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Landscapes of Origin: Geoparks and Pilgrimage

DOI: 10.31038/GEMS.2024641

Abstract

This is an ethnological analysis of six unique geology reserves (or geoparks) each being the center of a larger geological landscape (or geoscape). Each park has been given special historical preservation status in the United States because of its cultural meanings to Native Americans and its special geological features. Ethnographic studies were funded to understand the special cultural connections between individual geological areas and cultural a more general ethnological perspective on such heritage places. The authors of this analysis participated in the ethnographic study of four of the six affiliated Native Americans. This analysis further compares these findings, drawing out four themes common across the case studies and thus producing geoparks.

Keywords

Landscapes of origin, Geoparks, Geoscapes, Pilgrimage, North American, Native American sacred areas

Background

The most current understanding of the UNESCO preference for using geology heritage terms like geoparks for research and management is discussed in a special issue of the journal Land entitled Geoparks, Geotrails, and Geotourism—Linking Geology, Geoheritage, and Geoeducation that was edited by Margaret Brocx and Vic Semeniuk [1]. They summarize the worldwide movement towards using these concepts to better understand heritage places that involve a number of geoparks and geotrails that have been established, e.g., UNESCO. Global Geoparks where the geology, geotours, and local economy are linked for the well-being of the local people and operate under the auspices of UNESCO, and National or State-oriented geoparks/geotrails where the geology is identified as significant and preserved in conservation estates and utilized for tours, education, and other commercial purposes. Well-designed and organized geoparks/geotrails provide valuable sites for geoeducation, including suitable localities for collecting minerals and fossils, and all types of geoparks/geotrails can function for geotourism. Geotours in geoparks/geotrails provide excellent opportunity for introducing the public and students to the wealth of information and history that the Earth has to offer and professional geologists to the diversity of Earth Science globally. This analysis contributes to our understanding of the UNESCO use of geoparks by demonstrating how Effigy Mounds National Monument (NM) and its surrounding ceremonial landscape fits into a broader discussion of multi-ethnic [Ethnicity is the social organization of cultural difference (Barth 1969). We use ethnic groups here to denote socially defined subdivisions of a common cultural heritage. Ethnic group membership tends to be organized by a number of boundary mechanisms, which may include shared religious practices, ancestry and descent, origin stories, geographies of and attachments to place, and language] ceremonial centers also known here as Landscapes of Origin and geoscapes. The purpose of this ethnological analysis is to show that, while Effigy Mounds has its own unique functions and connections, it parallels other ceremonial centers discussed in this analysis. The six case studies presented here were selected to demonstrate how some time-keeping elements using geological features, healing places, and renewal ceremonial locations are comparable with other heritage geoparks. In a book entitled Landscapes of Origin in the Americas: Creation Narratives Linking Ancient Places and Present Communities, Jessica Christie (2009) [2] assembled nine case studies of how Native American ethnic groups understand, use, and are attached to origin places. The cases are from North, Central, and South America. The organizing thesis of her book is that Creation is a complex concept which variously can mean where we came into previous worlds, where we came into the current world, or where we were culturally recreated as a result of some monumental event.

All Creation events discussed here, and thus their recounting through time, are tied totopographic places and, often, multiple geological features. Normally these places are topographically spectacular—the junctions of large rivers, a salt deposit in the caldera of a massive volcano, a mountain in a flat terrain, or the outcropping of a special mineral for making ceremonial pipes. Landscape of Origin naturally has a destination area, which is the focus of various kinds of ceremonies such as those associated with world balancing and conflict resolution activities, individual vision quests, and spiritual healing. At the center of the destination there often are a series of sequential use protocols which we have termed local ceremonial landscapes [4,5]. The journey to the destination center typically occurs along well established pilgrimage trails, which in turn have functionally special locations for ceremony (Grassy pubs). This ethnological analysis helps us to understand Effigy Mounds by placing it in a wider Native American heritage geoscape frame.

Landscapes of Origin

Tribal representatives describe Effigy Mounds [Effigy Mounds is used in this article instead of the acronym Effigy Mounds NM in order to talk about not only the monument lands but also the surrounding immediate landscape. The distinction upholds Native American uses shared during ethnographic interviews] as a large ceremonial center, which is located in an extensive, functionally integrated cultural landscape, called here a Landscape of Origin. The Effigy Mounds center and landscape have been used by many different Native American groups for thousands of years. Native American people have long maintained connections to Effigy Mounds through ceremonial activity and their origin and creation stories. Effigy Mounds also has been understood as an area free from inter-ethnic conflict; thus all culturally associated tribes have an inherent right to visit for ceremonial activities and conflict is not allowed in this sacred space. With these core understandings, it is important to place Effigy Mounds into a broader discussion of multi-ethnic ceremonial centers (Figure 1).

FIG 1

Figure 1: Map Placing the Five Multi-Ethnic Ceremonial Areas

This essay describes and compares six (6) Native American Landscapes of Origin including Effigy Mounts, in North America. The five other cases are (1) Pipestone National Monument (Pipestone), (2) Medicine Wheel/Medicine Mountain National Historic Landmark (Medicine Mountain), (3) the Zuni Salt Lake and Sanctuary (Zuni Salt Lake), (4) Chaco Culture National Historical Park (Chaco), and (5) Sugarloaf /Gold Strike Canyon (Sugarloaf Mountain) (Figure 2.1). The patterns or elements of these well-known Native American geoparks and geoscapes are used to situate Effigy Mounds as a ceremonial center.

Effigy Mounds

In the past, a number of Native American groups visited places located within the monument boundaries and the surrounding landscape for a variety of reasons, such as holding ceremony, burying their dead, and maintaining the mounds (Figure 2). While at this ceremonial center, interactions between the diverse groups were peaceful, due to the shared value of the mounds as a neutral zone for ceremonial use (Figure 2).

FIG 2

Figure 2: Landscape and Viewscape from the Marching Bear Group

Howey, whose work focused on mound groups in northern Michigan, suggests that mound groups may have served as ceremonial areas that build on pan-residential interaction and trade [6]. She argues that embedding these centers in the sacred allows members of communities from separate territories to meet and exchange goods where liturgical order ensures moral behavior, therefore public ritual restrains individual competition or hostility [6]. In short, the political functions of public ritual were just as important as the religious functions. These mounds were centered in shared ritual that brought communities from great distances. These relationships strengthened social bonds between territorially distinct groups and added group interdependencies through economic specialization. Building upon his research on mounds in South America, Dillehay [7] notes that once monuments are engaged in public ritual, they organize people’s responses and patterns of interaction. Similar cultural use patterns occurred along the Upper Mississippi River watershed. Tribal representatives maintained that these mounds served as a gathering place for the celebration of the solstice and other ceremonies, as well as the final resting place for spiritual leaders and other deceased community members from a number of tribes. Through time, Effigy Mounds continued to be a sacred place, or spiritual center, lending credence that it was seen as hallowed ground and a place of nonviolence.

Origin Stories

Effigy Mounds are a key component of many Native American tribes’ oral histories and creation stories. According to ethnographic interviews conducted during this study, Dakota, Ioway, and Winnebago have stories that connect them with the various mound groups within the monument. Tribal representatives noted that the zoomorphic effigies are closely linked to medicine and clan origins and migration. In particular, the Marching Bear Group found in the South Unit is associated with a period in history where the Ioway, Winnebago, and others were once part of one larger group of people. At one point the various clans within this larger society agreed to separate peacefully into multiple tribes. An Ioway representative noted that the formation of the Marching Bear Group is representative of that event (Figure 3). Each group broke away and headed their separate ways, one by one.

FIG 3

Figure 3: Aerial View of Marching Bear Group in the South Unit of Effigy Mounds (NPS)

Ho-Chunk oral histories tell of an origin story that tribal representatives believe corresponds to the Marching Bear Group: One night, the Great Spirit appeared to Bear in a dream, “My son,” he said, “it is time to leave your home and go to a new home I have made for you. No longer will you eat solely from the water. There will be other food that I have out there for you to eat.” So Bear called a council with all the other animals, including Wolf, Deer, Eagle, and Buffalo. It was decided that Deer would lead the way, so he and his people left first. Bear and his people left in the second group, followed by Wolf in the third group. Buffalo left the next morning. The final animal to leave was the mighty Eagle. Before he departed, he blessed the people who were left behind. Eagle then flew into the sunrise and disappeared over the mountains. The spirits of the early people watched them leave with tears in their eyes, but happiness in their hearts [8]. Oral history, such as the Ioway and Ho-Chunk stories, reaffirms contemporary Native American people’s connections to Effigy Mounds.

Pilgrimage and Ceremonial Activity

Human societies form complex connections and relationships with the environment that surrounds them. Their cultural understandings of the land are shared and transferred over generations through oral traditions and ceremony [9,10]. Many cultural groups, or ethnic groups, can hold different understandings of the same land [3]. For many Native American people, these engagements are grounded in their epistemologies and oral traditions [11-13]. Places are connected through songs, oral history, human relations, ceremony, and both physical and spiritual trails. These connections create synergistic relationships between people, places, and objects during ceremony. These types of connections and relationships are important for understanding the concept of pilgrimage. The act of pilgrimage involves religious specialists traveling to unique and powerful places and landscapes along special, well-established ceremonial pathways. As the religious specialists, or pilgrims, follow these trails, they perform ritual acts, which are critical to successfully completing the pilgrimage ceremony. The pilgrimage process allowed the pilgrims to gain knowledge and power at their destination places to use in ceremonies to restore balance and promote sustainability in their home communities.

The term pilgrimage is used here to describe the ceremonial journey cultural and religious leaders took when they visited the Effigy Mounds NM area. The UofA team chose this term because it was believed to be the best way to describe how the tribal leaders’ travel and visitation to their area would have hade social and spiritual importance. During pilgrimages, the travelers are left without their normal social structure, and a community or communitas (even if it is temporary) is formed [14]. Pilgrims use these new relationships to develop protocols for how to behave and perform rituals along the trail. These roles are based on the pilgrims’ ceremonial responsibilities and needs that are necessary for a successful pilgrimage. Ceremonial activity brings together people from different communities and cultural backgrounds [15-19].

Effigy Mounds served as a major ceremonial destination place for many Native American groups for thousands of years. Religious specialists followed specific trails, which included both terrestrial and water travel components. During their journeys, religious specialists likely visited places to pray and leave offerings along the routes in order to physically and spiritually prepare themselves to enter Effigy Mounds. Once they reached their destination place, religious specialists engaged in certain types of ceremonial activities. It is believed that certain types of activities occurred seasonally while others occurred annually at Effigy Mounds. According to some of the tribal representatives, ceremonies occurring at various locations within the monument were tied directly to time keeping. At least one mound group found on the high bluffs was constructed and placed in such ways that solar and lunar movements could be observed during the summer solstice. Time keeping is an important activity that exists in all human societies. Designated medicine men/religious specialists were trained for this task by tracking the movements of the planets, stars, moon, and the sun. Originally, physical time was marked at stable places on the landscape. Time often dictates and influences when specific human activities, such as ceremony, take place. Tracking solar and lunar movements plays an especially important role in agriculture; time keeping helps determine the best time for planting and harvesting produce [20]. Another major ceremonial component of Effigy Mounds was the annual activity of reconnecting with the ancestors and memorializing the deceased, as noted by tribal representatives. Annually, Native American people from connected communities visited Effigy Mounds for funeral ceremonies. Families worked together to bring in raw materials to repair and stabilize the mounds. Native American people brought the remains of important community members or religious leaders to be placed in the burial mounds at Sny Magill or on the high bluffs. Additionally, as part of the ritual activities, offerings would be brought and placed in and around the mounds.

Historical Accounts

Reuben Thwaites documented Prairie du Chien, which is located just across the Mississippi River (Figure 4), as a key trading center amongst numerous Native American tribes. [21] asserts that up to 6,000 Native Americans would visit annually. Blaine [22] makes a similar assessment about the region, referring to Prairie du Chien as an “older Indian trading rendezvous.” The proximity to the Wisconsin and Yellow River further affirms the magnitude of trade in this area, tying this landscape to the west via the Yellow River, and to the Great Lakes region via the Wisconsin River. Materials found within the burial mounds in and around Effigy Mounds also help frame the context of centralized trade in this area. Located within the mounds were traces of copper, mica, shells, and obsidian. It is speculated that each one of these materials was traded from areas to the north, south, east, and west.

FIG 4

Figure 4: View of Prairie du Chien from Effigy Mounds

Native American people came together in the Prairie du Chien area for other types of events aside from trade rendezvouses. Early Euro-Americans in the region noted accounts of Native American people coming together to take part in ceremonial games, such as lacrosse. According to the Ho-Chunk Nation’s timeline of their tribal history, over 300 people representing the Winnebago, the Fox, and the Sioux gathered to participate in a large lacrosse tournament near Prairie du Chien [23].

Landscapes of Origin Cases Elsewhere

Various ceremonial centers found in North America were utilized by multiple ethnic groups for a wide range of purposes. These locations had ritualistic and ceremonial components related to Native American epistemology and reinforced both intra- and inter- tribal bonds. Among these locations are: (1) Pipestone, (2) Medicine Mountain, (3) Zuni Salt Lake, (4) Chaco, and (5) Sugarloaf Mountain. The following section provides information on these locations and shows the parallels between them and Effigy Mounds.

Pipestone National Monument Case One

Pipestone National Monument (Pipestone) is located in Pipestone County, near the three-state border of Minnesota, South Dakota, and Iowa (Figure 5). Before the arrival of Europeans, various Native American groups lived in the vicinity of the present-day monument. They, along with other Native American groups who did not live in the immediate vicinity of the monument, visited the quarry in order to obtain catlinite to manufacture ceremonial pipe bowls and other objects. The stone gets its name from nineteenth-century artist, George Catlin, who described and painted it. The monument takes its name from this resource, and later the quarry and adjacent area became a national monument in 1937 [24].

FIG 5

Figure 5: Pipestone Landscape

Before Euro-American settlers introduced drastic changes to its natural landscape, the monument included some wetlands and tall grass prairies. This area was under natural fire and drought cycles that preserved its open grassland ecosystems. The monument lies on the outer, southwestern edge of the “Prairie Lake” subregion of the Northeastern Plains, which is characterized by inland lacustrine and riverine drainage systems that once fed both grasslands and wetlands [25]. The ancient heritage cultural landscape of the Pipestone quarries was the product of several Native American tribes who made use of the area, and specifically the pipestone, since A.D. 1400-1450 (Figure 6). These included the Poncas, Omahas, Ioways, Otoes, Sacs, Foxes, and Sioux, although the latter were in control of the Coteau des Prairies by the early 1700s. Sioux interest in the quarries and surrounding region are attested to through migration stories and documented annual pilgrimages to this ceremonial center to obtain pipestone. The Sioux also went there to perform rituals, hold ceremonies, gather plants, and hunt wildlife. Some camp and village sites were established periodically in the region, as were breastworks or enclosures presumed to be defensive structures [24].

FIG 6

Figure 6: Artist’s Rendition of Ceremonial Activity at Pipestone from the Monument Visitor Center

While ceremonial activities may have occurred elsewhere, it seems that the healing and ritual activities primarily involved the water, the waterfalls, and the view of the treeless prairie from the quartzite ridge. Overall, most activities involved one or more of four primary features in the traditional cultural landscape: the waterfalls, the Pipestone quarries, the Three Maidens, and Leaping Rock [5]. The sacred nature of the Pipestone local ceremonial landscape began with medicine plants and rites-of-passage rituals. Then, according to Sioux oral history, White Buffalo Women brought the pipe to the Sioux and the practice of quarrying pipestone began. Native American interpretations and attachments to the place persisted through time, although they became secondary to quarrying the pipestone [5]. The Cree also have oral histories about the sacred pipe and the creation of the catlinite quarry at Pipestone. Catlin [26] recorded one story of a Cree that had visited Pipestone: …in the time of a great freshet, which took place many centuries ago, and destroyed all the nations of the earth, all the tribes of the red men assembled on the Conteau du Prairie, to get out of the way of the waters. After they had all gathered here from all parts, the water continued to rise, until at length it covered them all in a mass, and their flesh was converted into red pipe stone. Therefore, it has always been considered neutral ground – it belonged to all tribes alike, and all were allowed to get it and smoke it together. Catlin documented several tribes’ origin stories of Pipestone. Each attributed the use of Pipestone to multiple groups, and each tribe emphasized Pipestone as a place of peace. For thousands of years, during which Native American people used this ceremonial center, it was primarily a male place where medicine men sought plants for healing, performed rites-of-passage, and pursued vision quests. One such rite involved a four-day submergence in the Pipestone Creek (Figure 7), after which boys became men and could be counted on to have the stamina necessary for hunting and fighting [5].

FIG 7

Figure 7: Winnewissa Falls along Pipestone Creek

Upon arriving at the ceremonial center, they would set up camp away from the quarries. Once greeted by thunder and lightning storms, the men would make ceremonial camps near the Three Maidens and begin to prepare themselves by cleansing in the creek and giving prayers and tobacco offerings at the Three Maidens, which is the gateway into the sacred areas of Pipestone. If thunder and lightning greeted them again, the place had heard their prayers and given them permission to enter the site. If thunder and lightning did not occur, the men may have returned to the ceremonial camp for more preparation or to the main camp to prepare for the return home [5]. Having entered the quarry sites, many of which paralleled the quartzite ridge for nearly a mile, the men who were not quarrying might continue with sweats and prayers until they were needed. Upon entering a quarry, each man would make a tobacco offering to indicate their purity and to protect them while they worked. When they were done, they took the offerings with them to show respect for the spirits of the sacred area [5].

Medicine Wheel/Medicine Mountain Case Two

Medicine  Wheel/Medicine  Mountain  National  Historical Landmark (Medicine Mountain) is a large ceremonial center in present day Wyoming (Figure 8). Many Native American groups such as the Arapaho, Bannock, Blackfeet, Cheyenne, Crow, Kootenai- Salish, Plains Cree, Shoshone, and Sioux have all come to this area for ritual activity over the course of at least 7,000 years. Medicine men/religious leaders visited the mountain for a range of ceremonial activities related to doctoring and vision questing. During recent ethnographic studies, tribal religious leaders and tribal elders have pointed out that even across the many different groups connected to Medicine Mountain, there is a common and shared understanding of the spiritual and ceremonial importance of this landscape [27,28].

FIG 8

Figure 8: Medicine Mountain Landscape

Medicine Mountain (Figure 9) is at the center of numerous ceremonial trails leading into the area from different directions. Once religious leaders approached the base of the mountain, they would ascend the eastern slope. The trails along the eastern side of the mountain have been interpreted by some Native Americans as being linked to the notion that Medicine Mountain is not just a mountain, but rather it is a spirit lodge in a very literal sense [27-29]. The mountain houses important spirits, and for those visiting the mountain, they must approach it in the same culturally appropriate manner as you would a spirit lodge (Sun Dance or ceremonial lodges). In order to do so, it must be approached from the east.

FIG 9

Figure 9: Medicine Mountain (NPS 2015)

The trails leading up the eastern flank of the mountain are marked with rock cairns surrounded by ritually deposited materials, or offerings. Numerous features are located along the trails up the mountain, such as stone-lined arrow effigies, rock cairns, prayer shrines, patches of medicinal plants, and places for short- and long- term occupancy. When reaching the top of the mountain, religious leaders had access to designated areas for vision questing along the rim [27-29]. The Bighorn Medicine Wheel on the ridge west of the Medicine Mountain summit is the principal ceremonial site (Figure 10). Native Americans have described it as “the altar” for Medicine Mountain. Healing ceremonies for sick individuals who have made the pilgrimage tothe mountain are performed in the northeastern part of the district [27-29].

FIG 10

Figure 10: Bighorn Medicine Wheel

The large medicine wheel at the top of the mountain is also a ceremonial destination place. The medicine wheel has been used for two distinct ceremonial purposes during two time periods. It is believed that Native Americans first used the medicine wheel as a time keeping instrument with a select and highly specialized group of religious leaders involved in time keeping ceremonies. It was likely their pilgrimages to Medicine Mountain occurred at different periods than those for vision quest. At a later point in time, the medicine wheel became an area associated with doctoring ceremonies. During healing ceremonies, balance would be restored to both the patient and the surrounding environment [27-29].

Zuni Salt Lake and Sanctuary Case Three

Located 42 miles south of the Pueblo of Zuni, the Zuni Salt Lake and Sanctuary (Zuni Salt Lake) (Figure 11) is a ceremonial center that is approximately ten miles in circumference. This landscape of origin is on the NRHP as a historic archaeology district rather than a TCP due to the number of inholding private properties. The lake is located in a circular depression and contains a large concentration of salt. The crater was formed by volcanic activity associated with the two cinder cones found at the south side of the lake [30]. People are often drawn to volcanic sites; volcanic activity plays a key role in the development of unique minerals and biotic communities. Volcanoes are seen as special places, especially to Pueblo communities, whose membership often refer to them as Earth Navels [31]. This ceremonial center features in the oral histories of Acoma, Hopi, Laguna, and Zuni. Each pueblo has individual origin stories that account for the lake and the Salt Woman who resides in it. Duff et al. [32] identifies the Salt Woman in each pueblo’s history, known as Ma’lokyyattsik’i to the Zuni, Öng.wùuti to the Hopi, and Mina Koya to Acoma and Laguna (Figure 11).

FIG 11

Figure 11: Zuni Salt Lake Landscape

Stories about Salt Woman have common themes among various Pueblo peoples. Salt Woman took a long journey to each of the tribes before she settled down at the salt lake, and her home can still be identified by the people in these respective locations. While living with the tribes she was not respected: some people wanted her to leave because of her appearance, and some even polluted her home. The Salt Woman eventually left the tribes and traveled east on the back of an eagle where she met Turquoise Man. From there she traveled south, leaving remnants of her travels behind, and eventually settled at the lake (Figure 12) [32].

