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Knowledge, Attitude and Perception Towards Caesarean Section and Its Associated Factors Among Pregnant and Postpartum Women Attending Maternal Health Units in Burao District, Somaliland

DOI: 10.31038/AWHC.2024732

Abstract

Background: Caesarean section (CS) is a commonly performed surgical procedure in obstetrics that has significantly improved maternal and fetal outcomes worldwide in the 20th century. However, in the 21st century, the frequency of Caesarean section operations has surpassed the World Health Organization (WHO) recommendations due to unnecessary and inappropriate indications. There is a notable lack of data on this issue in Somaliland, particularly in the Burao district where no previous studies on Caesarean section have been conducted. This study aims to fill these research gaps by examining the level of maternal knowledge, attitudes, perceptions, and associated factors regarding Caesarean section among pregnant and postpartum women in Burao district.

Objective: To assess the knowledge, attitude, and perception towards caesarean section and its associated factors among pregnant and postpartum women attending maternal health units in Burao District, Somaliland.

Methods: A cross-sectional study design was employed to interview pregnant and postpartum women attending four maternal health centers in Burao district. Participants completed a questionnaire covering socio-demographic characteristics, obstetric histories, and knowledge, attitudes, and perceptions towards Caesarean section. Data were analyzed using Stata software and presented as frequencies and percentages.

Results: The study, involving 162 respondents, highlighted demographic and educational variations that influence delivery preferences and methods among women in the Burao District, Somaliland. Of the respondents, 39.51% were aged 22-28, and 23.46% were aged 15-21. A significant proportion (33.33%) of the women were illiterate, whereas 33.96% of their husbands had basic education. University enrolment rates were low, with only 8.64% of mothers and 23.27% of husbands having higher education. Regarding delivery preferences, 74.19% of women preferred vaginal delivery for their first birth, while 25.81% opted for a caesarean section. For their most recent birth, 70.00% delivered vaginally, whereas 30.00% delivered via caesarean section. The study also reveals significant associations between various factors and the attitudes, knowledge, and perceptions regarding caesarean sections among mothers. The mode of first and last delivery was significantly linked to mothers’ knowledge about caesarean sections, indicating that personal experience with different delivery methods influences awareness. Respondents’ attitudes towards caesarean sections were significantly associated with their monthly income and the method of their most recent delivery, highlighting the role of socio-economic factors and recent experiences in shaping attitudes. Additionally, mothers’ education levels significantly impacted their perceptions of caesarean sections, with higher education levels correlating with more informed and favorable views.

Conclusions: The study reveals that pregnant and post-partum women have good overall knowledge, positive attitudes, and positive perceptions towards Caesarean section, with rates of 64.81%, 51.85%, and 55.56%, respectively. However, the rates of Caesarean section for the first and last delivery modes were 25.81% and 30.0%, respectively, with elective Caesarean section at 5.45%. These findings emphasize the importance of addressing personal experience, socio-economic factors, and education in maternal health initiatives related to caesarean sections.

Recommendations: Maternal health programs should prioritize tailored education and awareness campaigns about caesarean sections, particularly for mothers with varied delivery experiences. Addressing socio-economic disparities and enhancing educational initiatives are crucial to ensure all mothers receive accurate information and support. These measures will promote informed decision-making and positive attitudes towards caesarean sections.

Keywords

Knowledge, Attitude, Perception, Caesarean section, Associated factors, Pregnant women, Postpartum women, Maternal health, Burao district, Somaliland

Introduction

In the twenty-first century, childbirth typically occurs through either vaginal delivery or caesarean delivery (CS). When vaginal delivery is not feasible, caesarean delivery serves as an alternative, involving an incision in the uterine wall to ensure the safety of both mother and child. Caesarean section is one of the most common surgical procedures in obstetrics and has significantly improved obstetric care globally, reducing maternal and fetal mortality [1,2].

Caesarean sections can be elective, planned before labor, or emergency operations based on medical necessity during labor. The primary indication for elective Caesarean section includes a narrow pelvis, where the pelvic outlet is less than 29.5 cm wide, or an interspinal measure of less than 8 cm. However, Caesarean section without medical necessity is associated with higher perinatal complications compared to vaginal birth (VB), affecting both short- and long-term maternal and neonatal outcomes. Despite this, Caesarean section rates have increased globally without clear evidence of reduced morbidity and mortality when Caesarean section is not medically justified [2,3].

Medical experts consider Caesarean section generally safe, albeit with higher complication risks than vaginal delivery. Decisions regarding Caesarean section often hinge on the best interests and safety of the mother and child. The World Health Organization (WHO) recommends a Caesarean section rate of 10%-15%, noting that higher rates may not correlate with improved health outcomes. In Sub-Saharan Africa, including Somalia, negative perceptions and limited access to Caesarean section contribute to higher perinatal and neonatal mortality [4-7].

Maternal mortality remains a global concern, with Sub-Saharan Africa, including Somalia, accounting for nearly 70% of maternal deaths in 2020. Somalia’s maternal mortality rate (MMR) dropped from 732/100,000 live births in 2015 to 692/100,000 in 2020, yet remains high compared to neighboring countries. The national Caesarean section rates vary, with developed countries like the UK and USA reporting rates of 23.8% and 32.8% respectively, while Somalia reports significantly lower rates [8,9].

Studies indicate varying levels of maternal knowledge about Caesarean section. In Manipur, India, 92.7% of pregnant women had inadequate knowledge regarding Caesarean section. In Nigeria, 82.3% had heard about Caesarean section, but many were unaware of specific details. Conversely, in Saudi Arabia, 94.2% of women knew that Caesarean section could save a newborns life. These findings highlight the need for enhanced maternal education on Caesarean section [10-12].

Attitudes towards Caesarean section vary widely. In Sweden, Somali women preferred Caesarean section due to concerns related to female genital mutilation. In Nigeria, 66% of pregnant women would not accept Caesarean section if indicated. Studies in Jordan found that most women preferred vaginal delivery, with attitudes influenced by past experiences and cultural beliefs [13-15].

Multiple factors influence maternal acceptance of Caesarean section. Repeat Caesarean section, dystocia, breech presentation, and fetal distress are common indications[6]. Studies indicate that financial incentives, fear of labor pain, and concerns about healthcare quality also drive higher Caesarean section rates. Socio-economic status, education level, and maternal age significantly impact Caesarean section acceptance [16,17].

Despite limited data, studies indicate Somaliland women face higher risks of Caesarean section due to circumcision-related concerns and the influence of healthcare providers. This study seeks to assess factors affecting maternal knowledge and attitudes towards Caesarean section in Burao district, enhancing community understanding and acceptance when necessary.

Objectives

General Objective

  • The purpose of the study is to assess knowledge, attitude and perception towards Caesarean Section and Its Associated Factors Among Pregnant and Postpartum women Attending Maternal Health Units in Burao District, Somaliland, in August

Specific Objectives

  • To identify Knowledge towards Caesarean Section and Its Associated Factors Among Pregnant and Postpartum women Attending Maternal Health Units in Burao District, Somaliland, in August 2023.
  • To assess the attitude towards elective caesarean section Among Pregnant and Postpartum women Attending Maternal Health Units in Burao District, Somaliland, in August 2023.
  • To find out the factors that are associated with maternal knowledge and attitude towards caesarean section Among Pregnant and Postpartum women Attending Maternal Health Units in Burao District, Somaliland, in August 2023.

Methods and Materials

Study Area and Period

This study was conducted at obstetric health units in Burao District, Somaliland, from May 15 to June 30, 2023. Burao, founded in the late 18th century, is the second largest city in Somaliland (UN- HABITAT, 2009). The district is served by two public secondary hospitals, ten private secondary hospitals, and five primary maternal and child health (MCH) centers providing obstetric services. We purposefully selected four of the most populated health centers: Burao General Hospital, Central MCH, Daaru-Hanan, and Sheikh Khalifa Hospital.

Study Design

An institutional cross-sectional survey was conducted to assess women’s knowledge, attitudes, perceptions, and associated factors regarding caesarean sections among pregnant and postpartum women attending selected obstetric health units in Burao District.

Study Participants

Study participants was pregnant and postpartum women who attend at obstetric health units during the data collection period. In terms of eligibility requirements, the sample was taking from pregnant women and postpartum who were available during data collection, were not in labour, were fully conscious, and were mentally competent.

Study Population

The overall population of this study was composed of all pregnant and postpartum women who attended the selected obstetric health centers in Burao District during data collection.

Sample Size Determination

During data collection, 162 women, composed of pregnant and postpartum women, who visited the study area were interviewed. Since the size of target population was less than 10,000, we employed a reduction formula to enroll the study participants. Although our target sample size was 384; we decided to take 162 samples due to financial and time constraints. The final sample size was drawn proportionately from each health center, and the participants were selected by using convenient sampling method. We assumed that the preferred health centers were sufficient to represent the community in Burao city and its surroundings. The formula below was used to determine the sample size (Fisher et al., 1991; cited in Kothari, 2004). Thus, the sample size was be calculated as following:

FOR 1

n: The desired sample size.

z: The standard normal deviation, which corresponds to the 95% confidence level (1.96).

p: The proportion of the target population estimated to have the particular characteristic being studied. In this study, p will be the proportion of pregnant women who will attend Burao General Hospital, which will be estimated at 50%. Hence, P will be 0.5. Since we did not have any related studies carried out in the country as well as in neighboring countries, we assume that the proportion of pregnant mothers’ knowledge, attitude and perception is all about 50 percent.

q=1-0.5 p

d=degree of accuracy desired, usually set at 0.05

1.962 x 0.5 x 0.5=3.8416*0.5*0.5=0.9604/0.0025=384. Hence, the sample size will be 384.

Sampling Procedures

A convenience sampling method was used to recruit study participants, including those available during data collection. Additionally, purposive sampling was employed to select the study area, which included four major maternity health centers: Burao General Hospital, Central MCH, Sheikh Khalifa Hospital, and Daaru-Hanaan Hospital. These centers, comprising three public institutions and one private hospital, are among the most frequented in the district and serve a diverse range of clients. This selection allowed for a comprehensive assessment of opinions from individuals with varied backgrounds.

Study variables

Dependent Variables

  • Knowledge
  • Attitude
  • Perception

Independent Variable

  • Socio-demographic Factors
  • Obstetric history of mothers

Inclusion and Exclusion criteria

Inclusion Criteria

All pregnant and postpartum women who attending at Obstetric health centers who were not in labour, were fully conscious, mentally competent, and available during data collection were enrolled in the study.

Exclusion Criteria

All pregnant and postpartum women attending at antenatal care who are unconscious, in labour, or mentally incapacitated at the time of data collection.

Data Collection Methods and Procedures

The researchers distributed a questionnaire, translated into Somali, to collect primary data on the levels of knowledge, attitudes, and perceptions regarding caesarean sections among pregnant women. To ensure data accuracy and completeness, each questionnaire was meticulously reviewed daily by the researchers to confirm that it was fully completed.

Data Collection Tools/Instruments

The data-gathering instrument for this study was a standardized questionnaire comprising three sections. The first part included two sections: Section One collected socio-demographic data, while Section Two gathered information on obstetric history. The second part contained six binary questions (yes/no) assessing knowledge about caesarean sections, with a maximum score of 6 and a minimum of 0 (one point per correct answer). The third part included 16 questions on attitudes and 9 questions on perceptions of caesarean sections, rated on a Likert scale from 1 (Strongly Disagree) to 5 (Strongly Agree), with a maximum score of 60 and a minimum of 12. This questionnaire was selected for its simplicity in administration, enabling the collection of extensive data from a broad sample efficiently and cost-effectively.

