Camila sat down on her faded pink sofa, unwrapped the bandage around her calf, and showed me a violet wound, some of the skin crusty and some of it wet. Her daughter Cecilia sat on the edge of a chair in the corner, filling gaps in the story – “remember we tried a gel that inflamed your skin,” “the pharmacy down the street never gives us enough gauze.”
At ReD Associates, we often work with big healthcare companies who seek more patient-centric approaches to product design, and our insights have implications on product, packaging, and patient-compliance. This project aimed to make wound care products relevant to more people by understanding how patients care for chronic wounds in emerging markets.
Camila, a sixty-four year-old Brazilian patient with a venous leg ulcer, was doing everything wrong. She risked infection by putting olive oil over her calf (“I know I’m not supposed to, but it’s the only thing that takes away my pain pain pain”); she used dry gauze with wisps that stuck to the ulcer; she swore by a papaya-extract ointment that doctors advise against because it eats away fresh skin.
Camila’s behavior contradicted our client’s theories about how patients care for wounds: she unwrapped her bandages constantly to check on her ulcer, she believed wounds should air out in the sun, she wanted a cocktail of creams. She also had her own theories about living with wounds. Camila had diabetes, high blood pressure, and a hernia, but she spent more time mulling over her less-life-threatening ulcer, because it was the ulcer that kept her from playing with grandkids and visiting friends. Wound care was not a routine but a meditative ritual she performed everyday on the same sofa, watching the same television shows. Camila and Cecilia cared for the ulcer together, and Camila spoke proudly of when she gave the last of her papaya-extract ointment to heal a friend’s injury. The wound was as much social as physical.
In 2013 medical anthropologist João Biehl published an article, “Ethnography in the way of theory” arguing that “through ethnographic rendering people’s own theorizing of their conditions may leak into, animate, and challenge […] philosophical universals” (594). Ethnography means telling the stories of active, unfinished, and self-reflective human lives, without shrinking their voices to comply with theories, philosophies, and hard scientific truths (Biehl 2013:577, 583). Corporations develop theories and truths – for example, how a wound should be treated based on the latest medical advancements. But as corporate ethnographers, we listen to informants with the belief that they tell us lived, human truths, even if they conflict directly with louder or seemingly more powerful truths about the world.
At ReD Associates we form our insights by connecting the ideas of our informants. When we return from the field and analyze data, informants come into conversation with one another in ways not otherwise possible. The insight that wounds are social, for example, emerged not just from our time with Camila and Cecilia, but from making connections to all the informants. When we asked to speak with a patient about their wound, we always spoke with the patient and a loved one who knew more about the wound than the patient did.
Often when we present our research to clients we worry that informants’ experiences will be dismissed as “anecdotal evidence.” Camila was so far from the ideal patient, her experiences so far from established norms of wound care, that it would have been tempting, convenient, and safe to quiet her voice to a whisper, perhaps only sharing an overarching insight such as “wounds are social.” But we don’t go to the field to collect anecdotes; we go to connect theories people create to make sense of their lives – and these theories come in vivid detail, in the significance of pink sofas and papaya extract when we observe them closely.
Across our work we are finding ways to make sure our clients participate in the process of building connections to the informants, to begin seeing the relevance of their stories.What was at first unnerving about this study was that we gave our clients access to our raw data from the very beginning, by sharing our observations on a digital workspace. The observations then became sticky and metaphorical; our clients retold particularly surprising stories (Camila’s meditative wound-cleaning session for example) as representations of human truths (wounds create rituals and intimacy). When we brought the rich details of informants’ lives into the board meetings and final workshops, the informants were already familiar faces, voices more than data points, with experiences as true and insightful as statistical analyses, focus group data, and surveys.
Is Camila wrong to apply olive oil to her wound? Probably. But is she wrong to perceive wound care as intimate, ritualistic, active, and social? No, she told us the truth of her experience, a truth that ultimately enlightened our clients and helped them reconsider the relevance of wound care in everyday life. A photo of Camila cleaning her ulcer on her faded pink sofa became the image for the company’s new internal campaign. It was mounted on walls and printed onto buttons. Our client’s perspective on chronic wound patients shifted from seeing them as passive and unengaged in wound care, to seeing them as active, social, and seeking better care for conditions that deeply hindered their lives. The company’s new goal is to empower and support patients in proactively managing their chronic wounds with the help of loved ones. Months after the project ended, our research team received an email from our clients: “We are trying to track down Camila in Brazil. Do you have her contact information?” They wanted to have a follow-up conversation with her. Even a company that knew everything about how to treat a wound had something to learn from a patient who knew everything about living with one.
About the Author
Maria Cury is a consultant for ReD Associates, an innovation and strategy consultancy applying social sciences and humanities to business problems. She has conducted ethnographic research for ReD in Brazil, Thailand, and the United States, in healthcare, technology, and consumer goods. She was trained as a social anthropologist at Princeton University and the University of Oxford, where she focused on visual, material, and museum anthropology.