FIG 12

Figure 12: Ariel View of Zuni Salt Lake (Duff et al. 2008)

Realizing their mistakes, the Pueblos reconnect with the Salt Woman at Zuni Salt Lake by collecting the sacred salt from the lake. Out of respect for Salt Woman, the Zuni Salt Lake area is a conflict-free area. Today, the sacred salt is acknowledged as spiritually important to the people and used for ceremony and healing. The lake is surrounded by prehistoric trails that connect associated Pueblos. Contemporary pilgrimages take these pueblos to Zuni Salt Lake via these trails for ceremony and ritual collecting of this highly valued salt (Figure 13) [32,33].

FIG 13

Figure 13: Aerial View of Zuni Salt Lake Taken from Google Earth

Oday, Zuni Salt Lake is protected by the Pueblo of Zuni. In order to access this sacred location, individuals would have to obtain permissions from governing Pueblo of Zuni officials. According to an elder from the Pueblo of Zuni, the idea of getting permission to visit the site is problematic because all culturally affiliated pueblos have rights to the sacred landscape, not just Zuni [32].

Chaco Culture Case Four

Chaco Culture National Historical Park (Chaco) (Figure 14) is located in the San Juan Basin of the Four Corners region of New Mexico in the Southwestern United States. Chaco is a large regional ceremonial center that builds on complex inter-tribal relationships [34-36]. Numerous Western Pueblo tribes are culturally affiliated with Chaco, including Acoma Pueblo, Hopi Tribe, Nambe Pueblo, Navajo Nation, Pojoaque Pueblo, Santa Ana Pueblo, Santa Clara Pueblo, Santo Domingo Pueblo, Tesuque Pueblo, Zia Pueblo, and Zuni Pueblo [36].

FIG 14

Figure 14: Chaco Landscape

Chaco was a regional pilgrimage center [37] and likely remained a destination of special importance and continued to be visited through pilgrimages after the fall of Chacoan culture [36,37] argue that “undertaking the pilgrimage [to Chaco] was a way to demonstrate one’s commitment to the religious system centered at Chaco and the identity and moral system tied to it.” Connections to distant communities are evident in exotic materials found within the canyon, such as macaw remains, which trace this linkage as far away as Mesoamerica. Much of the ceramics and lithic remains found within Chaco were identified as non-local, and great houses contained hundreds of rooms with sleeping platforms [37]. Estimates put the peak population of Chaco between 2,100 and 2,700. However, construction of structures and agricultural fields at Chaco could have supported much greater numbers [38]; this suggests Chaco served not as a larger pueblo for year-round living but as a ceremonial center for seasonal visitors. Lekson [39] also argues that Chaco served as the regional ceremonial center that was linked to Aztec Ruins and Casas Grandes (Paquimé) through the Chaco Meridian, a longitudinal line at approximately 108 degrees west that connects these three ceremonial centers.

Construction in Chaco suggests a ceremonial use of the great houses (Figure 15) within the area. According to Sofaer [40], “major buildings of the ancient Chacoan culture of New Mexico contain solar and lunar cosmology in three separate articulations: their orientations, internal geometry, and geographic interrelationships.” There are a series of great houses (Figure 15), large multi-level developments, often oriented with solar, lunar, and cardinal directions built within line of site with one another (NPS N.d. a) [41].

FIG 15

Figure 15: The Pueblo Bonito Great House as Seen from a Cliff

A unique system of signal fires connected the great houses of Chaco. Signaling stations played a major role in the organization of Chacoan communities. These stations, which were lit with fires and intensified with reflective materials such as mica or selenite, are located along the roads of Chaco, creating connections between the great houses [42]. Signal fires can have a wide range of purposes, such as for ritual and ceremony, warfare, hunting, scheduling, and even defense [43]. These signal fires are located in high areas with unobstructed views to the next, typically on a tall building or a hill. Selenite, a highly reflective material, was found at some of the signaling sites across Chaco [43]. These signaling stations were capable of quickly carrying information across the canyon to each great house, allowing ceremonies to be conducted simultaneously across the entire region.

Fajada Butte (Figure 16) is a large topographic feature that stands over 400 feet high. It was one of the primary ceremonial destination places for religious leaders who traveled from other Chacoan communities. These journeys would be part of major events that were marked by the Sun Dagger. Also, trips would be made to this area for continuous interactions with the sites and shrines, ceremonies, interactions with other religious specialists to share ideas, and for teaching inexperienced people about time keeping and the movements of the sun, moon, and stars. The Sun Dagger on Fajada Butte is in the southeastern gap of the primary canyon in Chaco, approximately one kilometer to the east of Chacra Mesa (Figure 17). The dagger is formed by three large sandstone slabs that collimate sunlight onto two spirals [44,45]. The slabs result from a natural rock fall, not human engineering. While impossible to date the rock fall and peckings, it can be inferred that ancestral Native Americans carved the spirals after observing the light patterns for numerous annual cycles, thus using naturally occurring patterns and human made alternations to engineer a calendar [36,44].

FIG 16

Figure 16: Fajada Butte

FIG 17

Figure 17: The Sun Dagger Over a Petroglyph at Fajada Butte

Along the predominant ledge just below the Sun Dagger, there are a series of rooms that extend around most of butte. These rooms have been exposed due to erosion processes. In nearly all of the rooms that were visited during the 1994 study, pieces of pottery were found. One of the rooms is circular shaped and visiting tribal representatives believed it to be a kiva. It has been estimated that 20 to 30 rooms were built at this level, and they are believed to be the rooms where time keeping specialists lived during ceremonial activities on the butte [36]. Rooms were used by more experienced specialists to teach newcomers about celestial movements. Near the roofs of these rooms are various calendars and peckings which have been identified as representing clans, origin beings, ancestral beings, and physical representations of time. In accordance with traditional and contemporary use patterns of Pueblo households, theroofs of these rooms were seen as appropriate places to study, teach, and record the movements of the stars, sun, and moon [36].

Sugarloaf Mountain/Goldstrike Canyon

Sugarloaf Mountain/Gold Strike Hot Springs (Sugarloaf Mountain) is the fifth Landscape of Origin to be described and used to compare with Effigy Mounds (Figure 18). Sugarloaf Mountain is a valuable point of comparison because it was the first Native American cultural property that existed in two U.S. states (Arizona and Nevada) to be placed on the NRHP as a Native American TCP. In addition, the Sugarloaf Mountain TCP includes a portion of the Colorado River where Indian people traditionally moved between the hot spring canyon in Nevada and the ceremonial mountain in Arizona (Figure 19). Because Sugarloaf Mountain has been placed on the NRHP, this description uses text from the formal document.

FIG 18

Figure 18: Sugarloaf Mountain Landscape

FIG 19

Figure 19: Sugarloaf Mountain and the Colorado River

This property (a technical term used in the TCP nomination process) was successfully evaluated as a part of a larger cultural landscape of origin that has significance to a number of Native American tribes in the region. Although the TCP evaluation focused primarily on the mountain and the hot spring canyon located just across the Colorado River to the west, its cultural significance is, in large part, determined by its place within this larger landscape of origin setting. The Southern Paiutes, Hualapais, and Mohaves have all traditionally used Sugarloaf Mountain as a place for practicing spiritual, scientific, educational, political, economic, and social activities. The long-term presence of Native Americans at Sugarloaf Mountain is evidenced by physical artifacts that include two noticeable demarcated ceremonial clearings, apetroglyph, a turquoise mine at the base of the mountain, a cave with grindstones for corn or paint, small healing rocks, and several lithic scatters [46]. In addition to archeological evidence, historical and contemporary documentation confirms the existence of strong connections between Sugarloaf Mountain and the Southern Paiutes, Hualapais, and Mohaves. These intimate and deeply forged connections to Sugarloaf Mountain are integral to the maintenance of cultural, spiritual, ecological, and historic continuity between the ancient people of southern Nevada and their contemporary descendants. Today, the preservation of sacred knowledge and traditional cultural practices through the education of young people hinges upon the recognition and protection of those sacred places of the Southern Paiutes, Hualapais, and Mohaves that have not been irrevocably altered. Sugarloaf Mountain is such a place [46]. Amongst the Mohaves, Sugarloaf Mountain is repeatedly mentioned as a place that is tied to the sacred mountain, Avikwame. In travel songs, bird songs, and celebratory songs, Sugarloaf Mountain is noted as the northern most boundary as well as a spiritual place of power, which islinked to the Origin Mountain, Avikwame. The Hualapais also experience enduring connections to Sugarloaf Mountain. Upon arriving to Sugarloaf Mountain, one Hualapai elder began to speak in the cry voice about that which came before. In the presence of the mountain, she re-experienced the memories of her ancestors whose presence at Sugarloaf remains strong. She relayed how elders, adults, youths, and babies were forced to leave their ancestral lands and march to La Paz. Many were shot, thrown into pits full of slain humans, and even buried alive. Hualapai women and children were frequently killed alongside Hualapai men. Those who were not shot often died of European diseases and starvation. Today the Hualapai meet each year to conduct a three-day ceremony to mourn and honor the people who died on the march to La Paz [46]. The Southern Paiutes also experience intimate connections with Sugarloaf Mountain. According to several elders, Sugarloaf Mountain is on the Salt Song Pathway to the afterlife. Although first recorded at the turn of the century, the Salt Songs have their origins in times before Euro-American histories. The Southern Paiutes continue to sing the Salt Songs today. As a result, the sacred places that are mentioned in these songs remain central to Southern Paiute identity and culture. This is confirmed in ethnographic interviews. The elders explained that “Sugarloaf is a sacred place to Southern Paiutes. It is the only place of its kind that is used as a path to communicate with spiritual beings in the area” [46]. In addition, “The doctor rocks, crystals, and offering places in this area were placed here by the Creator for Southern Paiutes and others” [46].

Since time immemorial, Southern Paiutes, Hualapais, and Mohaves have practiced cultural observances at Sugarloaf Mountain. On the top of Sugarloaf, individuals and shamans used the ceremonial clearings for spiritual purposes, astronomical observances, teaching, and both political and social gatherings. The base of Sugarloaf Mountain has frequently been used in connection with healing activities utilizing doctor rocks, plants, and whiptail lizards [46]. Today Sugarloaf Mountain is integral to the maintenance and perpetuation of the cultural traditions of the Southern Paiute, Hualapai, and Mohave. This sacred place serves as a location where cultural traditions and knowledge can be conveyed from generation to generation. As there are many factors that endanger the cultural traditions of these groups, it is essential to protect and preserve Sugarloaf Mountain so that it may continue to play its critical role in the transmission of knowledge from elders to youths. Many elders agree that Sugarloaf Mountain is “a good place to teach children and let them understand better what it’s all about” [46]. Sugarloaf Mountain has always been a ceremonial destination place where individuals, medicine men/ religious specialists, and healers have gone to develop and practice their knowledge. Amongst the Southern Paiutes, Sugarloaf Mountain has served as an area where people have gone to educate and prepare themselves for sacred ceremonies occurring at Gypsum Cave. Sugarloaf Mountain has also served as a community learning center. “The old people used to meet here with the Hualapais, Chemehuevi Paiutes, Moapa Paiutes and others for spiritualpurposes,” [46]. In addition, Sugarloaf Mountain has traditionally served as “a place away from main villages, where people came to talk about common interests,” [46]. Today the Southern Paiute, Hualapai, and Mohave express a unified desire to maintain these practices and thus ensure their knowledge and traditions will be kept alive and rejuvenated amongst younger generations [46]. The following are discussions of specific key cultural components of Sugarloaf Mountain as a TCP which is located within a larger Landscape of Origin. Figure 20 is a representation of the Sugarloaf landscape with the three pilgrimage trails marked in brown.

FIG 20

Figure 20: Diagram of Sugarloaf Mountain Pilgrimage Trails and Associated Features

A Landmark

Sugarloaf Mountain has been used as a landmark as well as a ceremonial center for the exchange of knowledge over thousands of years. This knowledge comes from elder teachers as well as the mountain itself, which the Southern Paiute, Hualapai, and Mohaves have been taught to attune themselves towards, and thus accrue knowledge from multiple rather than singular educational sources. As much of this knowledge is learned directly from the mountain itself, this place is integral to cultural traditions [46].

A Ceremonial Area

The ceremonial activities constitute one of the central functions of Sugarloaf Mountain. These activities involved both individual shamans and groups of people who regularly convened on Sugarloaf Mountain to worship, develop knowledge, and express knowledge through healing practices. These activities included astronomical observations, rituals, vision quests, and the collective augmentation of knowledge [46].

Vision Questing Area

Sugarloaf Mountain also served as a location for vision quests that sometimes involved both individuals and whole families. These vision quests occurred at Sugarloaf Mountain because it was a known center of power. Today this same power is acknowledged and understood by the Southern Paiute, Hualapai, and Mohave elders. The recognition of this power explains their need to teach their children at this location [46].

A Healing Area

Sugarloaf Mountain has always played an integral role in the healing traditions of the Southern Paiute, Hualapai, and Mohave. In both prehistoric and historic times successful healing required an in-depth knowledge of the healing resources provided at Sugarloaf Mountain, as well as a respectful relationship with this source of power. The power of Sugarloaf Mountain helped them to prepare themselves for receiving the songs necessary for healing, as well as the knowledge to utilize the water, doctor rocks, lizard tails, plants, and regions of healing in a manner conducive to physical and spiritual restoration [46].

An Area for Ceremony and Intertribal Gatherings

Sugarloaf Mountain has been repeatedly noted as a place of power. Those who gathered at Sugarloaf Mountain did so under varying circumstances. Frequently, the gathering focused on spiritual and educational purposes, which speaks to the focus on events that contributed to cultural continuity. It is suggested in interviews that Native Americans gathered at Sugarloaf Mountain under political pretenses including the Ghost Dance. Therefore, the ceremonial clearings had multiple functions [46].

A Component of a Cultural Landscape

Sugarloaf Mountain expresses its power through all of the elements of nature, which are understood to manifest in concert rather than as discrete entities. Sugarloaf Mountain exists as a place of power within a larger plane of interconnections. Tribal representatives noted that it is related to other significant places including Gypsum Cave and Avikwame. Sugarloaf Mountain has functions and uses that are simultaneously unique yet integrally related to places beyond itself. The cultural features/elements found at Sugarloaf Mountain are part of a larger cultural entity, preserving the larger traditions of multiple ethnic groups. The mountain and its natural/cultural elements are a significant part of a cognized landscape important to tribes in the region. From the top of Sugarloaf Mountain, the people who frequented this place had a viewscape that connected the mountain and its people to the four directions and the sacred places noted in both songs and oral histories [46].

A TCP with Continued Cultural Centrality

The Southern Paiutes, Hualapais, and Mohaves are invested in protecting and continuing their relationships with Sugarloaf Mountain because it is a ceremonial place in a landscape of origin and a significant source of knowledge and power. The designated boundaries of the TCP are shown in Figure 21. This power does not express itself in a unilinear fashion, wherein only humans benefit. Instead, the Southern Paiutes, Haulapais and Mohaves strive to create relationships that are mutually respectful, knowledge-based, and balanced [46].

FIG 21

Figure 21: Sugarloaf Mountain TCP Boundaries (Stoffle et al. 2000)

The Southern Paiute, Hualapai, and Mohave elders repeatedly voiced the need to bring their youth to Sugarloaf Mountain. This desire stems from the power of the place, as well as the educational process that has always played a primary function at this sacred landscape.

Discussion

These six case studies are comparable examples of geoparks in Landscapes of Origin. The purposes and uses of these places were different from place to place, however, there are distinct similarities. Numerous Native American tribes connected to these geoplaces have used these ceremonial centers for thousands of years. The connections that these groups have to these landscapes are complex and layered, and shift throughout time. Sacred connections to these areas are culturally significant to many different Native American people.

Landscapes of Origin – Creation

Common themes exist between these ceremonial centers and Effigy Mounds. One example is the connections made through origin stories. Places like Zuni Salt Lake, Chaco, and Pipestone are associated with multiple origin stories from surrounding Native American tribes. At Zuni Salt Lake, Salt Woman, the creator being that resides in the lake, features in the origin stories of Zuni, Acoma, Hopi, and Laguna. Furthermore, she continues to serve an important role in their cultures by providing salt to the associated Pueblos. Similarly, affiliated Pueblo groups have creation stories that tell of clan migrations through Chaco. At Pipestone, Sioux accounts attribute the creation of Pipestone to White Buffalo Woman, while Cree accounts associate the place with a great flood and the coming together of many different ethnic groups. Similarly, culturally affiliated tribes at Effigy Mounds have origin stories that link clan migrations to specific mound groups within the monument.

Landscapes of Origin – Ceremony

There are parallels between ritual activities conducted at Effigy Mounds and previously discussed ceremonial centers. For example, Effigy Mounds, Chaco, and Medicine Mountain have features used in time keeping ceremonies. Activities that occur at these three ceremonial centers are linked to solar and lunar observations made by religious leaders of the community. Tracking time was used for a range of activities including agriculture, pilgrimage, and balancing ceremonies. Chaco, a pilgrimage destination place, housed religious leaders from across the region to conduct large scale ceremony involving solar and lunar observations at Fajada Butte. Religious leaders were positioned throughout the canyon to conduct simultaneous ceremonies, which were coordinated through signal fires. Medicine Mountain also had a time keeping component; the medicine wheel itself was a calendar used to track the passage of time. Other ceremonies at Medicine Mountain involved healing and vision questing. At Effigy Mounds, a linear mound at the Marching Bear Group lines up perfectly with the sun during the summer solstice, similar to the structures across Chaco or the spokes of the Bighorn Medicine Wheel. Locations along the bluffs of Effigy Mounds and surrounding areas, such as Pikes’ Peak, contained evidence of fire use, which was used potentially to coordinate a region-wide simultaneous ceremony.

Landscapes of Origin – Pilgrimage

Pilgrimage is the third common theme among the landscapes of origin discussed in this article. Pilgrimages to these sacred landscapes involved patterned movements along predetermined routes and trail networks. The movement of people along these routes were part of the ceremonies themselves. Religious specialists traveled great distances to engage with these landscapes. Along the trails, the specialists (also referred to as pilgrims) visited shrines, leaving offerings and saying prayers. These acts provided the pilgrims with knowledge they needed to continue with their journeys. The six (6) case studies have well defined and understood trail systems that lead to the ceremonial destination places from the various home communities of the connected ethnic groups. For example, at Sugarloaf, Southern Paiute religious specialists traveled along trails from the west, Mohave people traveled from the south, and Hualapai traveled from the east to reach the mountain. The trails to Sugarloaf share similar features and places of prayer; along these trails a similar pecked figure is found, which is also found on the top of Sugarloaf Mountain. At Medicine Mountain, pilgrimage trails lead to the mountain from all directions, however these trails all come together at the base of the eastern slope of the mountain. All religious specialists seeking to engage the Medicine Wheel for ceremony must approach it from an easterly direction in a manner that parallels how one enters a medicine lodge. Effigy Mounds is a known destination place for many different ethnic groups, which would have used unique land and water trails to approach this scared landscape. River navigation likely played a key component in pilgrimage. Religious specialists would have canoed down the Mississippi, Wisconsin, and Yellow Rivers to reach their destination.

Landscapes of Origin – Conflict Free Zones

An important component of landscapes of origin in Native North America is the multi-ethnic use/neutral component to these places. Places, such as Pipestone and the Zuni Salt Lake, are well documented as playing an important role in the ritual, ceremony, and pilgrimage of multiple affiliated tribes and pueblos who have a shared use of the place and its resources. Pipestone and Zuni Salt Lake’s origin narratives indicate that the neutrality of the place is a part of respecting the creator being that resides in the landscape. Multiple narratives account for the multi-ethnic use of Pipestone, many of which were documented by Catlin [26] during his visit to Coteau des Prairie, though the territory was controlled by the Sioux during his travels. Similarly, Nicollet wrote about Pipestone being a place of peace that was visited at different times of the year by different tribes [47]. Zuni Salt Lake has an identified Sanctuary, 182,000 acres approximately ten miles around the lake, which was added to the NRHP. The area includes pilgrimage trails and religious shrines that play important roles in the ritual use of Zuni Salt Lake. This area is traditionally void of any violence out of respect for the Salt Woman [32]. The bluffs of Effigy Mounds were central to the ceremony conducted by multiple visiting Native Americans, but likely they were a part of a greater landscape that extended along the Mississippi River and across the river in Prairie du Chien, which was a documented trading hub and ceremonial center for visiting tribes. In order not to disrupt ceremonies at the mounds or the economic and cultural ties between these groups, this area would similarly be declared neutral grounds rooted in the creation narratives of the landscape. The common themes that have been highlighted throughout this analysis show that multi-ethnic ceremonial centers exist in Native North America, exist because of special geological features, and have ritual and cultural-historical components to them. Effigy Mounds fits into the definition of a multi-ethnic ceremonial center, because Native Americans have long-term spiritual connections to the mounds and the mounds serve as physical links to Creation stories. While the uses of Effigy Mounds are tribal and place specific, the broader pattern of this ceremonial center is found elsewhere. Like the five Zuni Salt Lake, Medicine Wheel, Chaco, and Sugarloaf Mountain, Effigy Mounds continues to hold cultural meaning and spiritual importance to contemporary tribal peoples.

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FIG 11

Cultural Meaning of Playas to Native Americans

DOI: 10.31038/GEMS.2024634

Abstract

The heritage cultural contexts of playas are poorly understood by United States federal and state agencies because there has been a persistent theory that these topographic features are marginal to Native American life. Despite this perspective, Native American peoples in formal public ethnographic interviews persistently state that these playas are old living areas going back to a time (end of the Pleistocene) when the lakes were full and surrounded by lush vegetation. Slowly the lakes receded but Indian people continued to live along their shores. Given the tens of thousands of years that Indian people have lived along the edges of these lakes, it is unsurprising that they should remember those past times and return to the playas today, seeking connection with their ancestors and the places that sustained them and permitted the formation of an ancient heritage way of life. The analysis is based on field ethnographic interviews with Paiute, Shoshone, and Goshute people.