Analysis and Presentation of Results

The collected data were entered into Epi-Data 3.1 for initial handling and then imported into Stata software package version 20 for further analysis. Data cleaning, coding, and analysis were performed using Stata. To evaluate the knowledge, attitudes, and perceptions (KAP) of pregnant and postpartum women regarding caesarean sections, both bivariate and multivariable logistic regression models were employed. The KAP outcomes were analyzed with socio- demographic variables to determine associations. The degree of association between the dependent (KAP) and independent (socio- demographic) variables was represented using crude odds ratios (COR) and adjusted odds ratios (AOR), with 95% confidence intervals (CI). Statistical significance was defined as a p-value of 0.05 or less. Summary statistics were computed, and the results were presented through tables and graphs.

Ethical Considerations

Before participating, all individuals were asked to provide informed consent, with a clear explanation that participation was optional and that the collected information would be used solely for research purposes and kept anonymous. Throughout the study, respondents were treated with transparency and integrity regarding the study objectives, procedures, potential outcomes, and any associated demands or discomforts. Approval was obtained from the University of Burao’s Research Ethics Committee. Participant information was handled confidentially, and no monetary incentives were offered to avoid bias in responses. Participation was entirely voluntary, with no coercion or undue influence exerted to encourage involvement.

Results

Socio-demographic Characteristics Among Pregnant Women in Burao Health Centers, n=162

In a study of 162 respondents, the majority were women aged 22-28 (39.51%), followed by those aged 15-21 (23.46%). Education levels varied, with 33.33% of the women being illiterate while 33.96% of their husbands had basic schooling; however, 8.64% of the women and 23.27% of their husbands had attained university education. A significant portion of the women (82.72%) were housewives, whereas 17.28% were employed. Family sizes tended to be large, with 42.21% having 5-7 members and 24.03% having 7 or more. In terms of income, 27.81% of families earned $350 or more per month, while 22.52% earned between $50-150 per month. Nearly all participants (97.53%) were married, and a majority (83.33%) were urban residents, with the remaining 16.67% living in rural areas (Table 1 and Figure 1). (Insert Figure 1after Table 1)

Table 1: Socio-demographic characteristics among pregnant women in Burao Health centers, 2023 n=162.

Variable

Frequency

Percentage

Age

15-21

38

23.46

22-28

64

39.51

>28

60

37.04

Marital Status

Divorced

4

2.47

Married

158

97.53

Mother education level

Illiterate

54

33.33

Primary school

52

32.10

Secondary

42

25.93

University

14

8.64

Husband education level

Illiterate

42

26.42

Primary school

54

33.96

Secondary

26

16.35

University

37

23.27

Occupation Status

Unemployed (household)

134

82.72

Employee

28

17.28

Family members

2-4

52

33.77

5-7

65

42.21

>7

37

24.03

Monthly income

50-150

34

22.52

151-250

37

23.50

251-350

38

25.17

>350

42

27.81

Place of residency

Urban

135

83.33

Rural

27

16.67

FIG 1

Figure 1: Bar charts, overall knowledge

Obstetric History of Mothers Among Pregnant Women in Burao Health Centers, n=162

In the study of 162 women, obstetric history revealed that most women (40.25%) married between the ages of 19 and 23, closely followed by those who married between 14 and 18 years old (39.62%). The majority of participants experienced two to three instances of gravidity (45.68%) and parity (45.06%). Regarding abortion, 28.40% of women had one abortion, and 6.79% had two or more. Concerning delivery methods, 74.19% of women had a vaginal delivery for their first birth, while 25.81% underwent a caesarean section (CS). For their most recent delivery, 70.00% delivered vaginally, whereas 30.00% delivered via CS (Table 2).

Table 2: Obstetric history of mothers among pregnant women in Burao Health centers, n=162.

Variable

Frequency

Percentage

Age of your first marriage

14-18

63

39.62

19-23

64

40.25

>23

32

20.13

Gravidity

Once

31

19.14

Two-three times

74

45.68

Four times and more

57

35.19

Parity

Zero

14

8.64

Once

24

14.81

Two-three times

73

45.06

Four times and more

51

31.48

Abortion

Zero

105

64.81

Once

46

28.40

More than once

11

6.79

Age of your first delivery

15-19

54

37.76

20-24

57

39.86

>24

32

22.38

Method of your first delivery

Vaginal delivery

115

74.19

Cesarean delivery

40

25.81

Method of last delivery

Vaginal delivery

98

70.00

Cesarean delivery

42

30.00

Knowledge of Mothers Towards CS Among Pregnant Women in Burao Health Centers, 2023 n=162

In the study of 162 women, 64% demonstrated good knowledge about caesarean sections (CS), while 35% had poor knowledge. All participants had heard of CS, and 66.05% had undergone the procedure. When asked about past surgeries, 33.95% reported having been operated on, with 54.55% having had CS once and 45.45% undergoing the procedure twice or more. Among those who had CS, 94.55% were for medical reasons, and 5.45% were elective. Consent for surgery was primarily given by husbands (80%) and relatives (20%). A significant majority (77.78%) believed that a woman could have a vaginal birth following a CS. Additionally, 72.84% thought that blood transfusions might be necessary before or after CS. Universally, all respondents believed that CS could save the lives of newborns, and nearly all (98.77%) agreed it could save the lives of mothers (Table 3).

Table 3: Knowledge of mothers towards CS among pregnant women in Burao health centers, 2023 n=162.

Variable

Frequency

Percentage

Have you ever heard about CS?

Yes

162

100.00

No

0.00

0.00

If yes, have you ever been operated on?

Yes

55

33.95

No

107

66.05

How many times have you been operated on?

Once

30

54.55

Twice and more

25

45.45

What were the reasons for your operation?

Medical indication

52

94.55

Non-medical indication

3

5.45

If it is non-medical indication, what enforced you to undergo CS?

My own choice

3

100.00

Were you asked to sign an informed consent before a CS?

Yes

55

100.00

If yes, who signed the consent form?

Your husband

44

80.00

Other relatives

11

20.00

Can a women achieve vaginal delivery after CS?

Yes

126

77.78

No

36

22.22

Does blood transfusion become essential for CS after and before the procedure?

Yes

118

72.84

No

44

27.16

Dose Cesarean section save the life of newborn?

Yes

162

100.00

Does CS safe the life of mothers?

Yes

160

98.77

No

2

1.23

Women’s Overall knowledge towards CS

Bad knowledge

57

35.19

Good knowledge

105

64.81

Attitude of Mothers Towards CS Among Pregnant Women in Burao Health Centers, 2023 n=162

In the study examining women’s attitudes toward caesarean sections (CS), 51% had a positive attitude, while 48% had a negative attitude. A significant portion of participants (46.30%) strongly agreed they would be prepared to undergo CS if medically indicated, whereas 4.32% strongly disagreed. Nearly half of the women (45.06%) strongly disagreed with the notion that CS is a woman’s right to choose without medical indication. The majority (59.88%) strongly agreed that CS should only be allowed when vaginal delivery is impossible, while 8.02% strongly disagreed. Additionally, 12.35% of women agreed that physicians influence their decision to undergo CS, with 4.94% strongly (Table 4 and Figure 2). (Insert Table 4 after figure 2)

FIG 2

Figure 2: Bar charts, Over all Attitude

Table 4: Attitude of mothers towards CS among pregnant women in Burao health centers, 2023 n=162.

tab 4(1)

tab 4(2)

Perception of Mothers Towards CS Among Pregnant Women in Burao Health Centers, 2023 n=162

In the study regarding women’s perceptions of caesarean sections (CS), 55.56% had a good perception, while 44.44% had a bad perception. When asked if their husbands preferred CS for greater sexual satisfaction, a majority (53.09%) strongly disagreed, while 3.70% strongly agreed. Additionally, when asked if they were concerned about decreased sexual satisfaction after vaginal delivery, the majority (56.79%) strongly disagreed, and only 1.85% strongly agreed (Figure 3 and Table 5). (Insert Table 5 after figure 3)

FIG 3

Figure 3: Bar charts, overall perception of respondents

Table 5: Perception of mothers towards CS among pregnant women in Burao health centers, 2023 n=162.

tab 5(1)

tab 5(2)

Association between Independents and Knowledge for Bivariate and Multiple Logistic Regression Analysis

Initial crude analysis indicated significant associations between variables such as family size, monthly income, method of first delivery and method of last delivery with respondents’ knowledge about caesarean sections. However, after conducting multivariate (adjusted) analysis, these associations were no longer significant, leading to the conclusion that there is no substantial relationship between these variables and maternal knowledge. In contrast, both multivariate and bivariate analyses revealed that the mode of first and last delivery was significantly associated with knowledge. Specifically, participants who had undergone first and last caesarean delivery were found to have 4.5 and 6.32 times greater knowledge compared to those who had a vaginal delivery respectively (Table 6).

Table 6: Association between independents and knowledge for bivariate and multiple logistic regression analysis, n=162.

Knowledge status

Odds ratio 95% CI
Covariates Poor knowledge Good knowledge Crude

Adjusted

Family members
2-4

25 (44.64)

27 (27.55) Ref Ref

5-7

16 (28.57) 49 (50.00) 2.84 (1.3-6.2)*

2.12 (0.74.6.02)

>7

15 (26.79)

22 (22.45)

1.36 (0.58-3.2)

Monthly income
50-150

15 (27.78)

19 (19.59) Ref

151-250

11 (20.37) 26 (26.80) 1.9 (0.7-4.10)

1.9 (0.57-6.30)

251-350

7 (12.96)

31 (31.96) 3.45 (1.2-10.1)* 2.99 (0.83-10.7)

>350

21 (38.89) 21 (21.65) 0.8 (0.3-1.10)*

0.71 (0.22-2.9)

Method of your first delivery
Vaginal delivery

48 (92.31)

67 (65.05) Ref Ref

Caesarean delivery

4 (7.69) 103 (100.00) 6.4 (2.2-19.3)*

4.5 (3.8-9.3)*

Method of last delivery
Vaginal delivery

45 (95.74)

53 (56.99) REF Ref

Caesarean delivery

2 (4.26) 40 (43.01) 16.9 (3.9-74.1)*

6.32 (1.23-32.4)*

Note: Reminded the significance of the variable (P value<0.05).

The Association between Independents and Attitude for Bivariate and Multiple Logistic Regression Analysis

Crude and multiple analyses reveal significant associations between monthly income and the method of last delivery with respondents’ attitudes toward cesarean sections. Initially, one income categories—$151-$250 and $251-$350—showed significant associations with attitude in the crude analysis. However, after adjusting for multiple variables, only the $251-$350 income category retained its significance, while the $151-$250 category did not. Additionally, participants who had undergone a cesarean delivery exhibited 2.4 times more positive attitudes compared to those who had a vaginal delivery. Similarly, individuals in the $251-$350 income category displayed 3.36 times more positive attitudes than those in the $50-$150 income category, indicating that both higher income levels and cesarean delivery experience contribute to more favorable attitudes towards cesarean sections(Table 7).

Table 7: This shows association between independents and attitude for bivariate and multiple logistic regression analysis.

tab 7(1)

tab 7(2)

Note: Reminded the significance of the variable (P value<0.05).

The Association between Independents and Perception for Bivariate and Multiple Logistic Regression Analysis

After both crude and multiple analyses, only the level of education—specifically, having a university education—remained significantly associated with perception toward caesarean sections. Participants with a university education were found to have 99.76% less likelihood of holding a negative bad perception compared to those who were illiterate. This indicates that higher educational attainment is strongly linked to good perception towards caesarean sections, underscoring the impact of education on shaping perceptions in this context (Table 8).

Table 8: The association between independents and perception for bivariate and multiple logistic regression analysis.

