Argentina since the end of December 1982. Thirteen of the cases occurred in El Chaco Province and one in Salta Province. Two of those affected were infants, 11 were children between one and five years old, and one was over five years old. Eleven of the victims had received poliomyelitis vaccine, and three had received three or more doses. Exten- sive immunization of children is being carried out in the affected area.
Source: World Health Organization, Weekly Epidcmiotogical Record 58(6):43, 1983.