Keywords

Pleistocene, Native American culture, Playas as Heritage, Persistent culture, Great basin ethnography, Ethnogeology

Playas as Native American Heritage Places

People from western cultures have regularly viewed desert playas of the western United States as sterile and of little utility except for gathering salt or minerals. In line with this unimportant valuation of desert playas by western observers, many call the region “The Great American Wasteland” [1]. The region’s culturally affiliated Native Americans, however, tend to view these playas as heritage areas extending back in deep time to the Pleistocene when they were filled with lakes, surrounded by wetlands, and drained by permanent streams. According to the University of Utah’s Shoshoni Dictionary[2] (Shoshoni Language Project 2024), the Goshute people refer to themselves as the Newe[nɨwɨ] or Newenee [nɨwɨnɨɨ] meaning the Person or the People. There have been times throughout their history where they have been referred to as Kutsipiuti (Gutsipiuti) or Kuttuhsippeh which translates to “People of the dry earth” or “People of the Desert” (literally: “dust, dry ashes People”) [1,3]. Goshute means people covered with dust, dusty people, or desert, terms which were reiterated generations later in Halmo et al. [4]. In the same study, contemporary Goshute people who are fluent in their language use the term in reference to the white alkali dust that lines the lowest portions of most valleys [4,5]. Our analysis explains why the playa dust symbolizes heritage connections with the land and past lives. Native American heritage perspectives regarding playas are required in national searches for places to drop bombs, make landing strips for large military aircraft, build industrial scale solar arrays, and mine rare earth minerals, including lithium. Native American cultural impacts regarding proposed federal land use are required by law and regulation and must be clearly articulated during environmental impact assessments. The spatial focus of this analysis is the Great Basin of the western U.S. It is largely defined by internal draining, endorheic lakes and rivers. Because of its unique topography, the Great Basin has been characterized by its state of being largely filled with water during the much wetter Pleistocene, as well as its dry salt, mineral, and sand flats in the latter Holocene. Playa is the term normally used to discuss these salty, white sand, mineral deposits (Figure 1).

FIG 1

Figure 1: The Great Basin

The temporal frame for this heritage analysis of playas is operationally defined as the late Pleistocene, which occurred between 128,000 BP and 11,700 BP, and the Holocene, from 11,700 BP to modern times. Scientific studies have placed Native Americans in the region at least by 37,000 BP with the geoarchaeology dates of 23,000- 21,000 BP at White Sands, New Mexico [6,7] and 38,900 to 36,250 BP at the Hartley locality, a mammoth kill site situated near the Rio Puerco, New Mexico [8]. These new geoscience dates indicate that Indigenous Peoples experienced this area as both a massive wetland filled with lakes, rivers, and swamps and later as an arid desert with intermittent streams, sand dunes, small artesian springs, and heritage playas.

Pleistocene in the Great Basin

The Late Pleistocene ecology of the Great Basin and western Colorado Plateau regions was rich in fauna and flora. Central to this supportive habitat were wet forested uplands, full grasslands, and long wetlands located along a complex network of streams feeding into medium and large lakes [9]. American Indian people lived here, hunting, gathering, making trails, building communities, and engaging the topographically interesting landscape with ceremonial activities. Large mammals, like mammoth, roamed these habitats from the lowest wetlands up to 8,990 feet where the Huntington Mammoth remains were found – a subalpine environment in the late Pleistocene [9]. While contemporary scholars often focus their studies on charismatic species like mammoth, dozens of medium sized mammals were found as well including camels, horses, ground sloths, skunks, bears, sabretooth cats, American lions, flat-headed peccaries, muskoxen, mountain goats, pronghorn antelope, and American cheetahs. Many smaller mammals were also present. Like their mammal cousins, avian species were abundant and ranging in different sizes from the largest being the Incredible Teratorn with a wingspan of 17 feet and the Merriam’s Teratorn with a wingspan of 12 feet (both related to the condors and vultures) to the smallest hummingbirds [9]. Other birds included flamingos, storks, shelducks, condors, vultures, hawks, eagles, caracaras, lapwings, thick-knees, jays, cowbirds, and blackbirds. The biodiversity of the land and air was matched by the fish species and with large numbers in the streams and lakes. There were at least 20 species of fish including whitefish, cisco, trout, chum, dace, shiner, sucker, and sculpin [9]. The fish species traveled widely across the Great Basin through a variety of interconnected lakes and streams. The massive late Pleistocene Lake Bonneville was a central portion of this hydrological network supporting fish species, and by implications of great biodiversity in flora and fauna (Figure 2).

FIG 2

Figure 2: Pleistocene Lakes in the western Great Basin [9]

Grayson concluded his analysis with an ecological assessment of the late Pleistocene natural conditions in the Great Basin region. “The large number of species of vultures, condors, and teratorns in the Late Pleistocene Great Basin raises a number of interesting ecological questions…the fact that there were so many species of these birds here suggests that the mammal fauna of the time was not only rich in species, but also rich in number of individual animals” [9]. Paleo- Indian populations were also well supported by this bounty of nature.

This Native American analysis of heritage playas is based on tribally approved public ethnographic findings derived from two major U.S. federal level environmental impact studies, generally referred to as either an Environmental Impact Study (EIS) or an Environmental Impact Assessment (EIA). Both EIAs were considered nationally important and referenced a Legislative EIS or a Programmatic EIS. The first study involves the US. Air Force and a Congressional review of a proposal to expand the Nevada Test and Training Range (NTTR) managed by the Nellis Air Force Base (Figure 3). The study involved three proposals for withdrawing lands from other federal agencies and adding them to the NTTR. Congressional review was required because the proposals involve multiple federal agencies and only the Congress has the authority to make these decisions [10]. The final report was called a Legislative EIS (LEIS).

FIG 3

Figure 3: Legislative EIS Proposed Withdrawn Study Areas [11]

The second study involved a Solar Programmatic EIS of nine proposed large-scale energy developments centered on large playas [12]. The playas are located on lands managed by the U.S. Bureau of Land Management (BLM) (Figure 4). These study areas were identified by a scientific team who suggested that establishing the social zones on playas was most effective. These areas were already managed by the federal government and the playas were largely devoted to natural and cultural resources [13]. The involved American Indian tribal governments and their appointed cultural representatives participated in the Solar PEIS to explain the meaning and cultural centrality of the plants, animals, spiritual trails, healing places, and places of historic encounters that exist in these playa lands.

FIG 4

Figure 4: Solar Map [12]

Both studies were funded by the involved federal agencies (U.S. Air Force and Bureau of Land Management) and conducted by a research team from the School of Anthropology at the University of Arizona, Tucson, AZ. These two large scale environmental impact assessments involved extensive and ancient playas occupied since the late Pleistocene by Native Americans. Formal government-to- government consultation with the participation of culturally affiliated Native American tribes was a foundation for each study. Each tribe selected representatives for field interviews and reviewed and approved the resulting ethnographic findings and recommendations.

Methods

The study areas of the LEIS and Solar PEIS were defined by the management agencies, but the University of Arizona ethnographers were asked to send invitation letters for study participation to culturally affiliated tribes. Those tribes interested in participating in the study were subsequently invited to participate. Each participating tribe had experience with the UofA ethnographic study team, so the parameters of the study were both clear and understood. The UofA methods have been published elsewhere (Stoffie 2007; 2000). The study methods were developed with participating tribal elders and tribal cultural departments.The following table cross-references participating tribes and the studies involved in this analysis. The reviewed and tribally approved research findings are available at Solar PEIS [12,13] and LEIS Websites [11] (Table 1).

Table 1: Cross-Referenced Chart of Tribes to Ethongraphies

TAB 1

In all studies, participating tribes selected culturally knowledgeable elders to visit the study area. Elders were provided Per diem, lodging, and transportation during the fieldwork. The timing and location of the site visits were influenced by the physical condition of elders. As a rule, up to 3 hours were available at each study site and all elders were provided with a confidential interview. The report text was written by the UofA study team and then sent to elders for review, corrections, and approval. Once the elder study team approved their text, it was sent to their tribal government who checked the text to be assured it did not contain confidential cultural knowledge. In all cases, the findings were available in final public report [12].

Playas as Heritage Places

The following are research studies where ethnographic interviews have been conducted with the permission of culturally affiliated tribal governments regarding their connections to a playa. The cases have been selected because they are both comparative and contrastive, thus providing a variety of cultural perspectives on the meaning of playas. We assert that the resulting database provides a solid foundation for an ethnographic statement on Native people and heritage playas.

Desert Lake Playa

Desert Lake Playa was observed and discussed by tribal representatives during field visits as part of the LEIS (Figure 5). It was said by tribal representatives that Desert Lake is a portal through which power flows and connects to other locations, people, and living ancestors of this sacred land [14]. These larger connections of the lake include the Southern Paiutes to the south and east and Shoshones to the west and north.

FIG 5

Figure 5: Location of Desert Lake Playa in LEIS Area 3c Proposed Withdrawal from the Desert National Wildlife Refuge.

A central pilgrimage trail documented by LEIS tribal representatives passes through a topographic constriction called Eagle Head and then connects with Desert Lake Playa (Figures 6 and 7). From the playa, the trail goes to other sacred features to the north and south [14]. Nuvagantu or Mount Charleston to the south, in the Spring Mountains the primary origin mountain range for Southern Paiute peoples, and Coyote’s Jar, or Pahranagat Valley to the north, a second origin location for Pahranagat and Moapa Paiutes, indicate a significance of the area tied to the oral histories of Native American people [16]. Visiting representatives identified the playa as the destination place, while others described the trail as a connection to their origin spots.

FIG 6

Figure 6: Satellite Picture of the Desert Lake Playa South along the Pilgrimage Trail from Eagle Head Gap [15].

FIG 7

Figure 7: Places along a pilgrimage trail that both goes to and passes through Desert Lake Playa.

A proposal to improve the Alamo Road, which crosses a portion of the Desert Lake Playa, created an EIA project study area of 322 acres of archaeology inventory and three backhoe trench excavations [17]. Seven archaeological sites were recorded, two of which were recommended as eligible for the National Register of Historic Places. This archaeology study documents that the area was occupied from the Middle Archaic to the Late Ceramic periods. Further carbon dating suggests occupation dates of 6970 BP and 2000 BP. The study is important to this analysis because it documents temporally old Native presence in the wetlands that formed around Desert Lake. Ethnographic interviews concluded that Desert Lake Playa is a Culturally Sensitive Area and a Scared Site and should be nominated to the National Register of Historic Places [14] as a Traditional Cultural Property (TCP) under Criterion D: history of yielding, or potential to yield, information important in prehistory or history. The ethnographic study concluded that for a very long time, the Desert Lake Playa developed a lush environment with a plentiful water source for the fauna and flora. As the playa gradually dried, Native American people continued to visit the playa feature, leaving offerings that remain today as archaeological investigations have determined. The connection between the Desert Lake Playa and a traditional pilgrimage trail to the north and south is a critical component of this history of Native American use, as are oral histories about spiritual beings that reside in playas even after the water has gone. Not only does the playa yield information about its cultural uses, but it also holds evidence of climate fluctuations that otherwise impacted the aboriginal communities throughout the broader landscape. The playa is considered a functional and thus still active portal to other dimensions.

Big Smoky Valley

A single study is useful because it produces ethnographic findings of a people, their culture, and their environment (for more on ethnography see- Agar [18]; Mead [19]). Multiple single comparative case studies become the basis for ethnological findings (for more on ethnology see- Benedict [20]; Lowie [21]). Shoshone tribal representatives were asked to evaluate the cultural importance of resources and places in the southern end of Big Smoky Valley, Nevada [22]. Big Smoky Valley is a north-trending basin within the Basin and Range physiographic province in south-central Nevada. The valley is roughly 567,700 acres and stretches 115 miles approximately 44 miles east of the California/Nevada border, 15 miles northwest of Tonopah, Nevada. The area has been perceived as aboriginal Shoshone lands since the Pleistocene.The environmental assessment of Big Smoky Valley was one of nine study areas considered for the large-scale solar farm to be placed on playa lakes formed during the late Pleistocene [12]. Each proposal focused on a large playa. Tribal consultations and findings were reviewed and approved by tribal government. During fieldwork, tribal representatives expressed deep knowledge of the now largely dry playas, which represented a time when large lakes and wetlands filled the valleys and were the central homes of Native American peoples. Cultural continuity back to the Pleistocene was expressed in each PEIS study.

Lake Tonopah

Central in the interpretation of Big Smoky Valley is a massive late Pleistocene Lake, wetland, river, and stream hydrological system dominated by what is called today ancient Lake Tonopah. This hydrological system supported both complex biodiversity and biocomplexity for tens of thousands of years—possibly since the Pleistocene as did a similar hydrological system centered on Fish Lake Valley and Columbus Marshes to the west [23] (Figure 8). According to their oral history, Indian people forever lived in this productive environment, and it became and continues to be centrally cultural in their lives.

FIG 8

Figure 8: The Big Smoky Valley Landscape and Pleistocene Lake Toiyabe

The watershed of ancient Lake Tonopah extends generally downhill from the north to the south along what is known today as Big Smoky Valley (Figure 8). This enclosed hydrological system is about 62 miles north to south and 21 miles east to west. Prominent mountains and ranges surround the major river, wetlands, and lakes in this watershed. Viewing this watershed anti-clockwise we find Lone Mountain in the southeast. San Antonio Mountains are in the East. Mount Jefferson and Wildcat Peak are high points in the Taquima Mountain Range, which defines the eastern edge of Big Smoky Valley. Round Mountain and Arc Dome are the southern and most visible portions of the Toiyabe Range, which is a portion of the Shoshone Mountains. Ironically the northern portion of Round Mountain is the headwater of the major north-flowing Reese River. The southeast side of Round Mountain contains Peavine Canyon, out of which flows the Peavine River. Royston Hills and Big Smoky Mountains define the watershed in the west as does the Monte Cristo Range in the southwest. Water flows off the slopes of all these mountains and hills, but Peavine River is the prominent hydrological feature today, as it flows down slope along the entire Big Smoky Valley to the current site of ancient Lake Tonopah. This hydrological system was a cultural and natural center in the lives of many Shoshone people for thousands of years.

While many individual resources and historic events were identified as significant in the Big Smoky Valley, this land was especially identified as the Origin place for the Shoshone people [22]. In ethnographic interviews, the Shoshone tribal representatives stipulated that because they have lived in these lands since the end of the Pleistocene and throughout the Holocene (or approximately 37,000 BP), they understand the dramatic shifts in climate and ecology that have occurred over these millennia.

Crescent Dune

Native American lifeways were dramatically influenced by natural shifts, but certain religious and ceremonial practices persisted unchanged. These traditional ecological understandings are carried from generation to generation through the recounting of origin stories occurring in mythic times and by strict cultural and natural resource conservation rules. At the time of the late Pleistocene, Big Smoky Valley was a wetland dominated by lakes, streams, and marshes. One Shoshone elder remembered that wetter, late Pleistocene landscape:

Just up the valley, from talking with elders and stuff, that’s where the Shoshone people started. That’s their Creation point. From there, they dispersed out into the north, south, east, and west. That’s where all the Shoshone came from, Smoky Valley, Monitor Valley. But then again, if we look at the stories, the people and the earth, they talk about a migration over water. We see that when the water skipper brought the coyote back with his little basket full of children that he made, they’re coming over water. Maybe these archaeologists have it wrong when they say that the people walked on the land. In out stories, they talk about coming over on a boat. I guess it would be a boat, if you look at the analogies. Again, we’re going back to the time when the animals talked, they conversed with each other, interacted with each other, and had ability to have children with each other. This is basically the Creation story, what I’m sharing with you. I listen to the Southern Paiute story and they talk about the Ocean Woman. You know, if you look at them, theirs is similar to ours, tied with the water. They’re the same as us. They didn’t come over walking, marching on the land like people think. They came over on the water. So we came over here in the time where this was all under water [22].

Although the climate has shifted, steams, seasonal playas and springs still dot the landscape and Shoshone use of the landscaped adapted to the drier conditions of the post-Pleistocene period. Streams originate in the mountains and at the base of the surrounding mountains and foothills, while springs provide water and luscious landscapes. Water occupies an important cultural role in the lives of Shoshone people. Natural water sources, called gwizho’naipe or life- producing water [24], play a large function in crucial rituals as well as day to day life. According to one elder:

Smoky Valley stands out. The whole valley is connected. The sand dunes and White Mountains stand out. I’m from the mountains so the mountains stand out. I was raised in the mountains so I’m a mountain person. 10,000 years ago, there was a big old lake right here where we’re sitting on [22].

In addition to the now seasonal and perennial lakes and streams, traditional Native American use of spiritual places persist. These include, for example, Crescent Dune, which is located in and around the playa with its own ecology today of pure sand and special plants. In Figure 9, Crescent Dune is viewed along with a large deposit of sand and Indian Ricegrass (Oryzopsis hymenoides), which is an ancient Native American food seen growing around Crescent Dune.

FIG 9

Figure 9: Crescent Dune in Big Smoky Valley

The dune rises above the valley bottom providing both a place of solitude and elevated viewscapes. Native traditional knowledge of sand dunes is extensive, and it is discussed in many of our ethnographic studies including the PEIS interviews of Big Dune on the Pleistocene Amargosa River in Nevada [25]. Dunes associated with Pleistocene lakes are understood as being a topographic feature placed at Creation for spiritual renewal and healing. According to a tribal representative, the Dunes Sing to Native people and convey information needed for ceremony. These dunes have eyes to watch over the land and a voice to share its messages in the songs that it sings and the stories it continues to tell our people ever since the beginning of time [25].

Escalante Desert

The Escalante Desert (Figure 10) is the southern portion of the extensive Pleistocene Lake Bonneville that continuously extended from Idaho to southern Utah [26]. The remains of Lake Bonneville are massive salt flats and the Great Salt Lake of northern Utah. Lake Bonneville filled its component lakes with sand, minerals, and salt which became the bottom of remnant playas like those in the Escalante Desert (Figure 11).

FIG 10

Figure 10: Escalante Desert with Wasatch Mountains to the east

FIG 11

Figure 11: Pleistocene Lake Bonneville with Southern End Filling What is Now Escalante Desert, Iron County Utah [22].

The Escalante Desert American Indian study area was traditionally occupied, used, aboriginally owned, and historically related to the Numic-speaking peoples of the Great Basin and western Colorado Plateau. This American Indian study area extends beyond the boundaries of the study area because of cultural resources in the surrounding landscape. The Paiute Indian Tribe of Utah (PITU) and the Confederated Tribes of the Goshute Reservation (CTGR) participated in the Solar PEIS field consultations to represent the cultural interests of Numic peoples. These Numic-speaking peoples have gone on record in past projects and stipulate again here that they are the American Indian people responsible today for the cultural resources (natural and manmade) in this study area. Their ancestors were placed here by the Creator, and they have subsequently lived in these lands while maintaining and protecting these places, plants, animals, water sources, and the cultural signs of their occupation. These Numic-speaking peoples further stipulate that because they have lived in these lands since the end of the Pleistocene and throughout the Holocene, they deeply understand the dramatic shifts in climate and ecology that have occurred over these millennia. Indian lifeways were dramatically influenced by these natural shifts, but certain religious and ceremonial practices continued unchanged. These traditional ecological understandings are carried from generation to generation through the recounting of origin stories occurring in Mythic Times and by strict cultural and natural resource conservation rules. PITU and CTGR have participated in this PEIS in order to explain the meaning and cultural centrality of the plants, animals, spiritual trails, healing places, and places of historic encounters that exist in these lands.

Escalante Desert (Figure 12) is named after the 1776 Spanish Fathers Escalante and Dominguez Expedition who became the first European to document the valley and the Native people living there (Figure 13). The expedition had followed well-traveled Native trails in an attempt to reach the Pacific Coast of North America. They failed, however, in this goal and turned back at the prominent hot spring in the valley. They returned via an alternative set of trails and would document the massive 1780 smallpox pandemic at Hopi on their journey to the northern New Spanish capital of Santa Fe. Because it was a government sponsored and formally approved expedition a gifted map maker was a part of the hundreds of participants.

FIG 12

Figure 12: The Escalante Desert, Utah is Generally Bounded by Enterprise in the South, Cedar City in the East, Lund in the North, and Modena in the West (Google Earth).

FIG 13

Figure 13: Escalante and Dominguez Expedition Map [22]

The Solar PEIS consulting tribes desired to be formally contacted on a government-to-government basis whenever projects or proposed land management actions occur on and/or near the following culturally special topographic places and features such as viewscapes, mesas from volcanic eruption, animals, and cultural plants for medicine and ceremony (Table 2). Points of contact with Euro Americans are remembered for their devastation due to diseases, armed conflicts, the arrival of grazing animals which ate Indian gardens and horticultural plants, and eventually settlement and physical removal from water and land.

Table 2: Table of Type and Names of Culturally Significant Topographic Features and Places

TAB 2

A few of these cultural places and features are indicated in this map (Figure 14) that identifies their spatial relationships with each other. Their temporal relationships are hundreds of thousands of years apart. Some of these are briefly discussed in this analysis to illustrate the heritage complexity of Escalante Desert.

FIG 14

Figure 14: Map of Special Cultural Features Considered in This Analysis [22]

Eagle Rock Ceremonial Complex

Eagle Rock is a translation of a Paiute name for an ancient healing rock. It is visually connected to the Escalante Deseret, which can be seen to the east from a landscape photo (Figure 15). The healing rock is spiritually connected though the Puha energy of the prominent mountain peak nearby, which is used for vision questing and restoring medicine songs. Next to Eagle Rock is Mountain Spring, which is used for bathing and water related plants. Nearby is Sulphur Spring, which is for purification before and after ceremony and healing.