Perception status

Odds ratio 95% CI
Covariates Bad perception Good perception Crude Odds ratio

Adjusted Odds ratio

Mother education level
Illiterate

20 (27.78)

34 (37.78) Ref Ref

Primary school

24 (33.33) 28 (31.11) 0.69 (0.315-1.49)

0.70 (0.29-1.73)

Secondary

17 (23.61)

25 (27.78) 0.87 (0.32-1.10) 1.02 (0.38-2.73)

University

11 (15.28) 3 (3.33) 0.16 (0.03-0.64)*

0.0024 (0.053-0.91)*

Occupation Status
Household

54 (75.00)

80 (88.89) Ref Ref

Employee

18 (25.00) 10 (11.11) 0.380 (0.16-0.87)*

0.54 (0.21-1.40)

Monthly income
50-150

14 ( (20.29)

20 (24.39) Ref Ref

151-250

14 (20.29) 23 (28.05) 1.15 (0.44-2.99)

1.22 (0.44-3.10)

251-350

18 (26.09)

20 (24.39) 0.78 (0.30-0.99)* 1.04 (0.35-3.10)

>350

23 (33.33) 19 (23.17) 0.58 (0.233-1.44)

0.82 (0.28-2.34

Discussion

The present study aimed to evaluate the knowledge, attitudes, and perceptions of women regarding caesarean section (CS and its associated factors among pregnant and postpartum women attending maternal health units in burao district, somaliland. Our findings indicate a high level of awareness and varied attitudes towards caesarean section among the participants.

The majority of women in our study (64.81%) demonstrated good knowledge about caesarean sections. This contrasts with findings from a study conducted in Berbera, where 38% of pregnant women had never heard of caesarean section. Our results align with another study in Nigeria, which reported that 82.3% of women were aware of caesarean section. Notably, our study found that all participants (100%) were aware that caesarean section can save neonatal lives, which is consistent with findings from Zayed study in Saudi Arabia [18-20], where 94.2% of mothers recognized the life-saving potential of caesarean section. Furthermore, a substantial proportion of our participants (77.78%) were aware that vaginal delivery is possible after a caesarean section, which is similar to the 94.4% awareness reported in Nigeria [14] Additionally, 72.84% of participants understood the need for blood before and after the operation, echoing the 86.4% awareness reported by [11].

Regarding attitudes, our study found that 51% of women held a positive attitude towards caesarean section, while 48% had a negative attitude. The majority of women (46.30%) expressed a willingness to undergo a caesarean section if medically indicated, whereas only 4.32% strongly disagreed with this. Interestingly, 75% of women strongly disagreed with the notion that caesarean section is a woman’s right and can be chosen at any time without medical indication. Most participants (59.88%) agreed that caesarean section should only be performed when vaginal delivery is not possible, while 8.02% disagreed. These findings are consistent with a qualitative study from Sweden, which highlighted concerns among Somali women about caesarean section, including fears related to female genital mutilation and perceived stigma from healthcare professionals [21].

In terms of perceptions, our study revealed that 55.56% of women had a good perception of caesarean section, while 44.44% held a bad perception. This contrasts with Waniala’s study, where women favouring vaginal delivery perceived caesarean section as dangerous, whereas those favouring caesarean section perceived it as safer than vaginal delivery. This discrepancy highlights the diverse views on caesarean section and underscores the need for tailored educational interventions to address specific concerns and misconceptions [22].

Conclusion

This study indicates that pregnant and postpartum women generally possess good knowledge (64.81%), a positive attitude (51.85%), and a favorable perception (55.56%) towards caesarean delivery. Despite this positive outlook, the observed rates of caesarean sections are notably high, with 25.81% of first deliveries and 30.0% of recent deliveries conducted via caesarean section. Additionally, elective caesarean sections account for 5.45% of all cases. This disproportionately high rate of caesarean deliveries may be influenced by factors related to healthcare professionals’ practices and decision- making processes. These findings suggest that while women are well- informed and generally positive about caesarean sections, the high incidence of such procedures indicates a need to examine the clinical practices and guidelines followed by healthcare providers.

Recommendations

Based on the research findings, it is recommended that maternal health programs prioritize education and awareness campaigns tailored to different delivery experiences. Efforts should be made to provide comprehensive information about caesarean sections to expectant mothers, especially those with varied personal delivery experiences. Additionally, targeted interventions should address socio-economic disparities, ensuring that all mothers, regardless of income level, have access to accurate information and support regarding delivery options. Furthermore, educational initiatives should be strengthened to enhance mothers’ understanding of caesarean sections, as higher education levels were associated with more informed and favorable perceptions. By addressing these factors, maternal health programs can better support informed decision-making and positive attitudes towards cesarean sections.

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  5. Yaqoub RM, Khouj MA, Alsaif AA, Eissa GA, Alhemdi JA, et (2022) Awareness and Knowledge of Caesarean Section Complications Among Women in Jeddah, Saudi Arabia. Cureus 14(12). [crossref]
  6. Ishaq, R, Baloch NS, Iqbal, Q, Saleem, F, Hassali MA, et al. (2017) Frequency and evaluation of the perceptions towards caesarean section among pregnant women attending public hospitals in Pakistan and the implications. Hosp Practice 45(3) [crossref]
  7. Anaman-Torgbor JA, Konlan KD, Owusu, E, Gbagbo B (2022) Factors influencing preference of birth method among pregnant women: a descriptive cross- sectional study in a tertiary health facility in Journal of Global Health Science 4(1)
  8. Hussein AI, Kurtay, S, Omar AA, Yusuf AA, Mohamud, RYH (2023) An Analysis of the Rate, Indications, and Associated Maternal Mortality for Cesarean Sections at a Tertiary Care Hospital, First Report from Somalia. International Journal of Women’s Health 15 [crossref]
  9. The Somali Health and Democratic survey in 2020.
  10. Oinam J, Shantibala K, Singh YN (2016) Women’s knowledge and attitude towards caesarean section in Imphal west district, Manipur. The Journal of Community Health Management 2013(4).
  11. Ashimi AO, Amole TG, Aliyu, LD (2013) Knowledge and attitude of pregnant women to caesarean section in a semi-urban community in northwest Journal of the West African College of Surgeons 3(2) [crossref]
  12. Kasasbeh AA (2023) Applying Artificial Intelligence and Machine Learning to Improve Healthcare Outcomes in Marginalized Patient State University of New York at Binghamton.
  13. Waniala, I, Nakiseka, S, Nambi, W, Naminya, I, Osuban Ajeni,et (2020) Prevalence, indications, and community perceptions of caesarean section delivery in Ngora District, Eastern Uganda: mixed method study. Obstet Gynocol Int V(2020). [crossref]
  14. Aziken M, Omo-Aghoja L, Okonofua F (2007)Perceptions and attitudes of pregnant women towards caesarean section in urban Acta obstet gyneco Scand 86(1). [crossref]
  15. Al-Matarneh BM, Al-khawaldeh OA, Alsaraireh AM (2023) Knowledge, attitudes and practices regarding obstetric danger signs among Jordanian pregnant women attending antenatal clinic in Jordan. Central European Journal of Nursing and Midwifery 14(2).
  16. Sorrentino, F, Greco, F, Palieri, T, Vasciaveo, L, Stabile, G, Carlucci, S, Nappi L (2022) Caesarean section on maternal request-ethical and juridic issues: A Narrative Review. Medicina, 58(9) [crossref]
  17. Koc I (2003) Increased cesarean section rates in Turkey. The European Journal of Contraception & Reproductive Health Care, 8(1).
  18. Mentor S, Johansson A, Mentor S, Suleiman B (2018) knowledge attitude and perception of somali pregnant women towards c-section delivery in berbera town, somaliland facility based study. Available from: https://www.umu.se/globalassets/ organisation/fakulteter/medfak/institutionen-for-epidemiologi-och-global-halsa/ somalia/bashir-dirie-jama.pdf
  19. Ezeonu PO, Ekwedigwe KC, Isikhuemen ME, Eliboh MO, Onoh RC, et al. (2017) Perception of caesarean section among pregnant women in a rural missionary Advances in Reproductive Sciences 5(3).
  20. Zayed MI, El Kelany OA, Alkalash SH (2021) Cesarean sections rate and maternal knowledge and attitude towards the mode of delivery in Egypt. Menoufia Medical Journal 4(2).
  21. Wallmo, S, Allgurin, K, Berterö C (2020) The lived experience among Somali women of giving birth in Sweden: an interpretive phenomenological BMC pregnancy and childbirth, 20(V).
  22. Waniala, I, Nakiseka, S, Nambi, W, Naminya, I, Osuban Ajeni, M, et al. (2020) Prevalence, indications, and community perceptions of caesarean section delivery in Ngora District, Eastern Uganda: mixed method study. Obstet and Gynacol Int V(2020) [crossref]

Different Scripts, Different Casts: A Crime Script Analysis Indicating Intimate Partner Violence is Not All the Same

DOI: 10.31038/AWHC.2024731

 

The endemic nature of intimate partner violence continues to pose a significant challenge to government policy makers and those on the frontline charged with responding to calls for help. Whilst not a panacea, innovative approaches may help reduce the burden of intimate partner violence. The study by Christine Carney, Mark Kebbell, Li Eriksson and Regan Carr, titled “Different Scripts, Different Casts: A Crime Script Analysis Indicating Intimate Partner Violence is not all the Same,” used a novel approach to understanding intimate partner violence reported to police [1].

Theoretical Framework

Crime script analysis tells the story of how a crime is committed from the initial decision of the offender to act through to exiting the scene of the crime and disposing of the evidence [2] Differing levels of analysis can be used ranging from the generic to the specific (Table 1).

Crime script analysis has been used to understand violent crimes such as sex crimes but the utility of this approach has rarely been used to explore intimate partner violence [3,4].

Table 1: Crime Script Levels of Analysis

tab 1

Methodology and Key Findings

Qualitative thematic analysis of police administrative data was used to develop a Protoscript of intimate partner violence. This Protoscript identified commonality across offender criminal histories and recent situational factors identified in the extant literature as precursors to high risk and/or lethality . These factors included a history of violence, recent substance use, recent or pending separation and ongoing relationship issues. The location of contact between offender–victim, precursors to escalation (such as an escalating argument and accusations of infidelity immediately prior to violence), followed by the actions of the offender and victim were also captured (Figure 1) [5,6].

fig 1

Figure 1: Intimate Partner Violence Protoscript

Cluster analysis was then used to identify distinct script tracks from the data, with Bonferroni’s Post-Hoc Test to determine statistically significant differences between the clusters. The analysis identified four distinct script tracks of intimate partner violence, ‘Escalating Jealousy’, ‘Persistently Possessive’, ‘Controlling Victim Agency’, and ‘Enduring Argument’ (Table 2).

Table 2: Cluster Analysis – Script Tracks

tab 2(1)

tab 2(2)

Note. Each superscript letter (e.g., a) indicates a subset of group categories (i.e., clusters) whose proportions do not differ from one another at the .05 significance level. Percentages that are not statistically different share superscript letters, while percentages that are statistically different do not share superscript letters.

Conclusion and Policy Implications

The clusters identified in this study found that half of all intimate partner violence incidents were associated with ongoing or escalating arguments as opposed to jealous or controlling behaviors – an important distinction given prior research has shown that jealousy and controlling behaviors are high risk factors for future harm and lethality. This suggests that of all incidents attended by police, it is likely that 50% of incidents involve potentially high risk factors that must be identified and effectively addressed. For incidents such as those within the persistently possessive cluster, where several high risk factors including history of control, jealousy, separation, and ongoing jealous, controlling, and stalking behaviors are evident, more punitive responses may be required. The remainder of incidents that do not display controlling behaviors may require a different response, such as support to referral services, anger management, financial support or other more generalist support options [7].

Understanding diversity within intimate partner violence may support policy and procedural changes designed to better identify specific behaviors evident within incidents that police attend. It could also provide guidance on the most appropriate action to take at the scene and following an intimate partner violence incident.