FIG 15

Figure 15: Eagle Rock looking east to the Wasatch Mountains

According to an elder, Indian people came to this location from great distances to conduct important ceremonies. Eagle Rock, a famous doctor rock (Figure 16), was identified by tribal representatives as a key cultural feature in the Escalante Valley. Tribal representatives linked Eagle Rock to places such as Sulphur Springs, Mountain Spring Peak, and Mountain Spring and they thought these areas formed a large ceremonial complex. Tribal representatives described this as a traditional area used by Southern Paiute Puha’gants (shamans) and most likely Goshute shaman to tend to people who were ill and in need of rebalancing and healing. The Puha’gants would conduct complex healing ceremonies that could only be performed in a place of Puha, such as a doctor rock.

FIG 16

Figure 16: Eagle Rock Looking West with Mountain Spring in Background

According to an elder, rain and snow run-off from the mountains to the northwest also flow into the Escalante Valley. It is important from a Numic perspective to understand the hydrological system in this region. The flow of Puha follows the flow of water across a given landscape and connects places, people, and other elements. As water drains from the mountains in and around Eagle Rock and Mountain Spring Peak (each a place with high concentrations of Puha), the water and the Puha flow into the valley, connecting them with places like Table Butte, located to the southeast of the valley [22].

Thermo Hot Spring

These springs have been the center of activities in the immediate area since time immemorial. The hot springs are unique because they are located in the center of a valley instead of lying in a more typical location along the fault at the base of an uplifted mountain range. Thus, the Thermo Hot Springs (Figures 17 and 18) have a commanding view of the surrounding region—a 360-degree viewscape that is even further facilitated by the fact that the springs are perched above the surrounding ground by an estimated fifty feet. The views from this location include the Cricket Mountains to the north, the Mineral Mountains to the east, the Black Mountains to the south, and the San Francisco Mountains to the west. To the north is Sevier Lake and to the south is the southern expanse of the Escalante Valley. For millennia, Indian people have traveled to these special hot springs to engage in a variety of ceremonial activities. These activities include the curing of individuals using both the sulfuric muds and the mineralized hot waters. Other Indian people came to the hot spring to purify themselves before going to distant destinations where special activities such as vision quests or ceremonial balancing activities would occur. The hot springs were also visited by Puha‘gants (shamans) to acquire songs and Puha (power) needed to help their communities.

FIG 17

Figure 17: Grasses atop Thermo Hot Springs

FIG 18

Figure 18: Water from Hot Spring Mound

Water from the hot springs is used in healing ceremonies both at the springs and at other locations. Patients would come to hot springs at the instruction of or accompanied by a Puha’gant. Before entering a hot spring, Indian people would speak to the spirit of the spring, introducing themselves, and tell the spirit what type of healing was needed. Indian people have traditionally carried water from hot springs back to individuals who were unable to leave home due to age or illness [27]. Healing places occur at the locations where doctors take patients to conduct healing ceremonies or that doctors go to in order to gain insight into how to heal. Hot springs are recognized as strong sources of healing-Puha that derives from their form and characteristics, such as thermal heat or the location of the hot spring. A Puha’gant is required to facilitate the healing. Powerful minerals like paint and obsidian are used in the ceremony to assist in the healing. Hot springs are places of mixed power. Hot springs, like all water, were created for expressed and varying purposes. They can be embedded in powerful rivers, like the Pumpkin Springs in the lower Grand Canyon, canyons, like those in the Gold Strike Canyon [28], and small rivers, like those along the Virgin River near Hurricane, Utah [27]. Numic elders have stated that hot springs were also used by shamans for ritual purification prior to visiting sacred caves, valleys, or other spiritual locations, such as Parowan Gap. Such purification was necessary in order to prepare the mind and body for a safe and proper interaction with spiritual beings.

Parowan Gap

Parowan Gap (Figure 19) is a portal to the valley and the ceremonial places it contains. Before entering, prayers were made, and permission was requested. These ceremonies occurred because the valley is itself a living being with rights. This valley was a home to people. Like here and there, something attracted people to certain places where they could find medicine or food or things like that. That‘s what all these mountains and flats produced for those people. The times have changed things. Even if it‘s invisible, it changed. And the people start to change their ways without realizing or some of the times, they were forced to change. And the dances, like I said, ask for blessings for more wildlife and plants. They still have those dances [to keep the world in order]. Yeah they had round dances and certain times, like early in the morning, they’d have a sunrise ceremony. That’s when they thank the Mother Earth when the sun is coming up. They’d get a bucket of water and drink a little while they’re praying. They do that with an eagle feather usually. So a lot of Indian people are still very serious about doing those ceremonies, preserving our relationship with the earth [22].

FIG 19

Figure 19: Parowan Gap

Parowan Gap is one of the ceremonial places identified in the valley by Southern Paiute tribal representatives. People on pilgrimage (Puhahivats) would travel through Parowan Gap as part of the ceremonial process to and from areas out in the Escalante Valley. The gap between the volcanic ridge is a place where Puha collects, and it serves as a physical and spiritual transition zone between the Southern Paiute communities and the sacred areas out in the valley. The Parowan Gap trail follows the natural waterways and passes through the narrow and constricted opening in the Red Hills. Narrow spaces such as this contribute to the overall cultural meaning of physical and spiritual trails, especially to the Puhahivats moving along them to reach a pilgrimage destination place [29-31]. It is in these constrictions that Puha concentrates as a result of geological barriers.

A PITU Tribal Representative Explains How Parowan Gap Functioned for Puhahivats

Yeah, this is a gathering place, coming through, this is a main travel route. As a destination they used to stop here; this is where they used to have the houses, right through here and on top. They used to have different places where the medicine men would pray. It‘s a long climb up there. When I was here when I was growing up, I heard that some old fellas a long time ago found some gold up there inside one of the hills up there. Apparently, way in there someplace. They found the gold up there and they took it out and took it home, then came back to get some more and couldn‘t find it. It disappeared. Someone had put the gold there [as an offering]. Yeah, in a little sack or something [22]. Parowan Gap is associated with a Southern Paiute Creation story that explains the existence of a gap in the middle of the volcanic ridge and the presence of thousands of rock peckings and rock paintings (tumpituxwinap) (Figure 20). Places with tumpituxwinap are areas used by religious specialists during ceremonial activities, because these rock peckings and paintings are believed to be derived from supernatural authorship. According to the Southern Paiute Creation Story, the rocks were once people, and they became rocks for the benefit of humanity. The images on the rocks are related to this transformation and are part of the living universe. Southern Paiute people hold strong beliefs that the rocks are alive, have Puha, and spiritual value.

FIG 20

Figure 20: Rock Peckings in Parowan Gap

The peckings are used by religious specialists during ceremonial activities because these rock peckings and paintings are believed to be derived from supernatural authorship. According to the Southern Paiute Creation Story, the rocks were once people, and they became rocks for the benefit of humanity. The images on the rocks are related to this transformation and are part of the living universe. Southern Paiute people hold strong beliefs that the rocks are alive and have Puha and spiritual value.

Discussion

The previous ten ethnographic studies document that playas are culturally central heritage places for participating Native American tribes. The studies also document the cultural connections between the playas, their host valley, and the surrounding mountains that have provided water to the valley bottoms since the Pleistocene. Combining the playas, the valleys where they are located, and the surrounding mountain provide a heritage assessment framework for a holistic understanding of why and how Native Americans are culturally attached to this complex landscape. These study observations are consistent despite cultural and linguistic differences between the eighteen participating tribes.

These ethnographic studies specifically document that a holistic heritage assessment centered on a large playa will typically involve the following:

  1. A persistent Pleistocene Lake that is the center of this heritage landscape and the source of the salts and minerals that compose the playa.
  2. A residual wetland surrounding the Pleistocene Lake regardless of whether it is shrinking or expanding due to climate shifts.
  3. An overflow river that connects places along the playa valley which connects it with other similar valleys during wetter periods but continues to serve as a traditional path for both the normal movement of people and subsequent ceremonial movement. It does this because puha tends to flow along extant and ancient waterways.
  4. A large singing sand dune that often existed before the end of the Pleistocene because it was derived from and even older intervals of climate change and glacial shifts.
  5. An origin place or mythic time portal located at a self-voiced perturbance such as a volcanic outcrop or hot spring which was defined in the valley or along its edges at Creation for the use of Native peoples.
  6. An abundance of animals and plants that have occurred and are missing today like Mammoths and Saber Tooth Tigers but are remember and continue to be a spiritual presence.
  7. An abundance of animals and plants that have become increasingly spiritual such as the horned toad as the valley becomes dryer.

A tribal representative from Pahrump and Timbisha, during the Amargosa River PEIS study [25,32] provided an understanding of the cultural meanings associated with playas and their surrounding heritage landscapes. These are paraphrased below:

Geologic resources include a range of culturally significant features such as minerals used as paint sources, salts used in curing, quartz deposits used to make tools, volcanic basalt boulders used to hold the prayers of travelers, mountain tops used for vision questing, and fossil evidence of rivers used as devices for teaching about the past. All these geologic resources are alive according to the shared epistemology of our Numic-speaking peoples. The Creator made geologic resources alive by placing Puha in them when the Earth was formed. Today the geologic resources discussed here in Amargosa River Valley all have a place in the lives and history of Indian people.

Federal agencies are beginning to recognize the presence of Native people in these Pleistocene ecosystems. This is appropriate because the scientific dating of Native people in these areas extends now to about 40,000 BP thus placing people and megafauna and massive wet ecosystems together. White Sands National Monument is such a federal response, and it has illustrated this shift in perspective with paintings of Native people and the animals and ecosystems of the heritage past (Figure 21).

FIG 21

Figure 21: Human & Animals Trackway, Printed with permission of Karen Carr 2024 [32]

Native Americans involved in our ethnographic studies have asserted that the image above accurately represents their oral history of these ancient times. Of importance are the heritage implications of ancient places, animals, plants, springs, and now dry lakes and rivers being celebrated by land managers museums, geoarchaeologists, and of course, the ability of new generations of Native people to be connected with their lives in Time Immemorial.

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fig 1

Safety Practice and Associated Factors among Waste Handlers at Selected Government Hospitals in Somali Region, Eastern Ethiopia: A Hospital Based Cross- Sectional Study

DOI: 10.31038/PSYJ.2024634

Abstract

Background: Healthcare waste is produced from various therapeutic procedures in hospitals, such as chemotherapy, dialysis, surgery, delivery, resection of gangrenous organs, autopsy, biopsy, and injections, and most of the wastes are toxic, harmful, carcinogenic, and infectious materials. Medical Waste handlers faced massive exposure to hazardous waste and occupational accidents as a result of manual handling of waste and working under unfavorable conditions. There are limited studies and updated information concerning these issues in the country.

Objective: To assess safety practice and associated factors among waste handlers at public hospitals in Somali Region, Ethiopia.

Method: An institutional-based cross-sectional study was carried out among 417 waste handlers in selected public hospitals from June 15 to July 15, 2021. Data were collected from respondents by using a simple random sampling technique. The collected data were entered into Epi-data 3.1 software and exported to SPSS 20 for analysis. Bi-variable analysis was done, and variables with p-values below 0.25 were identified as candidates for multi-variable analysis. Then multi-variable analysis was done, and an adjusted odd ration was computed and interpreted. A p-value less than 0.05 is the cut-off point for determining the significance of the association.

Result: The proportion of current safe practice among public hospital waste handlers was found to be 38.2% (95% CI: 33.2, 43.1). Good availability of safety materials (AOR=9.3; 95% CI: 5, 17.2), Good knowledge (AOR=7.2; 95% CI: 3.7, 14), a positive attitude (AOR: 5.4; 95% CI: 2.53, 11.47), and age group were significantly associated with safety practice.

Conclusion: The proportion of safe practices among hospital waste handlers was found to be low compared to national and international standards. Good knowledge, a positive attitude, a good supply of safety materials, and an age group are the determinants of safety practice. To provide good safety practice, adequate professional support and supervision should be in place to increase their knowledge about safety precautions, and similarly, providing enough safety materials is recommended to strengthen adherence to safety practice among hospital waste handlers.

Keywords

Safety Practice, Determinant Factors, Waste Handlers, Government hospitals, Somali Region, Ethiopia

Introduction

Workers and waste pickers handling solid waste throughout the world are exposed to occupational health and accident risks related to the content of the materials they are handling, emissions from those materials, and the equipment being used [1]. About 85% of wastes produced in health facilities are non-hazardous, and the remaining 15% of health care waste is characterized as hazardous and can pose a number of health risks [2,3]. Waste handlers are often at higher risk than health care professionals. Because healthcare professionals produce the waste and throw it in the garbage. However, waste handlers handle it extensively throughout, and mostly very little attention is given to their safety [4]. Medical waste handlers are working in a very poor and unsafe working environment, and mostly they are victims of occupational health hazards from poor safety practices [5]. The prevalence of needle stick injuries, sharp injuries, and blood and body fluid splashes among hospital waste handlers is higher because of the lack of personal protective equipment while on duty and inappropriate waste segregation practices [6]. The occupational safety of health care waste handlers cannot be overlooked because health care waste handlers are at constant risk of exposure to blood-borne pathogens .In Ethiopia, we have a set of Standard Precautions for health safety practices that have been demonstrated to be effective in reducing the occurrence of adverse healthcare events. Additionally, the set can help medical waste handlers and healthcare providers assess the degree to which safe practices have already been implemented in their settings and the degree to which the practices provide tangible evidence of the medical waste handler’s safety improvement and increased patient satisfaction and loyalty [7].

Worldwide, information on the spread of infections resulting from waste handling is limited. Studies from developed countries have shown that occupational exposure to waste may result from exposure to various work hazards [8]. There are studies showing different health complaints, such as respiratory problems [9,10], increased risk of hepatitis A and B [11,12] and skin diseases [13], for people working in waste handling. In addition, self-reported risks, including musculoskeletal, fatigue, gastrointestinal, and hearing complaints, were also identified [14]. Professional-related risk assessment reports showed that waste collectors had the third highest needle stick injury rate (18.4 per 1000 per year) and the second highest other sharps injury rate (7.1 per 1000 per year) compared with healthcare workers [15]. One study showed that each year, waste collectors reported 50–100 puncture wounds as a result of collecting medical waste from private medical practitioners and from the disposal of needles by drug addicts [16].Health care waste should be collected and transported in a safe way to avoid unnecessary exposure [17,18]. But about 58.8% and 41.2% of waste handlers were exposed to blood and body fluids due to carrying overfilled waste bags, which increase the risk of infection for different pathogens like HBV, HCV, and HIV/AIDS, and about 47% of medical waste handlers, had at least one accidental Sharp injury because of improperly discarded needles and sharp materials [19,20].Unavailability or shortage of personal protective devices aggravates the risk of acquiring infection while exposed to hazardous wastes (5). Waste handlers usually do not wear sufficient protective clothing during waste handling, which increases the potential risk of accidents .Inappropriate collection, storage, processing, transport, and handling of the health care waste exposes the staff of the facility, patients, and their attendants to the risk of serious health hazards. Many healthcare facilities in developing countries dispose of their waste in dustbins along with general waste; some even re-use sharps and syringes, thereby increasing the risk of transmission of infections [21].

Even though the impact of healthcare waste on healthcare workers is well described globally [22], less attention is given to waste collectors, and countrywide official statistical data do not address the health and working conditions of waste handlers [23].The study done in Eastern Ethiopia also showed that 30% of waste handlers were exposed to any sharp materials due to improper handling, poor waste segregation, and poor utilization of personal protective equipment (5). Waste handlers in Hawassa city in south Ethiopia have reported that they have experienced needle-stick injuries at least once in their lives at the different healthcare facilities, ranging from 25–100% [24,25].Studies in developing countries, including Ethiopia, indicate that there are limitations on safe waste handling practices among health care waste handlers due to different factors. However, there are few studies conducted regarding the prevalence of safety practices among hospital waste handlers in Ethiopia, and less attention is given to the prevalence of safety practices and factors exposing waste handlers to possible injuries and accidents. Hence, the intended study will determine the prevalence of safety practice and its associated factors among hospital medical waste handlers, which in turn will enable us to understand the overall situation of safety practice and minimize those factors that hinder the safety practice of hospital waste handlers.

Methods and Materials

Study Area and Period

The study was conducted in the Somali region, which is the second-largest and easternmost of the ten regions. The regional state borders the Ethiopian states of Afar and Oromia and the chartered city of Dire Dawa to the west, as well as Djibouti and Somalia to the south and north-east. Based on the 2007 census conducted by the central statistical agency of Ethiopia, the Somali region has a total population of 7,445, 2219, consisting of 3,472,490 men and 3,972,729 women. Urban inhabitants’ number 1,489,044 or 20% of the population and a further 5,956,175 or 80% were pastoralists and farmers. This region has an estimated density of 20.9 people per square kilometer in an area of 279,252 square kilometers. The region is divided into six councils and 93 districts for administrative purposes. The Somali Regional Health Bureau is responsible for the overall Health activity in the region.

There are Ten Primary Hospitals, Two General hospitals, and One Referral Hospital in the Somali region, namely, Dagahbour Primary Hospital, Qabri Dahare Primary Hospital, Warder Primary Hospital, Filtu Primary Hospital, Dollo Ado Primary Hospital, Raso Primary Hospital, Hargelle, Sitti/Biki Primary Hospital, Gashamo Primary Hospital, Fik Primary Hospital, Karamara General Hospital, Godey General Hospital, and Jig-jiga University. Sheik Hassen Yabare Referral Hospital, respectively, and the major common services given by those general hospitals and referral hospitals are maternal and child health services, prevention and control of major communicable diseases, non-communicable disease prevention and control, emergency services, laboratory services, and operational services. Generally, in the Somali region, there were approximately 710 medical waste handlers working in government hospitals. In selected hospitals, there were around 458 medical waste handlers. The study was conducted from June 15 to July 15, 2021, at public hospitals in the Somali Region and Eastern Ethiopia.

Study Design

Hospital based cross-sectional study was employed.

Source Population

Source populations were waste handlers working in Somali region public hospitals.

Study Population

All selected waste handlers working in the selected public hospitals during study period.

Inclusion Criteria

All waste handlers were enrolled in the selected government hospitals, present on duty during data collection period.

Exclusion Criteria

Waste handlers who were absent during the time of data collection and those with hearing impairments.

Sample Size Determination

Sample Size Calculation for the 1st Objective

The sample size for the first objective had been determined using the single population proportion formula by considering the prevalence of safe practice as 44.1% [26,27] from a previously conducted study on safety practice among waste handlers in Adisababa city administration public hospitals in central Ethiopia. Hence, assuming a 5% marginal error (d), a 95% confidence level (alpha=0.05), and the sample size for the first objective, it can be calculated as follows:

FOR

n=required sample size

Z=the standard normal deviation at 95%confidence interval=1.96

P=expected proportion (44.1%)

d=margin of error that can be tolerated 5% (0.05)

1-p=proportion of population that do not possess the character of interest.

Therefore n=(1.96) ^2 .0.441(1-0.559)=379

(0.05) ^2

=379 and by adding 10% non-response rate 417 was the sample size for the 1st objective.

Sample Size Calculation for the 2nd Objective

Sample size for specific objective 2 was calculated using the statcalc for sample size and power for cohort or cross-sectional studies of Epi Info version 7, considering the following assumptions (Table 1):

Therefore, from the calculated sample sizes for both objectives, the maximum sample size from the first objective, 417, was taken as the study sample since it covers the two objectives.

Table 1: Sample size determination for second specific objective using some important factors of safety practice

Factor

Cl Power (1-β) Ratio Proportion of outcome among exposed Proportion of outcome among un-exposed OR

Sample size(n)

Good Knowledge (27)

95%

80% 1 (Good) 53.3% (Poor) 24%  

3.57

 

100

Received Training (28)

95%

80% 1 (Trained) 73% (Not trained)53% 2.39

202

(Yes) Availability of colour coded bin (29)

95%

80% 1 (Yes)74.2% (No)31.1% 6.3

50

Sampling Technique

There are Ten Primary Hospitals, Two General hospitals, and One Referral Hospital in the Somali region; Three Primary Hospitals and One General Hospital were selected by lottery. Whereas the referral hospital was selected purposefully. Then the calculated sample size was proportionally allocated to each selected hospital based on the number of total medical waste handlers they had. To determine the total number of participants from each selected health facility, a computer-generated simple random sampling technique was used.

Sampling Procedure

Sampling procedure is shown in Figure 1.

fig 1

Figure 1: Schematic presentation of sampling procedure of waste handlers at selected government hospitals in Somali Region, Ethiopia 2021.

Data Collection Tool and Procedure

The data was collected by the interviewer through a structured questionnaire. A structured questionnaire was developed by the principal investigator after reviewing WHO, FMOH infection prevention guidelines, and different literature with modifications based on research objectives. Prior to the actual data collection, the questionnaire was adjusted and corrected based on the pre-test result, and the final questionnaire was translated into Somali and then back to English to ensure its consistency. Finally, one environmental health scientist and two public health professionals conducted face-to-face interviews to collect the data using the Somali version questionnaire.

Variables

Dependent Variable

Safety practice (Safe/Unsafe)

Independent Variables

Socio-Demographic and Economic Factor

  • sex
  • Age
  • Marital status
  • Educational Status
  • monthly income

Work Related Factors

  • working hours per day,
  • working departments/units,
  • Work experience

Waste handlers risk perceptions

  • Attitudes
  • Knowledge about safety practice

Organizational factors

  • Training,
  • Supportive supervision,
  • Availability of equipment’

Data Quality Control

To maintain the quality of the data, adequate training was given to data collectors and supervisors for three days on the techniques of data collection. The questionnaire was pre-tested by taking 5% of the study sample at one of the selected hospitals. The collected data was checked for completeness and consistency. Each questionnaire was coded and cleaned. Then the coded and cleaned data was entered into Epi-data version 3.1 software.