References

  1. Carney, CT, Kebbell, MR, Eriksson, L, Carr RM (2023) Different Scripts, Different Casts: A Crime Script Analysis Indicating Intimate Partner Violence Is Not All the Same. Violence Against Women, 30(9).
  2. Cornish D (1994a) Crimes as scripts. proceedings of the International Seminar on Environmental Criminology and crime analysis, University of Miami Coral Gables, Florida.
  3. Beauregard, E, Rossmo, DK, Proulx J (2007) A Descriptive Model of the Hunting Process of Serial Sex Offenders: A Rational Choice Perspective. Journal of Family Violence, Benoit Leclerc, S. a. R. W (2014) Interpersonal scripts and victim reaction in child sexual abuse.
  4. A quantitative analysis of the offender–victim In R. Wortley, B. Leclerc (Eds.), Cognition and Crime: Offender decision making and script analyses. Routledge.
  5. Boxall, H, Boyd, C, Dowling, C, Morgan A (2018) Understanding domestic violence incidents using crime script analysis. Trends and Issues in Crime and Criminal Justice, Available from: https://www.aic.gov.au/sites/default/files/2020-05/ pdf
  6. Stark E (2007) Coercive control: How men entrap women in personal life. Oxford University Press.
  7. Johnson, H, Eriksson, L, Mazerolle, P, Wortley R (2019) Intimate Femicide: The Role of Coercive Feminist Criminology, 14(1),Availabel From: https://doi. org/10.1177/1557085117701574
  8. Ibid, Myhill, A, Hohl K (2019) The “Golden Thread”: Coercive Control and Risk Assessment for Domestic Violence. Journal of interpersonal violence, 34(21-22) Available From: https://doi.org/10.1177/0886260516675464

Earth Birthing Geoscapes: Southern Paiute Ceremonies and Grand Canyon Volcanos

DOI: 10.31038/GEMS.2024644

Abstract

The Grand Canyon of the Colorado River is the traditional homeland of many Native American peoples, including the Southern Paiutes, Hualapai, Havasupai, Zuni Pueblo, Hopi Pueblo, and Navajo. Many massive volcanoes with widespread lava flows have been witnessed by these Native Americans over the past 40,000 years, so their various cultural understandings and ceremonial responses to volcanism are grounded in experience. Pilgrimage is one example of a persistent ceremonial response to volcanic areas by Native American peoples. This analysis is based on 902 ethnographic interviews with Paiute elders conducted over decades by the authors. The Paiute response to volcanism is typical of Native Americans in the Southwestern United States but manifests itself uniquely in the geology of the Grand Canyon and the Colorado River. The analysis argues that these are heritage places and landscapes to be protected by the IUCN World Conservation Congress (IUCN 2024) which is where the world comes together to set priorities and drive conservation and sustainable development action. More than 9,000 people participated in the 2021 Congress in Marseille. Experts shared the latest science and best practice, and IUCN Members voted on 39 motions to guide humanity’s relationship with our planet for the decades ahead.

Keywords

Volcanic cultural heritages, Geosites, Geoscapes, Geoheritage, Native Americans, Southern Paiutes aboriginal lands, Grand Canyon, Colorado river

Introduction

Piapaxa ‘uipi: The river there is like our veins. Some are like the small streams and tributaries that run into the river there. So the same things; it’s like blood- -it’s the veins of the world… This story has been carried down from generation to generation. It’s been given to them by the old people… it would be given to the new generation, too… (San Juan Southern Paiute elder, (interviewed about the Colorado River at Willow Springs, September 27, 1993).

The analysis contributes to the burgeoning academic literature that has responded to the United Nations’ call for the identification of geological places and landscapes as cultural heritage deserving preservation [1]. The ICUN and the WCPA have a Geoheritage Specialist Group that has documented the need for such new heritage preservation approaches [2]. That literature is illustrated by the 20 published peer reviewed papers in the Special Issue of the journal Land entitled Geoparks, Geotrails, and Geotourism – Linking Geology, Geoheritages, and Geoeducation edited by Brocx and Semenluk (2022) [3]. This Special Issue included studies from Europe, Australia, USA, Latin America, and Asia. Subsequently, published articles on this topic are illustrated by Geoheritage and Cultural Heritage Overview of the Toba Caldera Geosites, North Sumatr, Indonesia [4]. These studies [5] document a range of complexities involved in preserving, interpreting, and managing complex geoheritage. The Geology profession through the International Commission on Geoheritage [6] has responded by identifying significant geosites around the world using both their importance to science and to humans as criteria [6]. This analysis describes a long Native American pilgrimage trail that has been used for tens of thousands of years and located north of the Grand Canyon in Arizona. The analysis is based on 902 ethnographic interviews of which 149 interviews were conducted specifically in the study area. Interviews on this topic were conducted with Southern Paiute elders over decades with the authors. Especially important are two points (1) the pilgrimage trail is responsive to massive volcanic activities that have produced major lava flows, lava dams, and lakes in the Grand Canyon Colorado River Corridor (Figure 1 and 2) the analysis illustrates the need for holistic geoheritage understandings of Native American pilgrimage routes including the spaces between places, the presence of functionally integrated geosites along the routes, and multipurpose ceremonial destinations.

fig 1

Figure 1: The Colorado River’s flow through the Grand Canyon

fig 2

Figure 2: The Uinkaret Volcanic Field, the Grand Canyon, and the Colorado River

A Paiute described the Colorado River as a living cultural resource as follows:

Piapaxa ‘uipi: The river there is like our veins. Some are like the small streams and tributaries that run into the river there. So the same things; it’s like blood- -it’s the veins of the world… This story has been carried down from generation to generation. It’s been given to them by the old people… it would be given to the new generation, too (Stoffie et al. 1994) [7-8]. The focus of the analysis is the Uinkaret volcano field (the dark areas centered in Figure 2), which is a central component of USA federal lands managed by the following agencies: (1) the Grand Canyon National Park, North Rim Unit (NPS); (2) Grand Canyon – Parashant National Monument, (NPS and Bureau of Land Management); (3) Arizona Strip Bureau of Land Management (BLM); and (4) the Grand Canyon Colorado River Corridor, Bureau of Reclamation (BOR) (Figure 3). The analysis documents challenges associated with accurately knowing about, interpretating, and conducting culturally sensitive management of this and similar spatially long and temporarily deep Native American heritage areas. Management issues are dominated by problems of Environmental Communication especially when this involves Epistemological Divides [9].

fig 3

Figure 3: USA Federal Land Jurisdiction Map

This analysis is situated within the greater Uinkaret volcanic field and its related geosites and geoscopes (Figure 4). Using this geographic focus, this analysis aims to understand and elaborate upon the cultural understandings of the greater Uinkaret geoscape by Southern Paiute people, as well as their deep heritage connections to this aboriginal land. These heritage connections are further situated in time with new, scientifically backed occupation dates for Native People in the Southwestern United States of about 40,000 years Before Present (BP). The temporal frame for this heritage analysis is operationally defined as the late Pleistocene, which occurred between 128,000 BP and 11,700 BP, as well as the Holocene, which has occurred from 11,700 BP through modern times. Scientific studies have placed Native Americans in the region at least by 37,000 BP with the geoarchaeology dates of 23,000 to 21,000 BP at White Sands National Park in New Mexico [10-11] and 38,900 to 36,250 BP at the Harley Rock Shelter on the Rio Puerco, New Mexico [12]. These new geoscience dates indicate that Indigenous Peoples experienced this area as both a massive wetland filled with lakes, rivers, and swamps and then as an arid desert with intermittent streams, sand dunes, small artesian springs, and heritage playas.

fig 4

Figure 4: Geoscape and Southern Paiute Aboriginal Lands North of the Grand Canyon

The data used in this analysis argue that the Uinkaret volcanic study area contains a Native American heritage landscape that is best understood as being composed of geosites and geoscapes, also known as geoheritage [1, 13] as defined by the International Union for the Conservation of Nature [14]. The concept of heritage landscape implies that both natural and cultural components combined over time to produce a phenomenon that is clearly located somewhere and can be considered for identification and protection by contemporary nations and the guidelines of the International Union for the Conservation of Nature [14]. Native people argue that their traditional volcanos, lava flows, hot springs, charismatic viewscapes, the Grand Canyon, and the Colorado River all have been alive since Creation, and they remain so today. Native Americans argue that these geosites and geoscapes are key to their contemporary heritage because these contain the songs, prayers, ceremonies, and memories of ancestors who lived in this area since Creation.

Geoscapes of the Uinkaret Volcanic Field

The geology of the western Grand Canyon (Figure 5) represents what is perhaps the most spectacular three-dimensional display of volcanological processes in the world [15]. The dramatic sight of frozen basaltic lava falls cascading over the Canyon’s inner gorge was first documented during John W. Powell’s initial expedition into the region in 1869 [16]. The Uinkaret volcanic field is a tectonically controlled lava field whose southern reaches meet with both the Colorado River and Grand Canyon. Over the past two million years, lavas have erupted from both fissures and central vents, forming the volcanic field [15]. Mount Trumbull and its associated lava flows and volcanoes are located within the northern portion of the large Uinkaret volcanic field [17-18]. The Uinkaret lava field lies 120 km south of St. George, Utah, and is tectonically defined by two major normal faults — the Hurricane to the west and the Toroweap to the east. At its southern reaches where the Uinkaret volcanic fields borders the northern rim of the Grand Canyon, there are cinder cones that have produced lava flows that have repeatedly cascaded into the canyon, creating temporary lava dams [19]. While most of the volcanic activity in the Uinkaret volcanic field dates to the Pleistocene, some of the volcanic activity has been dated later to the Holocene including about 1000 AD [20].

fig 5

Figure 5: Uinkaret volcanic field where it meets the Grand Canyon and the Colorado River, with pilgrimage trail marked in red.

The latest lava flows that erupted close to the northern edge of the Grand Canyon’s rim flowed down and formed cascades over 900 meters high [15, 21]. In addition to this activity, multiple vents erupted within the canyon itself. The products of this activity effectively dammed the Colorado River a total of 13 times – the remnants of which are still visible along the canyon walls today. The largest of the dams formed a 700-meter-deep lake which extended upriver into present day Utah [21-22, 23].

Paiute Epistemology

The ways in which societies relate to their environments are grounded in their epistemologies. In Southern Paiute society, relationships and deep connections with the environment were formed during Creation. Southern Paiutes maintain that the Creator gave them the responsibility and the rights to manage their environment to promote environmental growth and sustainability. To fulfill these responsibilities endowed upon them since Creation, over tens of thousands of years, they have developed numerous strategies and activities that increase biodiversity and biocomplexity throughout their homeland. The basic tenets of Southern Paiute epistemology have helped forge the relationship they have with their environment. To Southern Paiutes, the universe is alive and everything is interconnected through all types of relations, what anthropologist Roy Rappaport (1999: 263-271; 446) [24] calls “the ultimate sacred postulate.” The universe is alive in the same way that humans are alive, and the universe possesses most of the same anthropomorphic characteristics as well. The universe has discrete physical components such as power and elements. It is a living system. This concept of the living universe is so fundamental that any discussion of Southern Paiute culture cannot occur without it.

As explained by Liljeblad (1986: 643-644) [25], to the Southern Paiutes, power is everywhere and is “a source of individual competence, mental and physical ability, health, and success.” Power is referred to as Puha. This concept is similar to that of many different tribes living throughout the western United States. Other Numic language speaking people, such as the Ute, Western Shoshone, Owens Valley Paiutes, and Northern Paiutes have similar words. In his article, “Basin Religion and Theology: A Comparative Study of Power (Puha),” Miller (1983: 79-89) [26] noted that: Ute- Puwavi, Western Shoshone- Puha and Poha, Northern Paiute- Puha, the Chemehuevi and Southern Paiute- Puhaare the same people with a common language. The term for Puha is the same among all of these cultural groups. Alternate spellings aside, Puha is a fundamental principle of each of their epistemologies as well. The concept of spiritual power is not limited to the Great Basin and Colorado Plateau peoples, however; it is also a core epistemological principle in the cultures of nearby Upland and Colorado River Yuman-speaking peoples such as the Mojave, Hualapai, and Havasupai. According to Numic beliefs, Puha is derived from Creation and permeates the universe, which resembles a spider web. Sometimes it is like a thin scattering, and at other times it occurs where there are clusters of life in definite concentrations with currents. Puha exists throughout the universe, but varies in intensity from person to person, place to place, element to element, and object to object. This is similar to how strength differs among humans. Puha can also vary in what it can be used for, and it determines the tasks certain elements (air, water, rocks, plants, animals) can perform or accomplish. Puha is networked; it connects, disconnects, and reconnects elements in different ways. This occurs because of the will of the elements that have the power. Puha is present in and can move between the three levels of the universe: the upper level— where powerful anthropomorphic beings live, the middle level—where people live now, and the lower level—where extraordinary beings with reptilian or distorted humanoid appearances live [27].