Operational Definition

Safety practice is the practice of using personal protective equipment’s such as (heavy duty glove, gown, boots and masks), hygiene, vaccination for HBV and appropriate waste segregation with separated bins to prevent oneself from disease causing microorganisms.

Waste handlers are cleaners that are involved in the handling of medical wastes.

Safe Practice

Respondents who scored more than mean of correct answer for seven practice questions with yes or no answer were classified as safe practiced [28].

Good Knowledge

Medical waste handlers who correctly responded4 and above out of the 7 knowledge-based questions were considered as having good knowledge [30].

Good Attitude

Attitude questions responses were indicated with the three-point Likert type scale of measurement as “         Disagree”, “neutral”, and Agree” and numerical values of 1,2 and 3 respectively were given. The mean score was determined after computing attitude assessing questions[26].

Good Supplies Availability

The presence of supplies like personal protective equipment’s (heavy duty glove, gown, masks and boots), three colour coded bins and hand washing facilities like soap and anti-septic hand rub.

Trained

Waste handlers who got any types of training concerning safe waste handling.

Data Processing and Analysis

The completeness of the data was checked manually and coded accordingly. The coded and cleaned data was entered into the computer using EpiData version 3.1 and exported to SPSS version 20. After completion of data entry, it was cleaned before analysis. A description of frequency, mean, proportion, and SD was done for the first objective. Binary logistic regression was employed to identify factors associated with safety practices. Initially, bivariate analysis was done, and variables with a p-value below 0.25 were identified as candidates for multivariate analysis. Then multi-variable analysis was done, and an adjusted odd ration was computed and interpreted. A p-value less than 0.05 is the cut-off point for determining the significance of the association. The results of the study were presented in text, tables, and graphs. Multi-collinearity was checked by the variance inflation factor (VIF), and the goodness of model fit was checked by the Hosmer-Lemeshow test.

Ethical Consideration

An ethical clearance letter was acquired from the ethical review board of the College of Medicine and Health Sciences, Jigjiga University, and a permission letter was secured from the regional health bureau and delivered to the public hospital administrations. Written informed consent was secured from each participant. The confidentiality of the information and the privacy of the study participants were maintained. The participation was voluntary, and they had the right to withdraw from the interview if it was not comfortable for them.

Dissemination and Utilization of Finding

The findings will be disseminated to Jigjiga University, the School of Graduate Studies, the School of Public Health, the Department of Epidemiology, the Somali Regional Health Bureau, and those selected hospitals through presentations and printed materials.

Results

Socio–demographic Characteristics and Work Related Factors of Respondents

From the total sample of 417 included in the study. 401 waste handlers were interviewed, with a response rate of 96.2%. The mean age of the study participants was 32.1 (SD 6.1) years, and all respondents were females (100%). About 118 (29.4%) of them were in the age group 31–35 years. Married hospital waste handlers were 220 (54.9%), while 251 (66.1%) were illiterate. The majority of them, 255 (63.6%), had greater than 5 years of working experience, and 235 (58.6%) of them had an income level of 2000 birr per month. Two hundred eighty-four (70.8%) waste handlers were working their job in regular time (8 hours only). As compared with the other departments, the highest numbers of participants (133, 33.2%) and 69, 17.2%) were from the emergency and surgical wards, respectively (Table 2).

Table 2: Socio demographic characteristics and work related factors of medical waste handlers in selected public hospitals in Somali region, Eastern Ethiopia, August, 2021(N=401).

Sn

Variables Category Frequency

Percentage (%)

1 Age ≤25yrs

56

14%

26-30yrs

107

26.7%

31-35yrs

118

29.4%

>35yrs

120

29.9%

2 Marital status Married

265

66.1%

Single

97

24.2%

Widowed

17

4.2%

Divorced

22

5.5%

3 Religion Muslim

296

73.8%

Orthodox

49

12.2%

Protestant

24

6%

Other

32

8%

4 Education level Illiterate

251

62.6%

Primary(1-8)

108

26.9%

Secondary(9-12)

28

7%

Diploma & above

14

3.5%

5 Service year ≤5yrs

146

36.4%

>5yrs

255

63.6%

6 Monthly Income ≤2000ETB

235

58.6%

>2000ETB

166

41.4%

7 Working hours per day ≤8hrs

284

70.8%

>8hrs

117

29.2%

8 Working departments Outpatient

50

12.5%

Emergency

133

33.2%

Laboratory

33

8.2%

Surgical

69

17.2%

Medical

33

8.2%

Pediatric

46

11.5%

Gyne & Obs

28

7%

Other

9

2.2%

Proportion of Safety Practice

The proportion of safe practice in this study was found to be153 (38.2%) with 95% CI: 33.2, 43.1) (Figure 2).

fig 2

Figure 2: The prevalence of safety practice among medical waste handlers at selected government hospitals in, Somali Region, Eastern Ethiopia, August 2021. Safety Practice of health care waste handlers.

About 108 (25.9%) of them wore at least four and above four types of personal protective equipment during the handling of health care waste. where 44 (11% of them) washed their hands at all the selected critical times of hand washing. Two hundred (49.9%) of the waste handlers were immunized for HBV. Among the medical waste handlers who participated in the study, 63.6% separated hazardous and non-hazardous waste during the collection and transportation of hospital waste to the disposal site. Nearly 90% of them used a separated, color-coded bin system during collection. But 265 (66.1%) were mixing waste stored at separate bins during transportation of hospital waste to the disposal site. Only 112 (27.9%) of them asked for decontamination of hazardous waste before disposal.

Among the respondents, 384 (95.8%) had ever had a needle stick injury. 127 (30.1%) of the respondents reported that they use antiseptic hand rub after handling medical waste, and 397 (99%) of the respondents reported that they hadn’t ever received post-exposure prophylaxis for HIV/AIDS. About 17 (4.2%) of the waste handlers had the intention to move medical waste using trolleys in the future.

Only 51 (12.7%) medical waste handlers of the study participants reported that they had been exposed to the blood or other body fluids of patients through contact; 383 (95.5%) of these waste handlers reported that they had ever faced a sharp injury in the last year. Finally, among all waste handlers asked, 153 (38.2%) of them were practicing safely, and the rest (248, 61.8%) were practicing unsafely (Table 3).

Table 3: The prevalence of safety practice among waste handlers in selected public hospitals of Somali region, eastern Ethiopia, August 2021.

Sn

Safety practice Category Frequency

Percentage (%)

1 Wore at least four and above four types of personal protective equipment’s

Yes

108

25.9%

No

293

73.1%

2 Hand washing at five critical time

Yes

44

11%

No

357

89%

3 Immunized for HBV

Yes

200

49.9%

No

201

50.1%

4 use colour coded bine system

Yes

360

89.8%

No

41

10.2%

5 separate hazardous and non-hazardous waste

Yes

255

63.6%

No

146

36.4%

6 Ask decontamination of waste before disposal

Yes

112

27.9%

No

289

72.1%

7 Mix waste stored in a separate bins during transportation

Yes

265

66.1%

No

136

33.9%

8 Ever had needle stick injury

Yes

17

4.2%

No

384

95.8%

9 Have you faced a sharp

Yes

18

4.5%

Injury in the last one year

No

383 95.5%
10 Have you ever exposed to blood or other body fluids of patients through contact

Yes

51

12.7%

No 350

87.3%

11 Ever got post exposure prophylaxis for HIV/ADIS

Yes

4 1%
No 397

99%

12 Move medical waste using trolley

Yes

17 4.2%
No 384

95.8%

13 Do you use antiseptic hand rub

Yes

127 30.1%
No 274

64.9%

Safety practice

Safe practice

153 38.2%
Unsafe practice 248

61.8%

Knowledge of the Respondents Regarding Safety Practice

Concerning knowledge of the study participants 244(60.9%) of the respondents were having knowledge about safety practice (Figure 3).

fig 3

Figure 3: Proportion of knowledge on safety practice of the study participants at selected public hospitals in Somali region, eastern Ethiopia, August 2021.

Knowledge of the Respondents Regarding Safety Practice

Out of 401 respondents, seven knowledge questions with a yes or no answer were asked to assess their knowledge about safety practices. 289 (72.1%) of the respondents knew they were at risk of hospital-associated infections. Nearly 70% of them knew that washing hands with plain soap and water inhibits resident flora, and 68.2% of them knew that gloves should be used not only in anticipation of blood or body fluid exposure. The majority of the respondents (274, or 68.3%) knew being vaccinated for the HBV vaccine was a means of preventing infection. Nearly 60% of them had knowledge of post-exposure prophylaxis. Nearly 61% of study participants had good knowledge (Table 4).

Table 4: Safety practice Knowledge related item responses of the study at selected public hospital waste handlers in Somali region, Ethiopia, August 2021.

Sn

Knowledge Category Frequency

Percentage (%)

1 Are hospital waste handlers are at risk of infections

Yes

289 72.1%
No 112

27.9%

2 Washing hand with plain soap and water inhibit resident flora

Yes

277 69.1%
No 124

30.9%

3 Gloves should be worn if blood or body fluid exposure is anticipated

Yes

276 68.2%
No 125

31.8%

4 Washing your hands with soap and alcohol decrease transmission of infectious disease

Yes

284 70.8%
No 117

29.2%

5 Immunized for HBV is a means of prevention from infections

Yes

274 68.3%
No 127

31.7%

6 Getting PEP with in 72hr of exposure is a means of treatment

Yes

240 59.9%
No 161

40.1%

7 Have you ever heard about safety practice

Yes

293 73.1%
No 108

26.9%

Knowledge about safety practice

Good

244 60.9%
Poor 157

39.1%

Attitude of Health Care Waste Handlers about Safety Practice

A total of 401 respondents were asked five attitude questions with Likert-type scale options ranging from “disagree to agree to assess their attitude about safety practices. The majority of them, 195 (48.6%), agreed that washing hands with soap or alcohol-based antiseptics decreased the risk of transmission of hospital-acquired infections. Nearly 56.1% of them disagreed that gloves provide complete protection against acquiring or transmitting hospital-acquired infections, and 252 (62.8%) disagreed that hand washing is unnecessary when gloves are worn. About 245 (61.1%) of the study participants disagreed that frequent hand washing damages the skin and causes cracking, dryness, irritation, and dermatitis. A total of 235 (58.6%) of the study participants disagreed that hospital waste handlers have a very low risk of acquiring infection from improperly disposed hospital waste. More than 50% (209) of the study participants had a positive attitude towards. Safety practices (Table 5).

Table 5: Attitude about safety practice of public hospital waste handlers in Somali region, Ethiopia, August 2021.

Sn

Attitude Category Frequency

Percentage (%)

1 Glove provides complete protection against acquiring /transmitting infections Disagree

225

56.1%

Neutral

46

11.5%

Agree

130

32.4%

2

Washing hands with soap or alcohol based antiseptic decrease the risk of transmission of hospital acquired infections

Disagree

161

40.2%

Neutral

45

11.2%

Agree

195

48.6%

3 Hand washing is unnecessary when gloves are worn Disagree

252

62.8%

Neutral

22

5.5%

Agree

127

31.7%

4

You have a very low risk of acquiring infection from improperly disposed hospital wastes

Disagree

235

58.6%

Neutral

106

26.4%

Agree

60

15%

5 Frequent hand washing damages skin and causes cracking, dryness, irritation and dermatitis Disagree

245

61.1%

Neutral

58

14.5%

Agree

98

24.4%

Attitude

Positive attitude

209

52.1%

Negative attitude

192

47.9%

Organizational Factors Affecting Safety Practice of Hospital Waste Handlers

Out of 401 waste handlers interviewed, 185 (46.2%) had gained any type of training about safety practices, 177 (44.1%) were supervised regularly by the organization, and 39 (9.7%) had both training and regular supportive supervision (Figure 4).

fig 4

Figure 4: Organizational factors affecting safety practice of hospital waste handlers in Somali region, Eastern, Ethiopia, August 2021.

Availability of Personal Protective Equipment’s among Waste Handlers

A total of 401 respondents were interviewed to check the availability of personal protective equipment in the health facility. From the interviewed respondents, almost 251 (95%) of them responded that gloves were available, while 376 (93.8%) of them responded that gowns were available. Almost 62.6% of them also responded that masks were available. Nearly 14.7% of them answered that caps were available, and 24 (6%) of them responded that goggles were available at the facilities. A few respondents (2.5%) responded that boots were available at the hospitals during the data collection period (Figure 5).

fig 5

Figure 5: Availability of personal protective equipment’s among waste handler in selected government hospitals in Somali region, Eastern, Ethiopia, August 2021.

Factors Associated with Safety Practice

Bivariate Analysis of Socio-demographic Factors Relating with Safety Practice

In this study, there is a significant association between respondent’s age and safety practices. Waste handlers whose age is between 31 and 35 years were 78% times (COR=0.22, 95% CI=0.13, 0.379; P=0.0001) less likely to be safe practiced compared to waste handlers whose age is included in other age categories. Also, health care waste handlers whose age is between 26 and 30 were 87% times (COR=0.13, 95% CI=0.72, 0.24; P=0.0001) less likely to be safe practiced compared to waste handlers whose age is included in other age categories.

The service year also showed a significant association with safety practices. Waste handlers who have worked less than or equal to 5 years were 34% (COR=0.66, 95% CI 0.44, 0.998; P=0.049) times less likely to be safe practiced compared to waste handlers who have worked greater than 5 years of working experience (Table 6).

Table 6: Sociodemographic and work related factors associated with safety practice using bivariate logistic regression at public hospitals in Somali Region, Eastern Ethiopia, August 2021.

Variable

Category Safety Practice COR (95% CI) P-value
Safe Unsafe
Age In Years ≤25yrs

4

52 0.033(0.11-0.098) 0.0001*

26-30yrs

25 82 0.131(0.72-0.237)

0.0001*

 31-35yrs

40

78 0.22(0.13-0.379) 0.0001*

>35yrs

84 36 1.00
Marital status Married

102

163 0.52 (0.22-1.25) 0.145

Single

32 65 0.41(0.16-1.1)

0.06

Widowed

7

10 0.58(0.16-2.1) 0.41

Divorced

12 10 1.00
Education Illiterate

84

167 1.84(0.5-6.79) 0.36

Primary(1-8)

54 54 3.67(0.97-13.88)

0.056

Secondary(9-12)

12

16 2.75(0.63-12.1) 0.18

Diploma & above

3 11 1.00
Monthly income ≤2000ETB

97

138 1.38(0.1-2.1) 0.126

>2000ETB

56 110 1.00
Service year ≤5yrs

55

114 0.66(0.44-0.998) 0.049*

>5yrs

98 134

1.00

Working hours ≤8hrs

103

163 1.1(0.69-1.62) 0.81

>8hrs

50 84 1.00
Working unit Outpatient

15

35 0.54(0.21-0.81) 0.398

Emergency

52 81 0.8(0.44-2.1)

0.75

Laboratory

7

26 0.34(0.17-0.86) 0.17

Surgical

28 41 0.85(0.65-3.1)

0.83

Medical

13

20 0.81(0.67-2.94) 0.79

Pediatric

21 25 1.1(0.5-2.93)

0.95

Gyne & Obs

13

15 1.1(0.43-5.64) 0.92

Others

4 5 1.00

Bivariate Analysis of Associated Variables Relating with Safety Practice

In this study, there was a statistically significant association between knowledge of waste handlers and safety practice. Waste handlers who had good knowledge were 4.3 times safer than those who had poor knowledge (COR=4.3, 95% CI 2.75, 6.75; P=0.0001).

Regarding attitude, there is also a significant association between attitude and safety practice. Respondents who had a positive attitude were 1.66 times (COR=1.66, 95% CI 1.1–2.6; P=0.024) more likely to be safe practitioners compared to respondents who had a negative attitude toward safety practices.

Whereas availability of materials is associated with safety practice, health care waste handlers who had availability of safety materials were 7.1 times (COR=7.1, 95% CI 4.4, 11.46; P=0.0001) more likely to be safe practitioners than those who had a shortage of safety materials (Table 7).

Table 7: Associated variables about safety practice of waste handlers using bivariate logistic regression at government hospitals in Somali Region, Eastern Ethiopia, August 2021.

Safety practice

COR (95% CI) P-value
Variable Categories Safe Unsafe
Knowledge Good 116 104 4.3(2.72-6.75) 0.0001*
Poor 37 144 1.00
Attitude Positive 113 156 1.67 (1.1,2.6) 0.024*
Negative 40 92 1.00
Training

 

Trained 83 111 1.46(0.976-2.19) 0.065
Not trained 70 137 1.00
Availability of materials

 

Good 125 96 7.1(4.4-11.46) 0.0001*
Poor 28 152 1.00

Multivariate Logistic Regression Analysis of Safety Practice among Hospital Waste Handlers in Somali Region, Ethiopia, August 2021

Bivariate logistic regression was done, and variables with p-values <0.25 were selected for the multiple logistic regression analysis, and multicollinearity was checked by looking at the VIF (variance inflation factor) in the linear regression model. In the bivariate analysis, it was found from socio-demographic variables: age group, had a statistically significant association with safety practice (p-value <0.05). From work-related variables, service year was significantly associated with safety practices. Also, the results revealed in the bivariate analysis of the variables, including knowledge, attitude, and availability of supplies, were significantly associated with safety practice.

In multivariate logistic regression, the confounding effect of one variable over the other variables was adjusted. Based on this, age category, knowledge of the participants, attitude, and availability of safety supplies were significantly associated with safety practice at a P-value of <0.05 (Table 8).

The odds of respondents with a positive attitude were 5.4 times more likely to be safe practiced compared to respondents who had a negative attitude toward safety practice (AOR: 5.4; 95% CI: 2.53, 11.47; P=0.05). The odds of waste handlers with good knowledge were 7.21 times safer than those who had poor knowledge (AOR=7.21, 95% CI 3.7–14; P=0.05). The odds of respondents who had availability of safety materials were 9.3 times higher than those who had a shortage of safety materials (AOR=9.3, 95% CI 5, 17.2); p=0.05. The odds of waste handlers with an age category between 31 and 35 years were 81.1% less likely to be safe practitioners than those whose age group was greater than 35 years (AOR=0.189, 95% CI: 0.094, 0.38; P=0.05). The results of the final multiple logistic regression models are found in the Table 8.

Table 8: Result of multiple logistic regression analysis on safety practice among hospital waste handlers in Somali region, Eastern Ethiopia, August, 2021.

Variable

Category Safety practice  COR (95% CI) AOR (95%CI)
Safe

Unsafe

Age in years ≤25yrs

4

52 0.03(0.11-0.098) 0.047(0.014-0.16)*

26-30yrs

25 82 0.13(0.72-0.237)

0.146(0.065-0.33)*

31-35yrs

40

78 0.22(0.13-0.379) 0.189(0.094-0.38)*

>35yrs

84 36 1.00

1.00

Service year ≤5years

55

114 0.66(0.44-0.998) 1.2(0.62-2.34)

>5years

98 134 1.00

1.00

Knowledge Good

116

104 4.3(2.72-6.75) 7.21(3.7-14)**

Poor

37 144 1.00

1.00

Availability of materials Good

125

96 7.1(4.4-11.46) 9.3(5-17.2)**

Poor

28 152 1.00

1.00

Attitude Positive

113

156 1.66 (1.1,2.6) 5.4(2.53-11.47)**

Negative

40 92 1.00

1.00

Discussion

The overall current prevalence of safety practice among hospital waste handlers in this study was 38.2% (95% CI: 33.2, 43.1). The finding was higher as compared with the study done in Shiraz, Iran [31]. This difference might be due to the difference in the study design, setting, and time of the study, as well as the implementation of different reforms by the federal ministry of health at hospitals like infection prevention and patient safety, which were promoting the safety practices of hospital waste handlers.

The prevalence of this study was lower than the prevalence of safety practice among medical waste handlers in Addis Ababa town and with research done in Gonder town among waste collectors, 44.1% (95% CI: 37.3-51) and 45% (95% CI: 40.3-49.4), respectively [26,32]. This difference might be due to the difference in the study setting and time, as well as the implementation of hospital infection prevention protocols. The number of participants with good safety practices reported in the finding was lower than the study done at KwaZulu-Natal (50%) [33]. This difference may be due to the study setting and time. Also, the finding was lower than the findings from Cameroon, in which 100% of the medical waste handlers used all the appropriate protective gear [34]. This difference might be due to the study setting, the difference in knowledge of hospital waste handlers, and the attention given to safety by the governing body. The finding was also lower than the finding from Debra Markos (80%) [35]. This difference may be due to the lower sample size they used.

In principle, all medical waste handlers should properly utilize personal protective equipment during the handling of medical wastes [5]. However, in this study, only 25.9% of medical waste handlers properly utilized personal protective equipment. The result was better than the study done in tertiary care health facilities at Shiraz Iran hospitals, the metropolitan city of Pakistan, and Adis Ababa government hospitals, in which 15%, 22.8%, and 25.2% of waste handlers utilized personal protective equipment properly[26,31,36]. This difference might be due to the implementation of different initiatives by the ministry of health like CASH, infection prevention, and patient safety, as well as an increase in knowledge of hospital-acquired infections among medical waste handlers.