Power is diffused everywhere in continuous flux and flow, which, however, is not haphazard because, as an aspect of memory, power is rational. From all available evidence, the routes of concentrated power within generalized dispersion are web-like, moving both in radial patterns and in recursive concentric ones, out from the center and back again… The web image is reflected in the stories where Coyote assumes the form of a water spider to carry humans to land and Sun takes the form of a spider who is webbing the firmament of the universe… The web of power, however, is not static like that of a spider because the webbing actually consists of the flow of power rather than filaments per se. Rather, the web is pulsating and multidimensional, even having aspects of a spiral, sometimes regular and sometimes erratic, intersection with the radials from the center. This spiral movement is represented most graphically by an in-dwelling soul of a person that can be seen escaping the body at death as a whirlwind. While operating in a dynamic equilibrium within the universe, Puha is also entropic [27-29]. This means that over time, Puha has gradually diminished since Creation in quality, quantity, and availability. The reason for this is that human beings at various times treated it improperly, and failed to uphold their responsibilities in the relationship they have with the interdependent system. Indigenous people believe that a very rapid loss of Puha occurred after the European encroachment. Knowledge concerning how to regulate relationships with powerful elements was lost through the processes of colonization. Despite this, Puha is always retrievable in some form, as long as new guidelines are established for obtaining, maintaining, and respecting it. In Southern Paiute culture, there are rules for handling Puha and powerful objects. These rules function to control the person with the Puha and prevent him or her from misusing it in one of two ways. First, power can only be used at proper times and places and must be used in accordance with standardized procedures, such as preparation and pilgrimage to ceremonial areas. Secondly, people who have obtained and controlled Puha and its knowledge may withhold information on procedures for acquiring and maintaining power from uninitiated persons or persons who are deemed unworthy candidates.

As Stoffie, Zedeño, and Halmo (2001: 65) [27] wrote, “the diversity and unpredictability of power was consistent with an ecosystem that was equally diverse and unpredictable, although often kind and bountiful in the resources provided.” In her ethnography of the Northern Paiute – a tribe that is culturally and linguistically similar to Southern Paiutes – Catherine Fowler (1992: 170-172) [30] described how the people of Fox Peak believe Puha is present in all elements of the Earth:

One of the most basic beliefs that guided the interactions of people with the land and its resources was the concept that the Earth was a living being, just as were the Sun and Moon, the Stars and natural forces such as Water, Wind, and Fire. The life force within all of these, as well as particular geographic features and classes of spirit beings, was power (Puha)… Although power potentially resides anywhere, its association with mountains caves, spirits or other water sources, and the results of past activities by Immortals or humans was particularly apparent.

This discussion of Puha in her ethnography emphasizes that power concentrates in all aspects of the universe and serves as the life force in these elements as well. Fowler also notes that power is attracted to special people who can channel it and use it during prayer and ceremony. For Numic-speaking peoples of the Great Basin and Colorado Plateau, this concept and understanding of Puha frames how they relate to, understand, interact with, and use the lands around them.

Puha and Ceremony

People use Puha in a number of different ceremonies, each of which occurs in a unique place and thus requires people to seek those places out for ceremony. One type of place that people visited for ceremonies was one where they could perform activities that brought individuals, communities, and the world in balance, also known as Round Dances. A suitable place for a ceremonial Round Dance required a large, flat space that had associations with Creation. Round Dance sites are found throughout the Great Basin and the Southwestern United States, and they can be sites that involve human participants or animal participants. The ceremony involved a large number of people, all of whom have traveled some distance away from their home community. One Round Dance site is the Rabbit Circle Dance site in the Spring Mountains [31]. Its name reflects the Southern Paiute belief that the site was used by Rabbit, a Creator being, in the mythic times to balance the world.

Other significant Round Dance places in southern Nevada are Corn Creek, Indian Springs, and Wellington Canyon. Another well documented Round Dance site is found near Kanab, Utah. On January 6, 1872, John Wesley Powell and Fredrick Dellenbaugh saw a Round Dance at this site. Dellenbaugh stated that the entire Kaibab Paiute band was camped together, which at the time would have been approximately 200 people. At the center of the dance circle was a cedar tree with most of its branches removed. All that remained was a tuff at its top. The entire group formed a large circle around the tree and danced and sang. A man who was in charge led the group in song and stood at the center of the dance circle [32]. Round Dances were performed seasonally in order to keep the world in balance. Some Round Dances took place following the harvest of planted crops or the gathering of wild plant resources like pine nuts or agave. There were other types of Round Dances performed on an irregular basis such as the Ghost Dance, when extraordinary forces seemed to place the world more out of balance than normal [33-34]. Some ceremonies, like pilgrimages, were performed by a small number of specialized shamans. These activities required physical and spiritual preparation to handle being isolated from normal daily lives, and for making the long difficult journey to high mountain peaks. Shamans also needed to be prepared to acquire large amounts of power during their ceremonial trek. Southern Paiute shamans went on pilgrimage for two predominant reasons—rites of passage activities for young males, and for obtaining knowledge and power to be used in doctoring and balancing ceremonies. The knowledge and power they gained during these ceremonies aided their communities, districts, and the entire Southern Paiute nation. Puha’gants, or the shamans who journeyed for themselves and their communities, gained the knowledge to conduct rain making ceremonies, heal the sick, and put the world in balance.

Puha and Volcanism

Volcanos have a special place in Southern Paiute epistemology, and Southern Paiute people are strongly culturally attached to volcanic places and events. Volcanic episodes are distinctive moments when Puha moves from lower to higher levels of existence, causing the power to accumulate in these areas [35-41]. Puha moves from the lower portions of the Earth to form hot springs, mountains, volcanic cones, basalt mesas, lava tubes, basalt bombs, and obsidian deposits. Volcanic places and materials play important roles in the formation of special minerals and biotic communities found here. Some resources can be found only where volcanic activity has created power landscapes. Southern Paiute people respect and interact with places of volcanic activity; because these places contain powerful forces and spiritual beings who can help balance human society at local, regional, and world levels. As one Southern Paiute elder said, “Volcanoes are sacred mountains. The old people knew it was alive, like the mother earth is alive. We have a song about the rocks shooting out of a volcano near home,” [42]. Places that contain volcanic activity are considered sacred and powerful. Numic peoples believe that volcanic events are moments when Puha deep inside the Earth is brought to the surface as a way for the land to renew itself or be reborn. Volcanism is also a way for Puha to be distributed across a landscape. Above ground, Puha follows the flow of water and distributes itself across a landscape. This distribution occurs similarly below the surface, where Puha follows the flow of magma rather than that of water. As Puha moves through underground channels, it distributes itself and connects volcanic places over vast distances.

Methods

BARA ethnographers collected cultural interpretations about natural resources, places, and landscapes by using both formal and informal interviewing techniques. These data gathering instruments have been drafted, approved by tribal governments, and applied in nine ethnographic studies of volcanic landscapes. This report is primarily based on such interviews conducted at field sites chosen as part of the six ethnographic research studies that are listed in Table 1, which presents the number of formal and informal interviews. Interviews are defined as a conversation between an ethnographer and a cultural representative during which information specific to the project is shared and recorded. Most interviews were guided by a set of prewritten, culturally sensitive questions, but informal interviews occurred when these types of formal interviews were not possible or appropriate. Informal interviews and discussions can occur for various reasons, with one of the most common reasons being that the ethnographer and the cultural representative are walking to or from a geosite that is being studied. Either the place or the conversation may elicit a response that is relevant to some cultural dimension of the study. In most cases, the information is offered at a time when it is difficult to record, and the ethnographer instead records a personal account of the conversation. Informal interviews are a common and important source of cultural information and have occurred throughout these studies. A number of formal interviews were conducted with survey instruments during six ethnographic studies. The spatial extent of these studies exceeded the narrower focus of this Uinkaret analysis, so of the 902 total interviews, only 149 interviews were conducted in areas specifically considered in this analysis. It is important to note, however, that cultural interpretations from places in the vicinity of the Uinkaret volcanic field were conducted with Southern Paiute tribal representatives, and therefore these other interviews helped to situate the Uinkaret data. Issues such as the purpose of pilgrimage and the cultural reasons for visiting kinds of geosistes were components of all 902 Grand Canyon Colorado River Corridor and Arizona Strip interviews (Table 1).

Table 1: Ethnographic Studies Used in This Analysis from the Grand Canyon Colorado River Corridor and Arizona Strip Studies.

tab 1

Confidence in interview findings, and thus this analysis, increases with the number of interviews that occur at a given place. In general, four interviews with the same form are required at each geosite for a minimal confidence level to be achieved. Four to 11 interviews were conducted at all sites. It is important to note that a few quotes were used in this analysis to represent both the primary and alternative interpretations of geosites. In any ethnographic study, participating tribal governments may request that some other interpretations remain confidential and not be used in technical reports. Such was the case on several occurrences with the studies that make up this report, so the requests of the tribal governments have been respected and these confidential interpretations have not been presented here, nor in past reports pertaining to the same studies. To further preserve the integrity of culturally significant places, the data of geosites is deliberately vague unless they are already marked on public maps. The vague locations are used to protect less well known culturally sensitive resources. Tourism is a critical threat to all geosites involved in the studies. The public copies of the study reports were reviewed by the participating elders and their tribal governments.

The Uinkaret Volcanic Case Study

There are spatially large geoscapes that involve hundreds of geosites that are connected by an extensive network of spiritual and physical trails. The following section is a reconstruction of two ceremonial geoscapes found near Mount Trumbull in the southcentral portion of the Arizona Strip. This analysis is based on geosite and geoscape interpretations made by Southern Paiute elders who participated in ethnographic studies and the interpretations of many others over the last forty years. Some of the geosites have cultural meaning and ceremonial roles in other geoscapes creating what can be best be described as an overlapping mosaic of nested geoscapes. Therefore, it is always important to think of Native American geoscapes and geosites in terms of having multiple cultural meanings for Native Americans with meanings that are both established at the same and different time periods. Mount Trumbull is connected to two local geoscapes. The first focuses on a pilgrimage to Toroweap Overlook (and Vulcan’s Throne) at the North Rim of the Grand Canyon. The second geoscape is a pilgrimage to a ceremonial landscape at Vulcan’s Anvil at the bottom of the Grand Canyon. Both geoscapes involve trails along the pilgrimage which lead to Mount Trumbull, followed by a visitation at Coyote Spring. One landscape, and perhaps both given the spiritual needs of the pilgrims, involves purification, acquiring Puha, and Puha’pah (power water) at Little Spring. These places have been interactive since they fundamentally conclude where past lava flows from the North Rim have filled the Colorado River— from top to bottom forming a massive upstream lake. Evidence of former lava flows exist in abundance at the Vulcan’s Anvil, Vulcan’s Throne, and Lava Falls.

Northern Pilgrimage Trail

This northern portion of the Uinkaret geoscape (also called the Arizona Strip) contains five geosites: (1) Coyote Springs, (2) Paiute Cave, (3) Little Springs Lava Flow and Hot Spring, (4) Nampaweap, and (5) Vulcan Volcano and Toroweap Overlook which are looks on the edge of the North Rim of the Grand Canyon, above Lava Falls (Figure 6). For Southern Paiute people seeking visions, spirit helpers, or medical cures, each of these places has a unique function. In addition, each place is sequentially linked, thus creating a ceremonial pilgrimage landscape that is integrated in terms of time, function, and space. For this geoscape, we consider the hypothesis that Southern Paiutes might not have been the only people using this area. Other Indigenous groups, such as the Hopi, Havasupai, and Hualapai may have also used the Mount Trumbull area for ceremony. As an example, it is well documented that the Hualapai frequently traveled across the Grand Canyon to participate in joint ceremonies with Southern Paiute people [45]. There are a total of twenty-three traditionally used trails across the Colorado River where it passes through the Grand Canyon making access possible [46]. Based in part on his work with Dan Bulletts, Stoffie (1982: 124) [47], wrote that “Trails tied Indian people together affording a regular exchange of goods, services, innovations, news, marriage partners, and occasionally warring parties. It is no wonder, then, that trails and often the people who used them became culturally significant.”

fig 6

Figure 6: Northern Mount Trumbull Geoscape

Paiute Cave

Southern Paiute representatives and UofA ethnographers visited a place located 15 miles north of the Little Springs Lava Flow and Mount Trumbull [42]. This site, known as Paiute Cave (Figure 7), is part of the northern portion of the Uinkaret Lava Field. The cave is found at the base of a large volcanic deposit which is bordered by the eastern edge of the Uinkaret Plateau. Given its geological composition and cultural resources, this cave is linked to ceremonial activity at the Little Spring Lava Flow and to geosites in the Grand Canyon.

fig 7

Figure 7: Entryway to the Paiute Cave

Paiute Cave is a collapsed volcanic lava tube. The area around and on top of the cave is part of a large pyroclastic deposit. These types of deposits are characterized as being cinder, bomb deposits, and reddish-gray, black, red, and gray tuff. These deposits are found near a pyroclastic cone. This cone is located near one or more vents that overlap the coalescing basalt flows [19]. Paiute Cave is one of these volcanic vents. Volcanic vents allow air to flow from deep inside the air outward which from a Southern Paiute perspective is a testament to the Earth breathing and being an active living entity. Caves in Southern Paiute culture are understood as powerful sacred places. Caves in general are deemed important because they provide shelter and collect water—both vital for all life. Caves also tend to be dark and moist like what Miller (1983) [26] refers to as the initial world. Caves have been described by Southern Paiute religious leaders as being the mouths of mountains [27]. Additionally, Liljeblad (1986) [25] noted that caves were often used during power acquisition ceremonies and that caves served as entrances to underground pathways. Each cave has its own purpose, and thus, no two caves can be considered the same. Caves were used by Puha’gants (medicine men) to gain spirit helpers or knowledge such as songs or prayers. Paiute Cave is unique in that it contains red, yellow, and white painted figures at various locations inside the cave which indicates that the cave was used for ceremonial activity (Figure 8). Tribal representatives maintain that the ceremonial activities conducted at Paiute Cave were linked to the Little Spring Lava Flow and Puha acquisition.

fig 8

Figure 8: Red and Yellow Figure on the Left side of the Cave (L) and Painted Cave Figure on the Back Wall (R).

As one travels south from Paiute Cave towards Mount Trumbull, the valley becomes bounded by high volcanic mountains and lava flows. These types of constrictions are important physical attributes to Southern Paiute pilgrimage trails, because culturally narrow and constricted spaces influence cultural meaning and affect the movement of natural elements like wind and water. Pilgrimage trails pass through these narrow spaces because these are areas where Puha converges and collects in a manner similar to how water will pool in constricted places. As a trail passes through these types of locations, a pilgrim can experience and draw upon the power of the area as he or she progresses on the journey.

Coyote Spring

Ceremonies are conducted at places with high concentrations of puha, too dangerous for non-religious specialists to stay for long periods at ceremonial places. Therefore, people who use a ceremonial area must have had to travel to it from safe home bases. Southern Paiutes would have come from oasis-based agricultural villages located away from ceremonial places elsewhere, like those located north of Mount Trumbull in the Kanab River area, the Virgin River area near present-day Zion National Park, and the Santa Clara River area [48- 50]. People traveling to the Mount Trumbull area traveled major trails, many of which have since been given Anglo names as a result of the frequency with which Euro-Americans traveled these trails during the exploration and expansion periods. These old Indian trails cut across large portions of Arizona, Utah, Colorado, and Nevada. The Mormon Temple Trail, the Honeymoon Trail, and the trail used by Escalante and Dominguez were originally Indian trails. These were the kinds of trails that would have been taken by people en route to the Trumbull area for ceremony in the Coyote Spring located on the southwestern flank of Mount Trumbull. The nearby Uinkaret Pueblo was formed in part from volcanic stones. When people traveled to the Mount Trumbull area for ceremonies, it was not uncommon for their families to come too. The families would have stayed in the Coyote Spring area while the others went on their pilgrimage. It would have been too dangerous for family members to accompany the pilgrims to the ceremonial places. These puha places were only visited by types of people who have certain amounts of puha and had begun a long series of preparations prior to arriving in the Mount Trumbull area. The people who remained at Coyote Spring carried on with daily activities while the pilgrims were away. Depending on the time of year, the families would have gathered different kinds of plants, like three- leaf sumac, cedar, or pine nuts. Family members could also take this opportunity to hunt animals like deer, rabbits, elk, or antelope.

Little Springs Flow and Hot Spring

The pilgrims traveled south to Little Springs Lava Flow and hot spring, which were produced by a recent basaltic lava flow. This analysis is shorted because information regarding this geosite has been published elsewhere [40-42, 51]. Pilgrims would have interacted with the lava flow spring to cleanse and purify themselves for their journey. The hornitos located throughout the lava flow would have been places for sweat lodges and the lava rocks are well suited for holding heat. Indian people have formed miles of trails on top of the lava flow connection places near the Hornitos. Pilgrims prepared for ceremony and travel by singing songs and saying prayers to the lava flow, the surrounding volcanic mountains, the water, the plants, and the animals. They asked for a safe journey to the North Rim of the Grand Canyon where some ceremonies were conducted. Water was taken from the spring and brought with them to Nampaweap where it would have been used in ceremony and left as an offering.

The Lighting Site

The Lighting Site is an enclosed and one roofed structure whose walls are formed of volcanic boulders carried from the Little Spring volcanic flow. Some of the boulders were made by puha’gants at hornitos (Figure 9) on the active lava flow at the time of the eruption [42]. The process of going on to active lava flows and making artifact boulders from splashes of lava at hornitos is documented for Sunset Crater [52]. There the boulders were imprinted with corn whereas at Little Spring the puha’gants placed ceramic pots on the edge of the hornito. These are generally called sherd rocks whereas at Sunset Crater they are called corn rocks. At both locations the artifact rocks were subsequently taken away and made into a structure used for ceremonies. Many Native American cultures had religious specialists who gathered, used, and prayed with volcanic rocks. Round volcanic rocks are often used in the Sweat Lodge fires where they are called Grandfather Rocks. These boulders and the places where they were taken are extremely sacred because they contain pottery sherds deriving from that ceremonial connection of a volcanic source and a human artifact. This site is not further discussed here due to its cultural sensitivity. The site continued to be used for ceremonies long after the eruption and is visited by tribal members today.

fig 9

Figure 9: Hornito at Kilauea Volcano, Hawai’i for a Visual Example (Elson et al. 2002)

Nampaweap

From Little Springs, the pilgrims would travel roughly three miles to Nampaweap; a small basaltic canyon that constricts the trail to the North Rim. The upper portion of the canyon has a series of peckings, a rock shelter, and a spring, and thus it has high concentrations of puha. The pecking were interpreted as associated with Origin Stories given some pecking were only used where such stories were recounted. The Ocean Woman’s Net is in the upper left of the image below (Figure 10). When people came to Nampaweap, they would have first offered the place water brought from Little Springs, and then explained the purpose of their visit and asked for the puha they need to continue to the North Rim.

fig 10

Figure 10: Peckings found at Nampaweap, Ocean Women’s Net Upper Left

According to representatives the small canyon provided a song to be sent to the big canyon and used during the ceremony at that place. Additionally, more water was collected from the spring found above the rock art panels. It would have served both as an offering and for members of the vision quest, support camp at the North Rim.

Toroweep Overlook and Vulcan’s Throne

Following prayers at Nampaweap, people traveled east towards Toroweap Valley and then south towards the North Rim of the Grand Canyon, covering a distance of twelve miles. While traveling, the pilgrims continued to pray and announce to the canyon and the mountains why they were there, and they would ask for permission to enter the area. The people would have been given a sign, like an eagle flying by that would have signaled they had permission to enter the area. Upon reaching the north rim of the Grand Canyon and receiving permission to enter, the vision seekers could go to either one of two locations to obtain their vision — Vulcan’s Throne or Toroweap Overlook. From these locations, there are impressive views of the Grand Canyon and the Colorado River (Figure 11).

fig 11

Figure 11: The Toroweap Overlook View Down into the Colorado River

Vulcan’s Throne is a pure cinder cone volcano located on the North Rim. This volcano erupted on five separate occasions and is recognized as a port of the volcanic system that was responsible for filling the Grand Canyon with lava twelve times during the last 1.2 million years. The lava flows created a series of dams in the Grand Canyon which were responsible for creating a series of lakes in the canyon that extended to the head of today’s Lake Powell. The Vulcan’s Throne flow was approximately eight to ten miles long. The flows from Vulcan’s Throne are some of the oldest and largest in terms of volume in the Grand Canyon (Hamblin 1989: 190-192) [53]. Pilgrims stopping at this volcano would have prayed to explain their purpose. They would bring puha’pah, plants, and stones to this place to leave as an offering. At Toroweap Overlook, people have a clear view of Vulcan’s Anvil and Lava Falls, two important powerful ceremonial features located within the Grand Canyon (see next local landscape description). It is important to note that Toroweap Overlook is the only place where a person can look from the upper rim of the Grand Canyon directly down at the Colorado River. This allows the pilgrim to have a clear view of the powerful places below. The person would be able to talk directly to the Colorado River and draw from its puha. The pilgrim would seek some type of puha from the place, such as a vision, song, or spirit helper. The person could seek more puha to confront new problems facing him or his people. Perhaps the pilgrim would be preparing to go into the canyon for ceremony at Lava Falls.

A small camp would be set up to serve as support for the vision seeker. This location would be near to where the vision seeking would occur but would be sufficiently removed from the location to give the vision seeker privacy. Little is known about vision quest support people except they had two roles: (1) to advise the seeker and help interpret what was happening and (2) to ensure that the vision seeker did not become comatose. The vision was sought over a period of two to three days. When the vision was achieved or at such time that the support person suggested the time to leave had come, they would leave the North Rim area and make their way back to their villages. On the return they would stop at Nampaweap, Little Springs, and Paiute Cave to say exit prayers thanking the spirits for protecting them during their pilgrimage and providing enough puha to withstand the intensity of the vision quest. It was very likely that the returning pilgrims collected puha’pah from Little Springs to bring back to their communities. The puhapah would have been used in curing and blessing ceremonies.