In this study, attitude was shown to be an independent predictor of safety practice among medical waste handlers. The odds of safety practice among waste handlers with a positive attitude were 5.4 (AOR: 5.4; 95% CI: 2.53, 11.47; P=0.05) times higher than those who had a negative attitude. This was slightly higher with the study done in Adisababa [26] which showed that health care waste handlers with favorable attitudes had 4.78 (AOR=4.78, 95% CI 1.64, 13.9) higher safe practices compared to respondents with unfavorable conditions. The difference might be due to the setting in which the study was conducted, the lower sample size they used, and the difference in providing pre-service and in-service supervision to increase their intention for safe medical waste handling.

The odds of safety practice among waste handlers with good knowledge were 7.21 (AOR=7.21, 95% CI 3.7–14; p=0.05) times higher than those who had poor knowledge. This was slightly higher with the study done by DebreMarkos and Adisababa [32,36], which showed that waste handlers with good knowledge practiced safety more than those with poor knowledge. The findings of this study were inconsistent with those of a study done in South India [8]. The difference might be due to the difference in study settings, which were undertaken at a tertiary care hospital, and the sampling techniques they used, which were purposive sampling, which may introduce selection bias, and that the knowledge acquired may not necessarily be translated into practice.

The odds of safety practice among waste handlers with adequate supplies were 9.3 (AOR=9.3, 95% CI 5, 17.2); p=0.05 times higher than those with a lack of supplies. This finding was higher in studies conducted in DebreMarkos and Adisababa [26,37], in which those respondents with adequate supplies had good safety practices. This difference might be due to the attention given by the state health bureau and hospital administration to the fulfillment of the required supplies and inputs. In this study, the age group has shown a significant association with safety practices among medical waste handlers. The odds of waste handlers with an age group between 31 and 35 years were 81.1% (AOR=0.189, 95% CI: 0.094, 0.38; P=0.05) times less likely to be safe practitioners than those whose age group is greater than 35 years. The findings were lower with the study done in Bahardar [38], which showed that respondents in the age group 30-35 years had 4.1 (AOR=4.1, 95% CI: 1.27, 13.4) times more safe practices compared to their counterparts. The difference might be due to the lower sample proportion they used.

Limitation of the Study

The study was conducted only in government hospitals, which do not represent private hospitals. Moreover, since this study was a cross-sectional study, it may not allow for the establishment of a causal link between the factors associated with safety practices.

Conclusion

The result of this study showed that the level of safety practice was low compared to the national and international standards among hospital waste handlers in relation to waste handling and safety, which may increase the chance of getting infected with hospital-acquired infections and occupational infections. So reducing those problems through adequate professional support and supervision should be in place to increase their knowledge about safety precautions, and availing of safety supplies should be implemented to increase adherence to safety practices among hospital waste handlers. This study will also help hospital administrators take appropriate interventions, including providing important PPE, motivating the worker to utilize it properly, and planning to improve the safety practices of medical waste handlers working in public hospitals in the Somali Region.

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FIG 2

Mind-Sets of “Verbal Judo” – How Young Males Respond to Described Interactions between Perpetrators and Police Officers

DOI: 10.31038/ALE.2024111

Abstract

The study focuses on how young males, ages 16-30, in the Virginia area respond to different scenarios of a police officer interacting with a prospective lawbreaker. The scenarios were created by systematic combinations of messages (elements), developed from human experience and artificial intelligence. The deconstruction of the ratings into the part-worth contribution of each of 16 elements showed the degree to which each element would be “listened to” by the prospective lawbreaker, as well as the degree to which the same element would lessen the anger. Three mind-sets emerged. The first mind-set is the police officer who creates empathy, which de-escalates the situation. The second mind-set is the take-charge officer, who clearly senses a developing problem, talks authoritatively. The third mind-set pays attention to community-oriented and empathic policing. These mind-sets represent the way ordinary people, young males, think about the police and what the police do when they read about these different potential crimes and interactions between perpetrators and police. The approach allows us to identify the way young people think about the information that they read. The results show that not everybody is the same and that there may be different strategies about the role of police officers depending upon the nature of that to which a person pays attention.

Keywords

Lawbreaker, Mind-sets, Police officer, Verbal judo

Introduction

The origin of this study can be traced to ongoing work by the authors in the world of working with police officers to figure out how to deal with the public, how to deal with active lawbreakers, prospective lawbreakers, situations which may turn violent, and finally, just as important, how to recruit police officers in a world where certain kinds of social activities have been set up to hamper police officers. The study that was done here concerns what the police officer should say to an individual who looks like that individual will engage in violence. The study is based upon a series of discussions with various police departments, as well as the recognition that there are different mind-sets of criminals. A detailed look through the literature of crime suggests that criminals, those who do violence for example, are not doing it all for the same motive [1-5]. This statement may seem like a truism, and it is to some extent. However, the ramifications of this truism are especially important. We are not dealing here with academic issues which will result in the same outcomes. Rather, we are discussing real-world situations in which violence may take place, in which people may get hurt or even killed. We are looking at a problem which is systemic all over the world, namely the interaction, and perhaps even confrontation, between a police officer and a lawbreaker. Crimes are committed for different reasons. What’s not necessarily obvious is the nature of the motivation of the criminal, and perhaps just as well, the type of communication to which the criminal or at least the prospective lawbreaker might be receptive. Negotiators recognize these differences in the types of language and the types of wording that might be effective, but all too often, such knowledge resides in the mind of the person who has had experience, who has been trained “on the job” through personal interactions.

We would like to bring this effort into the public eye by doing research on what people think will be effective communications [6]. The objective here is not necessarily to have an encyclopedia of those discussions. We leave that to the professionals. Rather, our objective is to use new research techniques, such as Mind Genomics, to discover the types of mind-sets of prospective lawbreakers and their situations in which things happen. And, for both of them to figure out what type of language might be effective as perceived by a person who’s asked to judge the situation.

The science of criminology has long recognized the existence of mind-sets or types of individuals. It could be no other way. People are different in the reasons underlying their commission of crimes or misdemeanors. We all operate within different life circumstances. Can we make a tool that the negotiator in a crime or the police officer can use for specific circumstances, named at the time of use? The objective would be to use that tool as a way to learn, and to instruct. We do not expect the work to be presented here to be anything other than a start of using Mind Genomics as emergent science to understand the mind of what we might call negotiation [7-10]

The Foundation and Approach of Mind Genomics

The foundation of Mind Genomics is the belief that it is possible to study the reactions to the world of the everyday in a scientific manner. When we look at the specific details of the everyday, we may often find that people react to these details in different ways, but in a limited number of different ways. These different ways are called mind-sets. The objective of Mind Genomics is to understand the world by understanding how people differ from each other in their response to features of and messages about the daily world [11]. Rather than assuming that there are a limited grand number of mind-sets — let’s say three or ten or sixty even — we assume that the mind-set emerges from the pattern of reactions or the pattern of potential reactions to a granular, everyday situation. That is, people can be in one mind-set when they think about how they’re going to order and eat breakfast but be in totally different mind-sets when they realize how they’re going to commute to work. The goal of Mind Genomics, therefore, becomes one to understand these mind-sets at the granular level, doing so in a way which is efficient, inexpensive, educational, reliable, powerful [12-14]. One ultimate goal is to create a “database of everyday life.” This paper presents one application, the messaging or “verbal judo” between a police officer and a prospective lawbreaker.

Setting Up the Mind Genomics Study Through a Templated System

The templated approach developed for Mind Genomics ensures that any user can do a study, whether the user knows the elements to be tested or whether the user wants to be “coached” by AI in the form. of an LLM (large language model) to create these elements. Figure 1, Panel A shows what confronts the user at the start of the study. The user is requested to tell four or select four questions which “tell a story.” Panel A is already filled in but one could imagine Panel A with no questions whatsoever simply with four blanks, one blank per question.

The prospect of course is quite daunting as has been the experience of the authors over the past decades. It is for that reason that we embedded artificial intelligence using ChatGPT 3.5 [15]. ChatGPT 3.5 was programmed to receive a small squib shown in the box on the right (Figure 1, Panel B). The squib describes the issue. From that squib ChatGPT 3.5 creates 15 questions for each iteration [16,17]. The user can iterate again and again, each time creating 15 questions, until the user selects a total of four questions across the various iterations. The user can select the questions, edit them, provide other questions, doing so for many iterations. The Mind Genomics process will record each iteration, whether the elements were selected or not. The result is an education simply through creating questions in each iteration. Thus, the four selected questions could come from a variety of iterations and reflect the results of editing the suggested questions [16,17].

What ends up of course is that the user can drop the questions into the study as shown in Panel A, can edit it, put it into different words, or even use the user’s own ideas (Figure 1, Panel A). Table 1 shows the types of questions which emerge when the user uses Idea Coach ChatGPT for creating the questions.

Table 1: Output of AI for the squib. Topic: A policeman is responding to a situation. What should I ask?

TAB 1

The same approach requiring the user to generate four answers to each question finally selected once again generates a sense of discomfort. The level of discomfort seems to be less, perhaps because it is easier to answer questions than to pose them. Once again AI proves valuable here, reducing the panelist. The user only needs to select Idea Coach and AI is prompted to return with 15 answers to each question. The process can go on several times for each question, resulting in a book of questions and answers to those questions. Table 2 shows the final set of four questions and four answers to each question.

FIG 1

Figure 1: Panel A shows the user interface screen requesting four questions, with the questions filled in. Panel B shows the user interface box to write in the squib for the Idea Coach, using ChatGPT 3.5.

Table 2: The final set of four questions, and the four answers (elements) for each question

TAB 2

Orienting the Respondents and Providing a Rating Scale

The next step in the setup of the Mind Genomics study involves the creation of the orientation for the respondent and an easy-to-use rating scale. Traditionally, the rating scale has been unidimensional, from low to high, from 1 to 5. More recent efforts have used two-sided rating scales, allowing the respondent to provide two pieces of information in the same scale. It is a two-sided rating scale that we use in this study. The first side involves ratings of listening. The second one involves ratings of reducing anger. Table 3 presents the text of the rating scale. Respondents typically have little problem assigning ratings using this type of scale, even though it would seem that they are making two types of judgments. Figure 2, Panel A shows the screenshot for the respondent orientation provided by the researcher. Figure 2, Panel B shows the set up for the rating scale, allowing the user to select the question itself (top), the number of scale points, and the optional anchoring phrase for each scale point.

Table 3: The rating scale

TAB 3

 

FIG 2

Figure 2: Panel A shows the user interface to create the respondent orientation. Panel B shows the user interface to create the rating question.

Table 4 shows the three self-profiling questions selected by the user, in addition to two additional standard questions (age, gender). These self-profiling questions allow the user to obtain otherwise impossible-to-obtain information about the respondent. Figure 3 shows the actual pull-down menu as presented to the respondent at the start of the evaluation session.

Table 4: The three self-profiling questions selected by the user

TAB 4

 

FIG 3

Figure 3: The pull-down menu presenting the self-profiling questions

Once the consumer respondent logs in and completes the self-profiling classification (Figure 3), the respondent is presented with an orientation and immediately evaluates 24 vignettes, one vignette after another (see Figure 4). The vignettes are created by experimental design, a systematized layout. Each respondent evaluates a unique set of the 24 vignettes, the uniqueness guaranteed by a permutation scheme which maintains the mathematical properties of the combinations (statistical independence, equal frequency of appearance, etc.).

FIG 4

Figure 4: Example of a vignette as presented to the respondent, who reads and rates the vignette. The vignette automatically advances to the next vignette after the respondent assigns a rating.

A vignette has two, three, or four elements, at most one element from each question or one answer from each question. According to the experimental design, the combinations of the vignettes are incomplete. That is, the vignettes are not created by the obsessive requirement that each vignette have exactly one element (viz., answer) from each question. That requirement would, in fact, end up being counterproductive in a statistical sense because the 16 elements would not be statistically independent of each other, and only relative value of coefficients would emerge, not the more desirable absolute values.

The strategy of having each respondent evaluate a unique set of combinations was developed by Gofman and Moskowitz in the early 2000’s [18]. The objective was to ensure that Mind Genomics would explore many combinations and thus might be well used as a tool for exploration rather than a tool to confirm what was known. In traditional conjoint measurement, the typical user ends up testing known combinations, creating these limited numbers of combinations to test the hypothesis. It is important in traditional conjoint measurement to “know” the important elements ahead of time. In a complete about face, Mind Genomics was designed to explore the response to messages, elements, welcoming the absence of any ingoing knowledge about “what is important.” In Mind Genomics, the user may have absolutely no idea of what the important elements are, and therefore it makes far more sense to have each person test a unique set of combinations different from the combinations of everybody else. The consequence of that is that the Mind Genomics system is much like an MRI of the mind, looking at different areas, identifying things, and then putting everything together at the end of the experience with one grand computer analysis which shows exactly what every element contributes.

Transformation to Binary Scales and Creation of Equations Using OLS (Ordinary Least Squares) Regression

The analysis of Mind Genomics data follows a simple series of steps and like the setup is templated to make the approach easier for people to use. The rating scale has two dimensions. One dimension is listening, the second dimension is lessening anger. We want to capture both of these. The transformations create two new variables, each taking on the values of 0 or 100, as shown. Each rating thus generates these two binary variables. As a precautionary measure to ensure that every respondent generates some level of variation in these two binary variables, we add a vanishingly small random number (<10-5) to each newly created binary variable. By so doing we ensure that the subsequent analysis using OLS (ordinary least squares) regression will not “crash.”

R54 (Listen to Officer)       Ratings 5 and 4 transformed to 100, ratings 1,2, and 3 transformed to 0.

R52 (Lessen Anger)    Ratings 5 and 2 transformed to 100, ratings 1, 3 and 4 transformed to 0.

The effort put into creating the combinations now pays out. It is straightforward to apply OLS regression to the data, whether at the level of a single individual or at the level of a group. The equation shows how one deconstructs the rating, or more correctly the transformed binary variable, into the part-worth contribution of each of the 16 elements. The equation does not have an additive constant, meaning that the equation is forced through the origin. This simple expression contains within it all of the information about the driving strength of each of the 16 elements for Listen to Office or for Lessen Anger.

Binary Dependent Variable = k1A1 + k2A2… k16D4

Table 5 shows the coefficients from the ordinary least squares regression. The coefficients are sorted by the magnitude for R54 (Listen to Police Officer). The convention for this analysis will be that any coefficient of 21 or higher will be shaded to highlight as being an extremely important, highly significant coefficient. The value 21 emerges from statistical tests of significance. The second column shows the coefficient for R52 the binary dependent variable for Lessened Anger. In neither case is any element shown as highly significant with a coefficient of 21, although D3 is close: Policeman says I respect your right to voice your grievances.

Table 5: Coefficients for the Total Panel

TAB 5

The fact that there are no very strong elements for R54 (Listen to Police Officer) or for R52 (Lessen Anger) may emerge because people have different criteria, and therefore their ratings may cancel each other out. We can think of two streams meeting another stream in opposite directions. A stream flows quickly, but if two streams meet together and they’re going in opposite directions, often the result is a pool with a lot of disturbance, but the pool is not going fast in any direction. It just becomes a maelstrom. The same thing may occur with the coefficients from the total panel. We may have different groups of people with different ideas, and the question is whether in fact these people are canceling each other out. We will see that when we come to mind-sets, but first we have to work our way through the differences between people as they have defined themselves in the classification questions.

Self-Profiling

The respondents were required to answer three questions at the start of the study, shown in Table 3. Mind Genomics can generate a wall of numbers because of the different binary dependent variables (R54, R52), the 16 elements, and the several groups self-defined by the respondent. To make understanding and discovering patterns easier, we focus from this point forward on one key dependent variable, R54.

Table 6 shows the coefficients based upon Question 1, attitude towards police. The story in Table 6 is clear. Only one of the three subgroups generate consistently high coefficients, viz., those who say they trust police.

Table 6: Coefficients for elements based on self-profiling Question 1 (Attitude toward police).

TAB 6

Table 7 shows the coefficients for R54, this time based on how the respondent feels about violence in society. Once again, a story emerges, although not one quite as clear as before. Those who feel that violence is never justified end up saying they will listen to direct statements to them by the police. Those who feel that violence is occasionally warranted say that they will listen in a number of situations, but the common link is not clear. Finally, those who feel that violence is simply part of everyday life do not end up saying that they will listen to the police officer.

Table 7: Coefficients for elements based on self-profiling Question 2 (Violence in society).

TAB 7

Table 8 shows the coefficients for R54, this time for self-profiling question #3, “positive interactions with police.” Those respondents who say that they have had several positive interactions with the police are likely to listen, especially when spoken to respectfully.

Table 8: Coefficients for elements based on self-profiling Question 3 (Positive interactions with police).

TAB 8

Mind-Sets

The last analysis creates mind-sets. Mind-sets are defined as clusters of individuals who respond in the same way towards a specific topic. Individuals within a mind-set find certain patterns to be extraordinarily engaging and other patterns to be virtually irrelevant. Mind-sets emerge from statistical analyses of the patterns of coefficients for the individuals. Ideally for a topic such as listening to police officers, the statistical analysis should generate a limited number of clusters of patterns, the mind-sets, with these patterns telling easy to understand “stories.” The former is parsimony, the latter is interpretability.

The creation of mind-sets for these data involved the estimation of 108 individual-level equations, one equation for each respondent. It is just as easy for the computer to create 108 equations as to create one equation, since each respondent’s 24 vignettes were arranged ahead of time to ensure that the 16 elements appeared in a statistically independent fashion. As before, the key dependent variable is R54, Listen to the police officer. The final analysis to generate the mind-sets used k-means clustering [19]. The outcome is two, and then three clusters or mind-sets. The three-mind-set solution was easier to interpret. Table 9 shows the three-mind-set solution, sorted from high to low for each mind-set separately. Elements which generate coefficients of 21 or higher in two mind-sets appear in each mind-set in the proper order, to make interpretation easier. Table 9 shows many more strong performing elements, with these elements telling simpler stories. It is important to keep in mind that these mind-sets emerge without the help of human interpretation except at the very end. All of the analyses come from pure mathematical considerations.

The strong performance of elements in Table 9 should not surprise. The analogy given above for the total panel was of two or more streams, moving swiftly in opposite directions, clashing with each other and creating a pool of turbulent, but non-flowing flowing water. The mind-sets flow in different directions. We see weaker performance for the total panel (see Table 5, column for R54). Only when the different mind-sets emerge do we see how really strong the mind-sets are.

Table 9: The three-mind-set solution emerging from clustering the coefficient on the basis of values for R54 (Listen to the police officer).

TAB 9

Using AI to Understand the Mind-Sets More Deeply

Our final analysis comprises the deeper interpretation of our mind-sets through artificial intelligence. We know the strong performing elements for the key binary dependent variable R54. Table 9 shows these elements in shade. The LLM embedded in BimiLeap.com, the Mind Genomics platform, “summarizes” the patterns behind these strong performing elements. Table 10 presents these summaries exactly the way they emerged from the LLM. It is important to keep in mind that the user does not have to accept the summarization. For example, the mind-set names used in Table 9 are not those recommended by AI. Rather, the summarization shown in Table 10 is meant as an aid to learning and to critical thinking, essentially acting as a “coach” to suggest other aspects meriting the user’s attention.

Table 10: AI-generated “automated summaries” of strong-performing elements for each of the three mind-sets shown in Table 9.

TAB 10(1)

TAB 10(2)

TAB 10(3)

Discussion and Conclusions

The goal of this study was to demonstrate how a combination of artificial intelligence and Mind Genomics thinking can create different features of the interaction between a potential perpetrator of a violent act and the police. With the increasing power of artificial intelligence as manifested in large language models, it becomes straightforward to request these large language models to provide relevant questions and then for each question relevant answers. We demonstrated this through Idea Coach. Whether or not we created the correct questions and selected the correct answers becomes a minor issue when we realize that we can do an iteration in a minute or less. What would take months of thinking, now with the help of large language models, really takes minutes to do in terms of searching for new questions and in turn for new answers to those questions, the elements of our study.

The first half of the study was devoted to finding the test stimuli. The second half is devoted to finding the response of real people, in our case young males living in the Virginia area. The issue was whether these people would respond in a specific way to the various scenarios, to the different elements combined. The data from our 108 respondents suggest three different mind-sets. It’s important to know that this is our first foray. The first mind-set would be strong responses to listening when the place is familiar and when the police officer says to the effect that “I’m going to not do anything to you, just let’s talk.” The second mind-set stresses that the person says they will listen when there are clear actions that suggest a hostile nature. The police officer clearly senses a situation and the problem developing and talks authoritatively. It’s important to note that the police officer who talks authoritatively may also want to talk in a more peaceful manner to find common ground. The third mind-set is that the police officer really knows what’s going to happen and essentially threatens or orders the potential perpetrator not to do anything. As a closing comment, one should keep in mind that these mind-sets are not hard and fast divisions, but interpretable regions on a continuum. That itself is key learning, that sometimes there are strong differences, opposite or independent, orthogonal, and sometimes the mindsets fall along a continuum of power. It’s quite possible that in the case of police behavior in these situations we are dealing with positions on a continuum rather than radically different mind-sets. Only experimentation will tell us.

Acknowledgment

The authors would like to thank Vanessa Marie B. Arcenas for helping to produce this manuscript.

Abbreviations

Abbreviation Definition
AI Artificial Intelligence
ChatGPT Chat Generative Pre-trained Transformer
LLM Large Language Model
OLS regression Ordinary Least Squares regression

Competing Interests

The authors have no conflict of interest to disclose.

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Fertility Preservation Among Cancer Patients in Saudi Arabia: A Hot Topic

DOI: 10.31038/CST.2024923

Abstract

The future quality of life of cancer patients with respect to their fertility is impacted by cancer treatment for those who were diagnosed before or during their reproductive years. Fertility cryopreservation technologies give hope to cancer survivors for life following cancer treatments. However, a limited number of patients are taking advantage of the benefits provided by fertility preservation alternatives because of a lack of standardized guidelines, a lack of awareness, and the need for additional education and training.