South Pilgrimage Trail: The Grand Canyon Geotrail

The second portion of the pilgrimage trail is the Grand Canyon Geoscape (Figure 12), which connects geosites on the North Rim with a functionally integrated ceremonial area that is centered on Lava Falls and nearby geosites along the Colorado River downriver from Vulcan’s Anvil. Considered in this analysis are (1) Vulcan’s Anvil, (2) Hot Mineral Spring, (3) Yellow Paint Source Wall, (4) Preparation Rock Shelter, and (5) Lava Falls and Water Babies Peckings Cave. This geoscape is especially critical given it is the location of several volcanic flows deriving from the north, south, and from the walls of the Grand Canyon. These often (apparently 13 times) created dams that filled the Grand Canyon, thus causing the Colorado River to become a massive lake. The remains of some lava flows are visible, and Vulcan’s Anvil is a flat-topped volcanic plug in the middle of the Colorado River. Lava Falls was produced by these lava flows, which formed a truly spectacular volcanic geoscape.

fig 12

Figure 12: South Pilgrimage Geoscape with Geosites and Geotrail in the Grand Canyon

Vulcan’s Anvil

The Colorado River, as it passes through the Grand Canyon, is a culturally special landscape comprised of many culturally important and interconnected places. The Grand Canyon has always (since Creation) played a critical role in the lives of Southern Paiutes. The canyon and the Colorado River define the boundary of four Southern Paiute sociopolitical districts – Shivwits/Santa Clara, Uinkaret, Kaibab, and the San Juan. Elders identified a network of more than twenty-three trails that permitted free movement across the Grand Canyon and the Colorado River. These allowed Paiutes to have access to many things within the canyon, such as farming, hunting, trade, and ceremony with the Hopis, Havasupai, and Hualapai. This section focuses on a particular local landscape involving places on the North Rim and a series of locations found within the Grand Canyon. This landscape is associated with Paiute doctoring, ceremony, and acquisition of spirit helpers. This landscape is linked to ceremonies discussed in the previous local landscape. This landscape involves steps in preparation for ceremonies at Vulcan’s Anvil near Lava Falls. Vulcan’s Anvil is a powerful doctoring area, which would require long periods of preparation and ceremony before a person or persons could enter this area. The Vulcan’s Anvil-Lava Falls complex was also known as a powerful doctoring site. A well-known Southern Paiute religious leader was associated with this area. Eventually, he moved across the Colorado River and married two Hualapai women, and because of this, he became one of their primary medicine persons. As such, he became an important figure in Hualapai history and a lesson in the meaning of cultural differences in the Grand Canyon region.

Hot Mineral Spring

Pilgrims swam or floated directly across the river to the southern bank of the river where there was and is a hot mineral spring (Figure 13). The spring water is heavily mineralized and was used for prayers and purification. Water was collected at the spring and brought to a nearby ceremonial rock shelter where the pilgrims would have used it as an offering. The spring was cleaned of natural fibers that were either blown out or produced when the Colorado River flooded. Plants, such as willows, were cut back from the spring so pilgrims could use them without interference.

fig 13

Figure 13: Mineral Springs

Yellow Paint Source Wall

From the spring, pilgrims traveled to a deposit of yellow ochre nodules (Figure 14), which occurs in a vertical gravel wall which is part of the boundary of Prospect Canyon. The yellow ochre deposits in this wall were formed as lava flowed past the wall, which was made of nonvolcanic materials some of which became ochre due to the intense heat and pressure. The Yellow ochre nodules deposit are pure power about the size of a large potato and situated in the wall composed of gravels. The Yellow ochre nodules can be removed easily as a single nodule. When the nodule is broken open it contains almost pure yellow ochre. Yellow ochre, like red ochre, is a powerful element associated with ceremony. The yellow ochre wall is covered in red ochre blessing smudges, which are produced when red paint is dipped with fingers and drawn as lines on the wall.

fig 14

Figure 14: Yellow Paint Ochre

The yellow ochre was used in medicine and ceremony conducted at Vulcan’s Anvil. To be used in ceremony, the pigment had to be mixed with water to make the yellow paint. To collect the pigment, the pilgrims would have left water from the Hot Mineral Spring as an offering as they collected the pigment. Once the pigment was gathered, the pilgrims ventured to a nearby ceremonial rock shelter where both yellow and red paint figures were painted on the rock walls.

Preparation Rock Shelter

At a ceremonial rock shelter (Figure 15), which is located directly above the yellow paint wall, is where the people continued their preparations for ceremonies at Vulcan’s Anvil and elsewhere like the Water Baby Peckings Cave across the river. The rock shelter contains paint figures made in part from the yellow paint nodules found in the nearby Prospect Canyon wall paint deposits. Inside the rock shelter, the pilgrims would have prayed and prepared themselves. They used the water brought in from the mineral spring. After prayers, the pilgrims would have waited for a spiritual signal to proceed with their journey.

fig 15

Figure 15: Yellow Paint Rock Shelter

Some Quotes:

  • It was a place they went to prepare for something to keep spirits away – that is what we do Images are not a ghost, which would be dots – a drowned person, flat and bloated.
  • It is a place where people with supernatural powers came. Women would come here if they needed to be healed by the shaman.
  • It may have been a female site – a woman’s isolated site for the moon.

More than half the representatives specifically discussed a connection between the panels and Vulcan’s Anvil. A majority of the representatives perceived the rock art site to be connected to other sites in the area.

People could have received songs during this period to take with them to Vulcan’s Anvil. According to Southern Paiute epistemology, rock shelters are powerful places that people visit to acquire puha and songs that are remembered from earlier times. Once the pilgrims received puha from the rock shelter, and after the appropriate signal, they could continue to visit and climb atop Vulcan’s Anvil. The pilgrim’s support persons would remain at the river’s bank –perhaps in the rock shelter during the pilgrim’s time on Vulcan’s Anvil.

Lava Falls and Water Baby Peckings and Cave

At a place immediately next to Lava Falls the pilgrims would stop to interact with Water Baby peckings located on large lava boulders at the entrance to a small cave. Water babies arespirit helpers for shamans who bring the rain and they are dangerous and powerful. These peckings were on a large boulder in a small cave splashed by water from the churning rapids. The peckings, boulders, and cave occur where the trail crosses the river. The peckings were interpreted as indicating the presence of water babies (Figure 16 and 17).

fig 16

Figure 16: Lava Falls

fig 17

Figure 17: Lava Falls Rock Shelter With Water Baby Peckings Inside

Some Quotes

  • It was a place where a medicine man or other people came to conduct ceremonies and get their spiritual healing before crossing the river to get the red paint or to visit Vulcan’s Anvil.
  • This is where they came to get their spiritual healing and their being able to go across the river and get the paint that they need to protect themselves from the spirits that are bad.
  • The majority of people interviewed said that Southern Paiutes visited or used the panel in the One said his family had traditionally visited or used the panel and two said that Southern Paiutes currently visit or use the panel.
  • A majority of the representatives said there would be stories or legends associated with the One individual interpreted the panel as reflecting a story or legend about Paiute philosophy.
  • A majority of the representatives said the panels would have been used by other Indian people. The Indian people named include the Havasupai, Hopi, Hualapai, and Navajo.

Pilgrims came to this location to say prayers of introduction and to request protection while crossing the river. It is possible that some spiritual leaders came to this spot to receive a water baby as a spirit helper for making rain [54]. The pilgrims drew upon the Puha from the peckings to continue their journey and in return they left offerings of tobacco and Puha’pah for the water babies represented by the peckings.

Vulcan’s Anvil

In order to reach Vulcan’s Anvil, the pilgrims (including medical patients if doctoring was the purpose of the pilgrimage) would have to swim to the center of the Colorado River where Vulcan’s Anvil occurs as a large volcanic plug or throat. Here Vulcan’s Anvil is surrounded by a calm and very deep portion of the Colorado River created in part with the backwater of materials that constitute Lava Falls. Vulcan’s Anvil is the only rock of its kind along the entire Grand Canyon Corridor. Vulcan’s Anvil can best be described as a power rock in a power place thus making it a very special destination for Puha’gants (medicine men) (Figure 18).

fig 18

Figure 18: Vulcan’s Anvil

When the pilgrim(s) reached Vulcan’s Anvil, they swim from the river’s edge and climb from the water up its vertical slick sides to the wide flat top. On top, a person had a view of the Grand Canyon and the Colorado River up and downstream. Looking up, the pilgrim would view the vertical canyon face containing evidence of a dozen previous volcanic dams and many separate lava flows. Here people could draw from the power of the volcanic rocks, the river, the canyon, and the presence of volcanic plug sitting in the bottom of the river. After a period (up to three days could be needed if medicine healing or if vision quest was involved), the pilgrims would leave the top of Vulcan’s Anvil, swim to the south shore, spend time in the ceremony rock shelter, cleanse themselves in the hot mineral spring, and begin to reverse their journey back to Mount Trumbull. Pilgrims return to the geosites they visited on the path to Vulcan’s Anvil in order to conduct exit prayers and offer expressions of gratitude for safety. Puha’pah was collected by the pilgrims at the base of Lava Falls and the mineral spring to bring back to their villages to be used in curing or other ceremonies. The yellow pigment was carried to be used again in Paiute Cave. There is evidence of the use of this yellow paint at ceremonial sites in Kanab Creek.

Discussion

This is a holistic ethnographic analysis of a long and ancient Native American pilgrimage trail that is situated in a volcanic field composed of cinder cones, lava flows, collapsed lava tubes, and mineral deposits made by lava flows. The area of analysis includes a large volcanic mountain to the north and the Colorado River as it passed through the Grand Canyon. The trail crosses an area of volcanic events where the Grand Canyon was filled with lava thus disrupting the flow of the Colorado River. When these massive dams were formed lakes then extended upriver and along canyons for hundreds of miles. Eventually the dams were eroded away, only to occur again a dozen times. Native people have lived in this area for 40,000 years or more and are documented as actually interacting with lava flows during the past thousand years [51]. In this volcanic landscape or geoscape are unique places or geosites that have special cultural importance to Native American people. Some of these places are culturally organized into the pilgrimage trail or geotrail described and explained in this analysis. The technical prefix – geo – is utilized to describe the trail, places along it, and the broader landscape withing which it occurs. Places along the geotrail are organized and utilized as central component of Native American heritage. The volcanic geology of the area is a primary foundation for Native ceremony. Thus, volcanic events are places critical to Native American heritage [55]. According to Native American Creation accounts volcanos are alive and intended for the benefit of all other (emphasis added) living beings including the wind, rain, animals, plants, and humans. Pilgrims traveled along this trail to perform ceremonies at these locations since Time Immemorial according to Native beliefs. The oldest types of artifacts are regularly found in the area [56,57]. The performance of these ceremonies increases balance between the involved beings, the communities and habitats where they reside, and the Earth itself. For Native Americans, the act of pilgrimage along the geotrail is essential because here they can draw on the most powerful Earth forces and thus can better form relationships between other beings and increase balance in the World [40]. The analysis is intended to explain Native American relationships with what in Western culture and science is call Nature [41]. The reason for participating in the ethnographic studies by tribal governments and their cultural representatives has been and continues to provide an alternative cultural interpretation of the volcanic landscape by which to better inform those people and agencies who manage and use this geoscape. Currently the geoscape is threated by spiritual and physical disruptions deriving from uranium mining, livestock grazing, offroad travel, river raft adventures, and millions of tourist visitors. Native participants in these studies believe (trust) that these actions and their impacts potentially can be mitigated through environmental education using Native American perspectives of the Living Earth. Also essential is Native American ceremonial use of the geotrail, geosites, and geoscape.

Acknowledgment

The authors would like to acknowledge the representatives of the USA federal agencies who are both land managers and funders of these ethnographic studies. For the Arizona Strip we thank the Bureau of Land Management Staff especially Gloria Bulletts-Benson. Tribal government support was provided by the Paiute Indian Tribe of Utah, the Kaibab Band of Paiute Indians, and the San Juan Southern Paiute Tribe. There were six Grand Canyon Colorado River Corridor ethnographic river trips, all of which were supported by the David E. Ruppert for the National Park Service and David Wegner for the Glen Canyon Environmental Studies, the Bureau of Reclamation. Special professional experts included Henry F. Dobyns, Helen C. Fairley, Arthur M Phillips, III, Gilford Harper, Angelita Bulletts and Vivienne C. Jake. Betty Cornelius, Director, Colorado River Indian Tribes supported the participation of the tribal video team. Special thanks to the dozens of tribally appointed cultural representatives who participated. This is their story.