Keywords

Knowledge, Attitudes, Practices, Fertility preservation, Cancer patients, Saudi Arabia

Introduction

Worldwide, the prevalence of cancer patients is increasing, with a long-term incidence projection showing that there will be a 1.8-fold increase by 2030, making it a life-threatening diagnosis [1]. Fortunately, recent advances in cancer treatment have resulted, for example, in female cancer survival rates increasing to 10% of all survivors under the age of 40 [2,3]. However, it is known that a number of cancer treatments harm the reproductive system, resulting in sterility or infertility. In order to improve the quality of life of cancer survivors of childbearing age, fertility preservation (FP), advice, and treatment are increasingly being offered [4]. The knowledge, attitudes, and practices (KAP) regarding FP, especially in cancer patients, are very advanced worldwide. In Saudi Arabia, FP in cancer patients is a topic that has gained increasing attention and importance. However, it is still a difficult problem, and for a variety of reasons, referral and consulting are not yet widely used.

The KAP among Oncologist

According to our previous studies in 2011, we identified several knowledge gaps among oncologists that could impact their attitude, which in turn was reflected in their poor practice. For example, the possibility of preserving female fertility was unknown to 45% of oncologists [5]. At that time, there was limited awareness about FP options, a lack of standardized guidelines, and a need for further education and training in this area, especially in the absence of legislation.

Twelve years after the above-mentioned study, the advice of senior religious scientists in 2018 allowed the freezing of tissue of the ovarian membrane, the entire ovary, and eggs for later use in reproduction in order to preserve the offspring. In a recent study conducted in 2023, we investigated whether oncologists’ knowledge, attitudes, and referral procedures regarding FP have improved. Their level of understanding has greatly increased, as we have discovered. Doctors were actually found to be significantly more knowledgeable about a wide range of female FP options, the most prevalent of which was egg cryopreservation (77%), than other options. It was still necessary to improve patient counseling and referrals to fertility services, though. Our results demonstrate Saudi Arabia’s deficiency in clinical practice standards for FP in cancer patients. [6].

The KAP among Health Practitioners

Understanding the knowledge, attitudes, and practices of health practitioners toward fertility preservation is crucial in ensuring that individuals receive accurate information and appropriate care regarding their reproductive options.

A recent study conducted in Saudi Arabia aimed to assess the attitude of health practitioners towards fertility preservation and showed that clinical practitioners’ knowledge is still inadequate. They concluded that there is a need to train health practitioners and establish practice guidelines and fertility preservation clinics for cancer patients [7].

The KAP among Medical Student

Medical students are the future doctors, and in order to successfully deal with the topic of FP, medical training should begin. To implement cancer education curricula related to fertility preservation, it is necessary to identify any gaps and other barriers that could be overcome through medical education to improve future clinical practices. Our recent study on the attitude and knowledge among Saudi medical students toward FP showed respectable awareness and attitudes toward FP. However, there are still some gaps; almost half of the respondents mentioned that cancer treatment should be started before FP, suggesting the need to improve education about FP in the medical curriculum [8].

The Knowledge among Cancer Patients

Cancer patients who may face fertility challenges in the future were recently surveyed. The study by Abusanad A. et al. in 2022 showed that 56.30% of the cancer patients surveyed had satisfactory knowledge about the consequences of cancer treatment for infertility and expressed a desire to have children through FP in the future. However, this desire has been hampered by limited oncofertility care and FP procedures. Unfortunately, such patients were occasionally referred to a specific fertility facility, where only 17% saw a fertility specialist and only 37.8% received fertility counseling [4].

Conclusions

To the best of our knowledge, there have not been studies addressing such an important topic in our region for a decade. To meet the patient’s needs and improve the quality of life of cancer survivors, the best way is to increase cancer awareness through cancer education and disseminate information about cancer prevention. This can be done in a number of ways: through educational events and continuing medical education programs for medical students, oncologists, and nurses caring for cancer patients whose fertility is affected by cancer treatment. Such educational programs will expand their knowledge and improve their practice. The public should be aware of the availability of fertility preservation services in government and private centers, as well as the cost, timing, and various procedures.

Acknowledgment

The authors are grateful to the Deanship of Scientific Research, King Saud University, Riyadh, Kingdom of Saudi Arabia, for funding through the Vice Deanship of Scientific Research Chairs.

Conflict of Interest

The author has no conflict of interest to declare.

References

  1. Arafa MA, Rabah DM, Farhat K (2020) Rising cancer rates in the Arab World: now is the time for action. East Mediterr Health J. 26(6): 1-5 [crossref].
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Thermal Properties of Natural and Hybrid Fiber Reinforced Composites

DOI: 10.31038/NAMS.2024731

Abstract

The thermal stability of natural fiber composites is a relevant aspect to be considered since the processing temperature plays a critical role in the manufacturing process of composites. At higher temperatures, the natural fiber components (cellulose, hemicellulose, and lignin) start to degrade and their major properties (mechanical and thermal) change. Different methods are used in the literature to determine the thermal properties of natural fiber composites as well as to help to understand and determine their suitability for a certain applications (e.g., Thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), and differential mechanical thermal analysis (DMA)). Weight loss percentage, the degradation temperature, glass transition temperature (Tg), and viscoelastic properties (storage modulus, loss modulus, and the damping factor) are the most common thermal properties determined by these methods. This paper provides an overview of the recent advances made regarding the thermal properties of natural and hybrid fiber composites in thermoset and thermoplastic polymeric matrices. First, the main factors that affect the thermal properties of natural and hybrid fiber composites (fiber and matrix type, the presence of fillers, fiber content and orientation, the treatment of the fibers, and manufacturing process) are briefly presented. Further, the methods used to determine the thermal properties of natural and hybrid composites are discussed. It is concluded that thermal analysis can provide useful information for the development of new materials and the optimization of the selection process of these materials for new applications. It is crucial to ensure that the natural fibers used in the composites can withstand the heat required during the fabrication process and retain their characteristics in service.

Keywords

Natural fiber reinforced composite material, Thermal analysis, Thermogravimetric analysis (TGA), Differential scanning calorimetry (DSC), Differential mechanical thermal analysis (DMA)

Introduction

The application of composites has continuously increased across many industries, in particular in the automotive and aerospace industries where lower weight and high resistance are key factors. The most commonly used fibers that attend these requirements are carbon and glass fibers [1-3]. However, nowadays, the industry is seeking new desirable characteristics of composite materials, such as renewability, eco-friendliness, and low cost. Consequently, there has been great interest in research and innovation in natural fiber composites owing to the advantages of these materials compared to their synthetic fiber counterparts (i.e., lower environmental impact and lower cost), supporting their potential across a wide range of applications in several industrial sectors [4-9]. The natural fiber-reinforced composites (NFRCs) are used mainly in non-structural car body parts, such as door panels, package trays, hat racks, instrument panels, internal engine covers, sun visors, boot liners, oil air filters, and even progressing to more structurally demanding parts, such as seat backs and exterior underfloor paneling [10,11]. Nowadays, most of the automotive makers, such as Audi, Volkswagen, Toyota, Daimler-Benz, Volvo, Ford, etc., use NFRCs to produce components. The continually growing demands for lightweight and fuel-efficient vehicles will further push the growth of NFRCs in the automotive market. There are other exciting market trends going forward in many different industries. For example, tri-dimensional hybrid natural fiber reinforcement preforms have been used recently by sports car manufacturers, such as Porsche and even McLaren in Formula 1 .Other applications of NFRCs include sport equipment, musical instruments, aerospace, construction industry [12-14], and ballistic armour [15,16].

Several types of natural fibers are currently used in industry, such as jute, sisal, oil palm, kenaf, and flax, which are well established in the global market with a well-defined production line. However, new promising natural fibers are being discovered and used on a smaller scale or are still being used only for research. This is the case of the buriti and curauáfibers, for example, that still need some improvements in their production line to be more commercially affordable and reach widespread use [17,18]. They are used as reinforcement fibers in thermoset or thermoplastic polymeric matrix in a variety of applications [19]. Depending upon the matrix type, NFRCs are categorized into completely biodegradable or partially biodegradable composites.The growing importance of natural fiber reinforced composites is reflected by the increasing number of publications (e.g., reviews, patents, book chapters, and books) during the recent years [20-25]. Therefore, it is important to study their thermal and mechanical behaviour in order to utilize their full potential. The thermal stability of natural fiber composites is a relevant aspect to be considered as the processing temperature plays a crucial role in the fabrication process of the composites. At higher temperatures, the natural fiber components (i.e., cellulose, hemicellulose, and lignin), start to degrade and the major properties (mechanical and thermal) of the composite change. Intense research efforts are continuously made and some of the shortcomings of NFRCs were addressed by recent advancements in fiber treatment and modification, exploration of new natural fibers, and hybridization. The fiber modification techniques provide improved fiber–matrix interfacial adhesion, improved fiber roughness, and wettability and depend on the particular fiber/matrix used and the composite application, while the hybridization methods provide flexibility in fiber selection for the material properties according to the end-use application requirements.

Even though there are many recent review articles concerning the use of natural fibers in the production of natural hybrid composites [26-34], one topic that was not covered in any significant detail relates to the thermal characterisation of NFRCs. This paper provides an overview of the recent advances in the thermal properties of natural and hybrid natural fiber composites in thermoset and thermoplastic polymeric matrices. First, the main factors that affect the thermal properties of natural and hybrid fiber composite materials (fiber and matrix type, the presence of additive fillers, fiber content and orientation, the treatment of the fibers, manufacturing process, and type of loading) are briefly presented. Further, the methods used to determine the thermal properties of natural and hybrid composites are discussed. Finally, some conclusions and critical challenges and future perspectives and research activities are summarized.

Influencing Factors

The main factors that affect the thermal properties of natural and hybrid fiber compo-site materials are: fiber and matrix type, the presence of additive fillers, fiber content and orientation, the treatment of the fibers, manufacturing process, and type of loading [35].

Methods Used to Determine the Thermal Properties of Natural and Hybrid Composites

The following methods are used

a) Thermogravimetric Analysis (TGA)

b) Differential Scanning Calorimetry (DSC)

c) Dynamic Mechanical Analysis (DMA)

Conclusions

Thermal analysis can provide useful information for the development of new materials and optimization of the selection process of these materials for new applications. The most common thermal properties studied in the literature are: the percentage of weight loss, the degradation temperature, Tg, and viscoelastic properties (storage modulus, loss modulus, and the damping factor). Different factors affect the thermal properties of natural fiber composites (i.e., fiber and matrix type, the presence of fillers, fiber content, and fiber orientation, the chemical treatment of the fibers, manufacturing process, and type of loading). It is crucial to ensure that the natural fibers used in the composites can withstand the heat required during the fabrication process and retain their characteristics after exposure to heat. Different approaches were used in the literature for the enhancement of thermal properties of natural fiber-based composite materials. For example, using natural fibers with low lignin content leads to a better thermal performance of composites. Another approach involves the removal of lignin through fiber treatment. Finally, the incorporation of synthetic fillers or synthetic fibers in natural fiber reinforced composites increase their thermal stability.

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A Narrative Enquiry on the Ethno-Religious Conflict on the Health of Women in Plateau, Nigeria

DOI: 10.31038/AWHC.2024722

Abstract

This study investigates the impact of ethno-religious conflict on the health of women in Plateau State, Nigeria, utilizing a comprehensive review of existing documents and literature. Plateau State, often referred to as the “Home of Peace and Tourism,” has been plagued by persistent ethno-religious violence, which has had profound implications for the health and well-being of its female population. This research synthesizes data from governmental reports, non-governmental organisation (NGO) publications, academic journals, and health surveys to delineate the multifaceted health challenges faced by women in this region. The findings reveal that ethno-religious conflicts in Plateau State have significantly exacerbated physical, mental, and reproductive health issues among women. The physical health impacts include increased rates of injuries, malnutrition, and infectious diseases due to disrupted living conditions and healthcare services. Psychologically, women experience heightened levels of stress, anxiety, and post-traumatic stress disorder (PTSD) as a result of exposure to violence, displacement, and the loss of family members. Furthermore, reproductive health is severely affected, with limited access to prenatal and postnatal care, higher instances of sexual violence, and inadequate menstrual health management. The study implicated policymakers, health care providers, humanitarian organisations, faith-based organisation working in Plateau State. Recommendations are discussed.

Keywords

Religion, Ethnicity, Health, Women, Plateau, Nigeria

Introduction

Ethno-religious conflicts have long been a persistent challenge in various parts of Nigeria, significantly impacting the social fabric and overall well-being of its population. Plateau State, located in the central region of Nigeria, is one of the areas most affected by these conflicts. The intersection of ethnic diversity and religious plurality in Plateau has often led to violent clashes between different groups, resulting in substantial socio-economic and health-related repercussions. The health of women, in particular, has been severely affected by these conflicts. Women in conflict zones often face unique vulnerabilities, including displacement, loss of livelihoods, and increased exposure to violence and exploitation. These factors collectively exacerbate health issues ranging from physical injuries and psychological trauma to disruptions in maternal and child healthcare services [1,2].

In Plateau State, the cyclical nature of ethno-religious violence has created a volatile environment where healthcare delivery is consistently disrupted. Hospitals and clinics are often targets during conflicts, leading to their destruction or abandonment, which severely limits access to essential medical services for women. Additionally, the breakdown of social networks and support systems further compounds the health challenges faced by women, as they are often left to cope with the aftermath of violence with limited resources and support [3].

Studies have shown that women in conflict-affected areas of Plateau State experience higher rates of physical and mental health issues compared to those in more stable regions. For instance, maternal mortality rates are significantly higher in these areas due to the lack of access to emergency obstetric care and skilled birth attendants. Furthermore, the pervasive fear and stress associated with ongoing conflict contribute to a higher prevalence of mental health disorders, such as depression and anxiety, among women [4,5].

This study aims to explore the multifaceted impact of ethno-religious conflict on the health of women in Plateau State, Nigeria, and to identify potential strategies for mitigating these effects. By examining the direct and indirect health consequences of conflict and highlighting the experiences of affected women, this research seeks to contribute to a better understanding of the challenges and inform policy and programmatic responses to support women’s health in conflict-affected regions.

Research Methodology

This study is a qualitative study using narrative method. The narrative method is a qualitative research approach that focuses on the collection, analysis, and interpretation of stories to understand the experiences, meanings, and cultural contexts of individuals or groups. Data was gotten from gazettes, periodicals, journal articles and archives of humanitarian organization such as governmental organizations, non-governmental organisations, civil based organizations, community based organization and faith-based organization. The data was analyzed using discourse analysis.

Ethno-Religious Conflict in Plateau, Nigeria

Plateau State, located in central Nigeria, has been a hotspot for ethno-religious conflicts for several decades. This region, known for its ethnic and religious diversity, has witnessed recurrent violent clashes between different groups, primarily driven by competition over land, political power, and resources. These conflicts are often framed along ethnic and religious lines, exacerbating tensions and leading to significant loss of life, displacement, and destruction of property. The roots of ethno-religious conflicts in Plateau State can be traced back to colonial and post-colonial policies that disrupted traditional land ownership and governance structures. The British colonial administration’s divide-and-rule tactics, coupled with the post-independence government’s failure to address these divisions, laid the groundwork for contemporary conflicts [6].

Plateau State is home to over 50 ethnic groups, with the Berom, Afizere, and Anaguta being the indigenous ethnicities, while the Hausa-Fulani are significant settler communities. The state is also religiously diverse, with a roughly equal distribution of Christians and Muslims. This diversity, while a potential strength has often been exploited by political actors to mobilize support and resources, deepening ethnic and religious divides. Several factors contribute to the ethno-religious conflicts in Plateau State. First, the competition for fertile land and grazing rights between indigenous farming communities and migrant herders is a primary driver of conflict. This competition has intensified with population growth and environmental changes, leading to frequent clashes. Second, the political marginalization of certain ethnic groups fuels resentment and conflict. Indigenous groups often feel that the settler communities, particularly the Hausa-Fulani, are favored in political appointments and economic opportunities. Third, religious identity is a significant factor in Plateau’s conflicts. Incidents of religious violence elsewhere in Nigeria often spill over into Plateau State, inflaming local tensions. Both Christians and Muslims perceive themselves as victims of marginalization and discrimination, leading to mutual suspicion and hostility. Fourth, high levels of youth unemployment and poverty create a fertile ground for recruitment into militant groups. Young people, feeling disenfranchised and without prospects, are easily mobilized by leaders who exploit ethnic and religious narratives for their purposes [7-11].

The impacts of the conflicts in Plateau State cannot be underestimated. First, there is the loss of life and property. Thousands have been killed in violent clashes, and many more have been injured or displaced. Entire communities have been destroyed, with homes, schools, and places of worship burnt down [3]. Second, the conflicts have led to massive internal displacement, with many people living in camps under harsh conditions. Displacement disrupts education, healthcare, and economic activities, perpetuating poverty and instability. Third, the continuous cycle of violence has caused deep psychological trauma among the affected populations, particularly women and children. This trauma manifests in increased mental health issues and social fragmentation. Fourth, the persistent conflicts have severely affected the local economy. Agriculture, the mainstay of the state’s economy, has been disrupted, leading to food insecurity and economic decline [12-14].

Various efforts have been made to address the conflicts in Plateau State but the issue has continued to escalate with women being at the receiving end. The first effort of the government is the deployment of security agencies. The Nigerian government has deployed security forces to quell violence and established commissions of inquiry to investigate the causes of conflicts. However, these measures have often been criticized for being reactive rather than preventive [15]. Another intervention of the government was the setting the pace for dialogue and reconciliation initiatives. Local and international organizations have initiated dialogue and reconciliation programs aimed at fostering understanding and cooperation between conflicting groups. These initiatives include peace education, interfaith dialogues, and community mediation [7]. Also, there are the economic empowerment programs such as vocational training and economic empowerment programs targeting youth. These programs aim to reduce unemployment and provide alternative livelihoods. Unfortunately, these strategies have not yielded the needed results because the ethno-religious conflicts in Plateau State are complex and multifaceted, rooted in historical grievances, competition for resources, political marginalization, and religious tensions [16].

Women and Conflict in Nigeria

Women in Nigeria are significantly affected by various forms of conflict, including ethno-religious violence, insurgency, communal clashes, and political unrest. These conflicts, which are prevalent in different regions of the country, have profound and multifaceted impacts on women’s lives. It is important to state that ethno-religious conflicts, particularly in the Middle Belt and northern regions, have a devastating impact on women. These conflicts often arise from long-standing ethnic tensions and religious differences, exacerbated by competition over land and resources. Women are frequently targeted in these conflicts, experiencing violence, displacement, and loss of livelihoods [10].

Also, the Boko Haram insurgency in northeastern Nigeria is one of the most severe conflicts affecting women. Boko Haram’s brutal tactics, including mass abductions, sexual violence, and forced marriages, have garnered international attention. Women and girls are particularly vulnerable to these abuses, which have long-lasting physical and psychological effects. Furthermore, during communal clashes and resource-based conflicts women are the targets. In various parts of Nigeria, communal clashes often revolve around land disputes, resource control, and herder-farmer tensions. These conflicts, prevalent in states like Benue, Taraba, and Kaduna, disrupt communities and displace thousands of women and children. The loss of homes and livelihoods significantly affects women’s ability to provide for their families [17,18].

Women are also affected by political violence, especially during election periods. Political thuggery, assassinations, and post-election violence create an environment of insecurity that disproportionately affects women, limiting their participation in political processes and exposing them to further violence. The impact of the conflict on women cannot be overemphasized. It causes physical violence and sexual exploitation. Women in conflict zones are often subjected to physical violence and sexual exploitation. Rape and other forms of sexual violence are used as weapons of war, leading to severe physical injuries, unwanted pregnancies, and sexually transmitted infections. These experiences not only cause immediate harm but also have long-term health implications. It resulted in displacement and humanitarian crisis for the women. Conflicts in Nigeria frequently result in mass displacement. Women and children constitute a significant portion of the internally displaced population. Displacement exacerbates existing vulnerabilities, as women in camps often face inadequate living conditions, limited access to healthcare, and increased risk of exploitation. Also, it has resulted in economic hardship for women [19-21].

Conflict-induced displacement and disruption of economic activities lead to significant economic hardships for women. Many women lose their means of livelihood and struggle to provide for their families. The destruction of markets, farmlands, and other economic resources further deepens poverty and economic instability among women. Also, the psychological impact of conflict on women is profound. Women who have experienced violence, displacement, and the loss of loved ones often suffer from severe mental health issues, including depression, anxiety, and post-traumatic stress disorder (PTSD). The lack of mental health services in conflict zones exacerbates these problems, leaving many women without the support they need [22,23].

There is also disruption of education and healthcare. Conflicts disrupt essential services, including education and healthcare. Many girls drop out of school due to insecurity and displacement, limiting their future opportunities and perpetuating cycles of poverty and dependency. Healthcare services, particularly maternal and reproductive health services, are often severely limited during conflicts, increasing risks for pregnant women and new mothers [24].

Women and Conflict in Plateau, Nigeria

Women in Nigeria are profoundly affected by various forms of conflict, facing physical violence, displacement, economic hardships, psychological trauma, and disruptions to education and healthcare. It has resulted in the physical violence and sexual exploitation. Women in conflict zones are at high risk of physical violence and sexual exploitation. During clashes, women are often targeted for rape and other forms of sexual violence as a tactic of war and intimidation. Such violence has devastating immediate and long-term effects on women’s physical and mental health, leading to trauma, unwanted pregnancies, and sexually transmitted infections, including HIV/AIDS [25].