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Interferon Activating Effect of Staphylococcal Enterotoxins

DOI: 10.31038/MIP.2024513

Abstract

The cellular target for staphylococcal enterotoxins is human spleen cells. The effect of enterotoxins is to induce the production of endogenous IF. St. aureus enteropathogenic proteins (enterotoxins) possess an antitumour effect. After intraperitoneal inoculation they decrease the size and, in some cases, prevent the development of the human hypernephroma in the cheek pouch of golden hamsters. The effect of enteropathgenic proteins may possibly consist in inducing the production of endogenous immune interferon which activates the host immune system and enhances the rejection of heterologous tumour cells.

Keywords

Gamma-interferon, Enterotoxins, Antitumour activity

Introduction

Staphylococcal enterotoxins (SE) were first described and designated serotypes A,B,C by Bergdoll [1]. Unlike enterotoxins, which have a subunit structure, the protein of staphylococcal enterotoxins is a single-chain consisting of 22-24 amino acids. The sequence connected by a disulfide bond. Molecular weight of SE proteins no more than 20-25 kD.

Being the main factor of enteropathogenicity, staphylococcal thermostable enteropathogenic proteins also have superantigenic activity and the ability to confuse antibiotic resistance [2]. The St.aureus enteretoxins function is both as potent gastrointestinal toxins as well as superantigens that stimulate non-specific T-cell proliferation. In the enterotoxin molecule, the sites that control the secretion of the main factor of enteropathogenicity and superantigenic activity have different domain localization [2]. The impact of enterotoxins on the immune system is carried out through superantigenic activity, determined by the corresponding domain structure of the molecule.

Staphylococcal enterotoxins possess low antigenic activity and low toxicity in animalexperiments.The exception is type B (SEB), which has high lethal activity [3]. This article presents the results of the immunomodulatory effect of SEA on human splenocytes, the secretion of interferon gamma and the antitumor effect in animals.

Experimental Part

In the experiments, preparations of staphylococcal enterotoxins were used, previously obtained by the ion exchange cellulose method [4].

I. Binding of Staphylococcal Enterotoxin A (SEA) with Human Splenic Lymphocytes, 1983

Summery

  1. In experiments studying binding to human splenocytes, staphylococcal enterotoxin thia A, labeled I125] SEA, was used. A high degree of specific binding of [I I25] SEA to human splenocytes has been established [5].
  2. It has been established that the binding of SEA to the surface of splenocytes at 4 C is characterized by saturation, reversibility and high affinity for the receptor Kd = 4.0 x 10-7 M)
  3. The number of binding sites on a splenocyte cell is 6000,0.
  4. The effect of temperature on the binding of SEA to the surface of the splenocte was studied. It was shown that at 23°C, the binding of the labeled toxin to the cell is described by a two-phase curve.
  5. The conditions under which there is an increase in the connection of SEA with splenocytes and, accordingly, an increase in the level of interferon gamma production, have been determined.

Printing increases the association of SEA with the splenocytes and correspondently increases the production level of gamma-interferon.

II. Nonspecific Antitumour Activity of Staphylococcal enterotoxins, 1987 [6].

It is known that the components of the interferon (IF) antitumour activity include the direct effect on tumour cells and the indirect effect on various body systems [7,8]. It is not entirely clear what is the contribution of each IF effect to the tumour process inhibition. Thus, in thymus-deprived mice, a slowdown in the growth of transplanted human tumours was noted when they were injected with both human and mouse IF [1]. In addition, there are reports of the inhibitory effect of IF on tumour development in vivo with the resistance of tumour cells to IF in vitro [9].

Inductors of IF are also used in the experiment for the tumour treatment [10]. Staphylococcus aureus proteins deserve special attention in this regard – staphylococcal enterotoxins, which are also active immunomodulators [11,12]. Immune IF produced by T-lymphocytes induced by these proteins has a pronounced antiproliferative effect [13]. We studied the effect of St. aureus enterotoxins on the development of human hypernephroma in the cheek pouch of golden hamsters.

Methods

The passaged culture of human hypernephroma was obtained from cells of a similar tumour. The culture has passed more than 200 times; it contains specific markers and has properties inherent to the primary tumour [14]. The culture was passaged on the Eagle medium with lactalbumin hydrolysate (1: 1) and 10% bovine serum. The culture formed a monolayer with growth, the passage index was 1: 3. As an experimental model, 50 golden hamsters weighing 250 g were used supplied by the kennel Stolbovaia of the USSR Academy of Medical Sciences, to which, 4 x 106 cells of human hypernephroma were injected into the cheek pouch under Nembutal anaesthesia.

Human leukocyte IF (HLI) was obtained by the method described by V. D. Soloviov, T. A. Bektemirov [15], human immune IF (HII) – according to the method proposed by L. M. Mentkevich et al. [16]. The potency of HLI and HII was 1,000 U/mL. Enterotoxins A and B of St. aureus were obtained by the method of Ezepchuk et al. [4]. IF and enterotoxins were injected into golden hamsters intramuscularly or into the abdominal cavity in a volume of 1 mL daily, starting from the next day after human hypernephroma cells administration. The size of the tumours was considered 2 weeks after the experiment start. The level of IF in the blood serum of golden hamsters was determined by titration on human embryo fibroblast cultures and the transplanted culture of BHK-21 golden hamster. Titration was carried out by micro method on a monolayer of cells inoculated into 96-well plates. The IF titre was considered as its last dilution protecting cells from the cytopathic effect of 100 doses of the vesicular stomatitis virus. The titre of antibodies to staphylococcal enterotoxin in the blood serum of golden hamsters was determined 3 weeks after the start of experiments by immunoprecipitation.

Results and discussion. A preliminary study of HLI showed that it had absolute species specificity: it showed antiviral effect in the culture of human embryo fibroblasts and had no effect on the culture of BHK-21 golden hamster. The culture of human hypernephroma cells turned out to be weakly sensitive to the antiviral effect of HLI, as well as other transplanted human cultures, and sensitive to its anti-proliferative effect. On this basis, it was concluded that human hypernephroma cells injected into the cheek pouch of golden hamsters should be sensitive to the virus injected into hamsters, and due to its species specificity, it should not affect the host organism.

Human hypernephroma cells were injected into the cheek pouch of 30 golden hamsters. Then, the animals were divided into five groups. Animals of group I, which were not injected with IF, were the control; HLI was injected into the abdominal cavity of group II animals; intramuscularly into group III animals; HII was injected into the abdominal cavity of group IV animals; intramuscularly into group V animals.

In animals of groups II and III, compared with animals of group I, neither the incidence of tumours nor their size decreased (Table 1). The introduction of HII to golden hamsters had a therapeutic effect. So, tumours occurred in 50% of group IV animals compared to 83.3% in the control. The average diameter of tumours in group IV animals was significantly lower than in control animals: 1.0 ± 0.57 and 4.0 ± 0.93 mm, respectively, the difference is significant. In golden hamsters of group V, the incidence of tumours was the same as in the control, and the tumour size was lower (2.0 ± 0.57 mm). However, due to the large spread of figures, these differences turned out to be not significant. So, the HII injected into the abdominal cavity prevented the occurrence, and in case of occurrence, inhibited the development of human hypernephroma in the cheek pouch of golden hamsters.

Table 1: The development of tumours in golden hamsters after the introduction of human hypernephroma cells exposed by HLI and HII.

Introduced IF

Administration method Tumour incidence, %

Tumour diameter, mm(M ± m)

HLI Abdominally

83.3

3.4 ± 1.16

HLI Intramuscularly

83.3

4.6 ± 1.54

HII Abdominally

50.0

1.0 ± 0.57*

HII Intramuscularly

83.3

2.0 ± 0.57

Control

83.3

4.0 ± 0.93

*The difference is significant (Р < 0.05).

One of the differences between the used drugs of IF was that HLI did not contain an active inducer of IF, whereas HII contained staphylococcal enterotoxin A (SEA). We suggested that the therapeutic effect of HII could be associated not only with the administered IF, but also with SEA, which could induce the production of endogenous immune IF in the body of golden hamsters. To test this assumption, intact hamsters were injected with native HII into the abdominal cavity and then blood was sampled over time. The presence of IF in the blood serum of golden hamsters was determined in the monolayer of human fibroblast cells and hamster cells.

HII in the blood was not detected throughout the experiment. Apparently, it was quickly adsorbed by tissues and excreted from the body. IF of hamsters was detected in the blood of animals 15 minutes after administration of the IF drug reaching a maximum after 1 h (64 U/mL) and disappearing after 6 hours from the bloodstream. Therefore, SEA contained in native HII induced the production of endogenous homologous IF in the body of golden hamsters.

Several types of enterotoxins were isolated from St. aureus. Enterotoxins A and B have the same interferon-inducing, but different immunomodulatory property [17].

The objective of this series of experiments was to study the antitumour effect of enterotoxin B (SEB), since it is less toxic than SEA. Otherwise, the experiments were planned similarly to those already described. From the next day after the introduction of human hypernephroma cells, golden hamsters were injected daily into the abdominal cavity with 1 or 0.1 µg of SEB. 2 weeks after the administration of a higher dose of SEB, tumours in the cheek pouch appeared in 16.6% of golden hamsters compared to 85.7% o in the control. The mean diameter of tumours in experimental animals was 0.66 ± 0.67 mm, and in control animals – 3.6 ± 0.61 mm (P< 0.01). When a lower dose of SEB was administered, the number of experimental animals with developed tumours was the same (83.3%) as in the control (85.7%), the average diameter of tumours in experimental animals was slightly lower than in control animals (2.65 ± 0.62 mm), but the difference was not significant (Table 2).

Table 2: The development of tumours in golden hamsters after the introduction of human hypernephroma cells exposed by SEB.

Experiment settings

Drug concentration, µg Tumour incidence, %

Tumour diameter, (M ± m)

Test

0.1

83.3

2.65 ± 0.62

1.0

16.6

0.66 ± 0.67*

Control

85.7

3.6 ± 0.61

*The difference is significant (P < 0.01).

Thus, SEA and SEB slow down and in some cases prevent the development of human hypernephroma in the cheek pouch of golden hamsters. The effect of enterotoxins is to induce the production of endogenous immune IF, which activates the body’s immune system and enhances the effect of heterologous tumour cells rejection noted in the model system used. We cannot exclude the direct stimulating effect of enterotoxins on the immune system of golden hamsters.

St. aureus enterotoxins are proteins with weak antigenic properties. In our experiments, after repeated administration of these proteins, antistaphnococcal antibodies in titres 1: 2-1: 4 were detected in the blood of golden hamsters with implanted human hypernephroma cells. With the same scheme of enterotoxins administration to intact hamsters, the level of antibodies was significantly higher (1: 16). It has been established that even a small amount of anti-staphylococcal antibodies in the blood can serve as an obstacle to the enterotoxin action. In this regard, for further work, it is necessary to obtain fragments of proteins that do not cause the production of antibodies, but have an antitumour effect.

III. Effect of spleen cells sensitized with staphylococcal enterotoxin type A on metastasis of Lewis lung carcinoma in mice [18].

The effect of intact murine splenocyte cells sensitized in vitro with staphylocoeic enterotoxin (SEA) on spria – ding of mouse Levis carcinoma was studied. A significant reduction in the number of lung metastases and lung weight was found after multiple intrapulmonary inoculation of plant cells treated with SEA for 6 hours. The effect was less noticeable after inoculation of sensitized cells intraperitoneally or sensitized intraperitonialy or into the femoral muscle of the leg affected with the tumour.

Discussion and Conclusion

Staphylococcal superantigennenic enteropathogenic proteins, which have weak antigenic activity, exhibit high immunomodulatory properties in animal experiments. It has been shown that the intensity of gamma interferon secretion correlates with the presence of SEA binding compounds on the surface of splenocytes. The antitumor effect is apparently due to the effect of immune interferon on oncogenic cells.

The fact of different domain localization in the enterotoxic protein molecule indicates that only the superantigenic activity of the toxin is related to the secretion of immune interferon. Of great interest is the spatial structure of the domain that controls superantigenic activity. Deciphering the molecular structure of the domains holds the key to the use of enteropathogenic proteins for medical purposes.

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