Women have encountered displacement and loss of livelihood in Plateau, Nigeria. Ethno-religious conflicts frequently lead to large-scale displacement. Women and children make up the majority of internally displaced persons (IDPs) in Plateau State. Displacement disrupts women’s lives profoundly, stripping them of their homes, livelihoods, and social networks. Many displaced women find themselves in IDP camps, where living conditions are often dire, and access to basic necessities like food, clean water, and healthcare is limited. The destruction of property and loss of livelihoods during conflicts disproportionately affect women, who often bear the primary responsibility for their families’ welfare. With traditional agricultural activities disrupted, many women struggle to provide for their children, leading to increased poverty and economic instability. Additionally, women frequently face barriers to accessing financial support and resources needed to rebuild their lives after displacement [26,27].

The psychological impact of conflict on women in Plateau State cannot be overstated. Women who have experienced violence, displacement, and the loss of loved ones often suffer from severe mental health issues, including depression, anxiety, and post-traumatic stress disorder (PTSD) [22]. The lack of mental health services exacerbates these problems, leaving many women without the support they need to recover. Conflicts disrupt essential services, including education and healthcare. Women and girls are particularly affected by these disruptions. Many girls drop out of school due to displacement or insecurity, limiting their future opportunities and perpetuating cycles of poverty and dependency. Healthcare services, especially maternal and reproductive health services, are often severely limited during conflicts, increasing risks for pregnant women and new mothers [24].

Health of Women in IDP Camps

Internally displaced persons (IDPs) camps are temporary shelters established to accommodate people who have been forced to flee their homes due to conflict, violence, or natural disasters. In many regions, including Nigeria, women make up a significant portion of the IDP population. The health of women in IDP camps is a critical issue, as they face numerous challenges that impact their physical, mental, and reproductive health. There are physical health challenges that women go through. There is poor living condition for women in IDP camps. IDP camps are often overcrowded and lack adequate sanitation facilities, which contribute to the spread of infectious diseases. Women in these camps are at heightened risk of contracting illnesses such as cholera, malaria, and respiratory infections due to poor hygiene and limited access to clean water [21].

Also, there is limited access to healthcare services in IDP camps. Access to healthcare services in IDP camps is often severely limited. Health facilities are typically understaffed and under-resourced, making it difficult for women to receive the care they need. This is particularly problematic for pregnant women and those with chronic health conditions. The lack of access to maternal healthcare services increases the risk of complications during pregnancy and childbirth, leading to higher maternal and infant mortality rates [28].

Furthermore there is malnutrition affecting women in IDP camps. Food insecurity is a common issue in IDP camps, where food supplies are often insufficient and lack nutritional diversity. Malnutrition is a significant health concern, particularly for pregnant and lactating women, who require increased nutritional intake. Malnourished women are more susceptible to health complications and have a higher risk of giving birth to underweight babies [29].

The mental health challenges of women cannot be underestimated. It has resulted in psychological trauma. The experiences that lead to displacement, such as violence, loss of family members, and destruction of homes, are traumatic. Women in IDP camps often suffer from severe psychological distress, including depression, anxiety, and post-traumatic stress disorder (PTSD). The lack of mental health services in these camps exacerbates the problem, leaving many women without the support they need to cope with their trauma [23].

It has led to increased gender-based violence. Women in IDP camps are at increased risk of gender-based violence (GBV), including domestic violence, sexual harassment, and rape. The lack of security and privacy in these camps makes women vulnerable to exploitation and abuse. GBV has profound impacts on women’s physical and mental health, leading to injuries, psychological trauma, and sexually transmitted infections [25].

There is the reproductive health challenge facing women. There is the lack of reproductive health services such as family planning, prenatal care, and childbirth assistance, are often inadequate in IDP camps. This lack of services leads to high rates of unintended pregnancies, unsafe abortions, and complications during childbirth. Women in IDP camps frequently lack access to contraception and other reproductive health supplies, further exacerbating these issues [28]. Also, there is the inadequate menstrual health management. Managing menstrual health in IDP camps is a significant challenge. Women often lack access to sanitary products, clean water, and private spaces to manage their menstruation, leading to poor menstrual hygiene. This can result in infections and other health complications, as well as contribute to feelings of shame and embarrassment [30].

Recommendation

Finding a roadmap towards solving the impact of ethno-religious crisis in plateau state requires a coordinated effort that combines healthcare, protection, mental health support, and empowerment initiatives is essential to address the complex challenges faced by these women. There is the need for the state government of Plateau state to collaborate with non-governmental organization and faith-based in supporting women affected by conflict in Nigeria. These organizations will assist in providing essential services, including food aid, healthcare, psychosocial support, and educational programs. There is also the need to strengthen healthcare infrastructure. This could be done through an expansion of healthcare facilities in IDP camps. This could be done through the increase in the number and capacity of healthcare facilities in conflict-affected areas to ensure accessible and adequate medical care for women. There is also the need for the government, NGO’s and FBO’s to ensure that healthcare centers where sick and displaced women are kept are well-equipped with necessary medical supplies and staffed by trained healthcare professionals, particularly those skilled in trauma care and reproductive health services.

The importance of mobile health clinic cannot be overemphasized. There is the need to deploy mobile health clinics to reach women in remote or insecure areas, providing essential services such as vaccinations, prenatal and postnatal care, and treatment for injuries and infectious diseases. Also, there is the need to implement comprehensive psychosocial support programs to address the mental health needs of women affected by conflict. These programs should include counseling, support groups, and trauma-informed care. Furthermore, training for healthcare workers is paramount. Train healthcare workers in mental health care to recognize and treat conditions such as PTSD, depression, and anxiety among women in conflict zones.

There is the need to improve reproductive health services. Access to reproductive health Supplies should be improved. Furthermore, ensure that women in conflict areas have access to reproductive health supplies, including contraceptives, sanitary products, and safe childbirth kits. Also, establish safe spaces within IDP camps and affected communities where women can receive reproductive health services and information in a secure and private environment.

There is the need to strengthen protection mechanisms within IDP camps and conflict-affected communities to prevent gender-based violence. This includes improving security, increasing the presence of female security personnel, and implementing zero-tolerance policies against perpetrators of physical and sexual violence against women in IDP camps. There is the need to provide medical care, legal assistance, and psychosocial support for women in IDP camps.

Conclusion

The ethno-religious conflict in Plateau State, Nigeria, has had a profound and detrimental impact on the health of women in the region. The violence and instability have exacerbated physical, mental, and reproductive health issues, creating a public health crisis that demands urgent attention. Women in Plateau State face heightened risks of injury, malnutrition, and infectious diseases due to disrupted living conditions and inadequate access to healthcare. Additionally, the psychological toll of conflict, including stress, anxiety, and PTSD, has severely impacted their mental health. Reproductive health has also suffered, with limited access to essential prenatal and postnatal care, and a rise in instances of sexual violence. To address these challenges, it is imperative to strengthen healthcare infrastructure, enhance mental health support, and improve reproductive health services. Protection mechanisms must be fortified to prevent gender-based violence, and comprehensive support must be provided for survivors. Ensuring food security and nutrition is crucial for the overall health and resilience of women and their families. A multi-sectoral approach that promotes collaboration between government agencies, NGOs, international organizations, and local communities is essential for holistic and sustainable solutions. Policy advocacy and robust monitoring and evaluation systems are needed to ensure effective implementation and continuous improvement of interventions. By addressing the health needs of women in conflict-affected areas comprehensively, stakeholders can work towards mitigating the adverse effects of ethno-religious conflict and enhancing the overall well-being of women in Plateau State. The commitment to peace-building, healthcare access and women’s empowerment will pave the way for a healthier, more resilient community. The ethno-religious conflict in Plateau, Nigeria, has profound and far-reaching impacts on the health of women. By implementing these recommendations, stakeholders can work towards mitigating these effects and improving the overall health and well-being of women in conflict-affected areas. A coordinated effort that combines healthcare, protection, mental health support, and empowerment initiatives is essential to address the complex challenges faced by these women.

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The Evolving Landscape of Gender and Happiness: A Commentary “Does Reversal of the Educational Gender Gap Affect Men’s Happiness: Evidence from China”

DOI: 10.31038/AWHC.2024721

 
 

The study by Steven Zhongwu Li and Fengzhi Lu, titled “Does Reversal of the Educational Gender Gap Affect Men’s Happiness? Evidence from China,” explores an essential aspect of social dynamics within a rapidly evolving Chinese society. This research examines the relationship between a wife’s educational advantage over her husband and the resulting impact on the husband’s happiness. The study reveals a significant shift in gender attitudes and the evolving role of education in shaping personal happiness [1].

Context and Global Trends

Globally, there has been a marked increase in the number of women surpassing men in educational attainment, a phenomenon often referred to as the “educational gender gap reversal.” China exemplifies this trend, driven by economic development and policy initiatives aimed at promoting gender equality in education. Since 2009, the proportion of female undergraduates and college students in China has consistently exceeded 50%, with female graduate students surpassing their male counterparts since 2010. This shift aligns with patterns observed in many developed countries, challenging traditional gender norms that have historically privileged men’s education and professional development over women’s [2].

Theoretical Framework

Li and Lu’s analysis is grounded in the role-action theory, which posits that societal expectations and norms significantly influence individual behavior and happiness. As gender norms evolve towards greater equality, men’s acceptance of and adaptation to these changes can enhance their happiness. Conversely, adherence to traditional norms that privilege male educational and professional dominance may lead to feelings of insecurity and decreased well-being when confronted with a spouse’s higher educational attainment [3].

Methodology and Key Findings

Li and Lu leverage the nationally representative China Family Panel Studies dataset to analyze the impact of this educational shift on men’s happiness. By meticulously controlling for various individual, familial, and community-level factors, the authors provide robust evidence suggesting that husbands are indeed happier when their wives are more educated than they are. So, the research challenges traditional gender stereotypes that associate a man’s masculinity and status with being the primary breadwinner or the more educated partner in a relationship. Instead, it underscores the growing appreciation among men for the benefits of having a spouse with educational advantages.

This statistical rigor is further enhanced by the application of instrumental variable regression, a technique designed to address potential endogeneity issues. The authors contend with the possibility that men embracing egalitarian gender norms may be predisposed to enter into unions with women who have educational advantages, whereas those with more traditional views might shy away from such arrangements. To counterbalance this, the researchers introduce an instrument that correlates with the wife’s educational edge while being exogenous to the husband’s current state of happiness. Conscious of the limitations inherent in their chosen instrument, the researchers further employ Lewbel’s method to construct an alternative instrument [4,5].

Nuanced Heterogeneity

A key aspect highlighted in the research is the nuanced heterogeneity in this relationship. Specifically, the positive association between a wife’s educational advantages and her husband’s happiness is found to be particularly strong among men who are highly educated themselves, younger in age, and residents of China’s eastern region. This subset of men is more likely to embrace egalitarian gender ideologies, underscoring a generational and geographical shift in attitudes towards gender equality [6,7].

However, the researchers do not rest on this general observation. They explore deeper into the issue of potential clustering effects, suggesting that the educational advantage of wives is exclusively confined to specific demographic subsets. Contrary to this assumption, their calculations reveal that wives with educational advantages are dispersed across all education levels, age groups, and regions, albeit with varying prevalence.

The study attributes this trend to the influence of the country’s opening-up policy since 1978, which has facilitated the adoption of progressive gender norms and encouraged men to support their partners’ educational and professional aspirations. These men are at the forefront of embracing a new social norm where female education and career success are seen as complementary to, rather than competing with, their own.

Considerations of Sample Selection and Women’s Well-being

The study focused specifically on married couples, excluding those who divorced as a result of the reversal of the gender gap in education. This exclusion raises concerns about sample selection bias. Nevertheless, it had minimal influence on the main findings, underscoring the significant emphasis Chinese society places on family and marital stability. The study also highlighted that China’s divorce rate is considerably lower compared to Western countries, with various measures implemented to prevent divorces. In the future, researchers should address the sample selection problem rather than emphasizing the small number of divorced samples.

While the primary focus of the research is on men’s happiness, the researchers also incorporate women’s well-being into their study. Interestingly, in the context of a reversed education gender gap, they discovered a potential inverse relationship between a wife’s educational advantage and her subjective well-being. This finding suggests that traditional gender ideologies persist among many women, who prioritize male dominance in education and career pursuits while believing that women should devote more attention to familial roles. Consequently, when gender roles are reversed, such as when women surpass men in educational attainment, it challenges deeply ingrained traditional notions of gender and negatively impacts women’s overall happiness.

Conclusion and Policy Implications

The impact of educational gender reversal on male happiness is profoundly relevant, reflecting the evolving dynamics of education and gender roles while challenging traditional norms and expectations. This understanding is crucial for policymakers, educators, and sociologists striving to cultivate inclusive and equitable educational environments. It underscores how socioeconomic progress has significantly shaped men’s perspectives, particularly among younger individuals, highly educated individuals, and those from improved socioeconomic backgrounds.

There is a growing recognition among men of women’s educational advantages and their positive impacts on male well-being. The findings have profound implications for societal structures and cultural narratives. They indicate that as women gain greater educational parity or surpass men, the conventional gender hierarchy is being reconfigured. Men who embrace this shift may experience increased happiness, challenging the notion that traditional gender roles are essential for male well-being. Furthermore, the study suggests that the normalization of marriages where women are the more educated partner could accelerate the transformation towards more equitable gender dynamics.

Li and Lu’s study provides a nuanced exploration of the complex interplay between education, gender, and happiness in contemporary China. It not only confirms the positive association between a wife’s educational advantage and her husband’s happiness but also elucidates the underlying factors that drive this correlation. The findings challenge conventional wisdom, highlight the importance of progressive gender attitudes, and underscore the transformative power of education in fostering a more equitable society. As China continues its trajectory of modernization, this research serves as a valuable compass guiding policymakers and society at large towards fostering environments where educational achievements are celebrated regardless of gender, contributing to enhanced happiness and well-being for all.

Acknowledgements

Dr. Steven Zhongwu Li expresses gratitude to his students Qiming Zhang, Yufei Huang, and Yinqi Huang at the School of Economics, Zhejiang University of Technology, for their participations in writing the short commentary within a brief period. He also thanks the editor of Archives of Women Health and Care for inviting him to write the short commentary on the published paper.

References

  1. Li SZ, Lu F (2024) Does reversal of the educational gender gap affect Men’s happiness: Evidence from China. Review of Development Economics 1-30.
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  4. Nie, H, Xing C (2019) Education expansion, assortative marriage, and income inequality in China. China Economic Review 55: 37-51.
  5. Lewbel A (2012) Using heteroscedasticity to identify and estimate mismeasured and endogenous regressor models. Journal of Business & Economic Statistics 30(1): 67-80.
  6. Wei Si (2022) Higher education expansion and gender norms: Evidence from China. Journal of Population Economics 35(4): 1821-1858.
  7. Valentova M (2013) Age and sex differences in gender role attitudes in Luxembourg between 1999 and 2008. Work, Employment and Society 27(4): 639-657.
FIG 1

Primary Angiosarcoma of the Spleen: A Case Report and Clinical Pathological Study of 52 Cases

DOI: 10.31038/CST.2024922

Abstract

Primary splenic angiosarcoma is an uncommon and fatal cancer that affects 2 out of every 10 million people worldwide, according to epidemiological incidence rates. For primary spleen angiosarcoma, there are not enough systematic clinical data available, there have been only 90 cases reported since 1950. In this study, we analyzed 25 publications published between January 1950 and November 2022, providing thorough information on 52 cases of main spleen angiosarcoma. We also described a case of primary spleen angiosarcoma with metastases to the liver and bone. This study will go into great length on the etiology, clinical manifestations, laboratory and pathological features, and available treatments for primary spleen angiosarcoma, with the purpose to provide a thorough review and guidance for clinical guidance of this rare disease.

Keywords

Spleen, Angiosarcoma, Systematic review, Clinical features, Pathology, Prognosis

Introduction

Primary splenic angiosarcoma is a rare and fatal neoplasm arising from vascular endothelial cells within the spleen; it was firstly described in 1879 by T. Langerhans. The incidence is 2 cases per 10 million people worldwide [1] and has a poor prognosis due to its high metastatic potential, it was reported that angiosarcoma has the poorest prognosis among all soft tissue sarcomas [2].

Case Report

A female patient, aged 43, was admitted to our hospital with complaints of “Upper left abdomen distension and fatigue persisting for a period of four months”. The patient had repeated discomfort and mild pain in the left upper quadrant for 4 months. There was an absence of any noticeable medical or familial history. Her blood pressure and breathing were normal at admission. There was a mild anemia visible in the conjunctiva. The cardiac rhythm was consistent, and the respiratory vibrations were visible. The abdomen was soft, and there were no swollen superficial lymph nodes, with spleen margin 2cm lower than the left rib. Clinical laboratory results revealed moderate anemia, thrombocytopenia, increased D-dimmer. Red blood cells 2.75×1012/L (normal range, 3.8-5.1×109/ L), hemoglobin 87 g/L (normal range, 115-150g/L), platelets 79×109/L (normal range, 125-350×109/L), D-dimmer 1058 ug/L (normal range, 0-550 ug/L). Liver and kidney functions were normal. The levels of serum tumor indicators, such as carbohydrate antigen 199 (CA199), carcinoembryonic antigen (CEA), α-fetoprotein (AFP), and carbohydrate-125 (CA-125), were all within the normal ranges. We also excluded hepatitis B, hepatitis C, syphilis, AIDS.

Electronic gastrography revealed multiple stomach and duodenal ulcers. Ultrasound Doppler showed a 7 cm × 6 cm mass in the spleen, the internal echo was less uniform, and the blood flow was rich. The abdominal CT showed a mass measuring 13×12cm in the spleen as the right red arrow indicated (Figure 1a), the patient had very large spleen, which oppressed the stomach, gastric cavity was significantly reduced as the left red arrow indicated, we also noticed obvious liver metastasis before surgery (Figure 1b). The patient received complete splenectomy and partial hepatectomy. One month after the surgery, abdominal CT showed tumor metastasis to gastric wall, as we can see from the CT image that some part of gastric walls was thick as the red arrow showed (Figure 1c).

FIG 1

Figure 1: The abdominal CT showed a mass measuring 13 × 12 cm in the spleen as the right red arrow indicated (a), the patient had very large spleen, which oppressed the stomach, gastric cavity was significantly reduced as the left red arrow indicated, we also noticed obvious liver metastasis before surgery (b). The patient received complete splenectomy and partial hepatectomy. One month after the surgery, abdominal CT showed tumor metastasis to gastric wall, as we can see from the CT image that some part of gastric walls was thick as the red arrow showed (c).

We performed an exploratory laparoscopy for her, the neoplasm was located within the central region of the moderately enlarged spleen, and there was no obvious invasion and metastasis to the liver. We performed splenectomy, the cut-off was sent for pathology examination. The spleen was 20cm × 14cm × 10cm, red with foci bleeding, there was an 8 cm × 7 cm × 7 cm neoplasm within it. Under the microscope, tumor cells were arranged into spindles and coincide with each other into irregular revascularization, the nuclear was large, deep stained, nuclear mitotic phase were common, the tumor was polymorphic and composed of spindle cells and multinucleated giant cells arranged in a storiform pattern, which mimics undifferential polymorphic sarcoma. H&E stain, ×10 (Figure 2A left) and H&E stain, ×40 (Figure 2A right). Tumor cells were arranged into spindles and coincide with each other into irregular revascularization. H&E stain, ×40 (Figure 2B left) and H&E stain, ×200 (Figure 2B right). The nuclear was large, deep stained, nuclear mitotic phase were common. H&E stain, ×40 (Figure 2C left) and H&E stain, ×100 (Figure 2C right). The immunohistochemical analysis revealed that the tumor cells exhibited positive expression of endothelial markers of CD34++, FVIII++ and viimentin++ (Figure 3).

FIG 2

Figure 2: Histopathological examination revealed that the tumor was polymorphic and composed of spindle cells and multinucleated giant cells arranged in a storiform pattern, which mimics undifferential polymorphic sarcoma. H&E stain, ×10 (A left) and H&E stain, ×40 (A right). Tumor cells were arranged into spindles and coincide with each other into irregular revascularization. H&E stain, ×40 (B left) and H&E stain, ×200 (B right). We noticed red with foci bleeding. The nuclear was large, deep stained, nuclear mitotic phase were common. H&E stain, ×40 (C left) and H&E stain, ×100 (C right).

FIG 3

Figure 3: Immunohistochemical stains were performed with a panel of monoclonal antibodies. It showed positive for ALK, ×40 (A left) and ×200 (A right); CD68, ×40 (B left) and ×200 (B right), and negative for CD45, ×40 (C left) and ×200 (C right).

It was negative for desmin, LCA, cytokeratin, lysozyme and S100. Liver nodules were confirmed by immunohistochemical analysis to be homologous with spleen.

The patient received postoperative 4 cycles of IFO and paclitaxel chemotherapy. Although the patient was still alive 5 month after surgery, she experienced body weight loss and cachexia.

Systematic Review

Primary splenic angiosarcoma accounts for 10% of all primary splenic malignancies and 2.6% of all angiosarcoma cases [3]. Benign spleen vascular neoplasm [4] include hematoma, lymphangioma, hemangioma, extra-medullary hematopoiesis (EMH), and sclerosing angiomatoid nodular transformation (SANT). Malignant spleen vascular neoplasms include angionsarcoma, myeloma, lymphoma, and metastases tumors. Littoral Cell angiomas have malignant potential, although they were once considered benign [4]. Spleen angiosarcoma derives from the spleen sinus endothelial cells, extramedullary hematopoietic is typical.

Etiology

Arsenic, vinyl chloride, ionizing radiation, and chemotherapy for lymphoma are among the potential causes [5,6]. Nonetheless, certain research indicates that splenic angiosarcoma arises from pre-existing benign tumors, including hemangioma or hemangio-endothelioma. In the 1970s scientists had explored correlation between vinyl chloride exposure and angiosarcoma, and an estimated 25%-30% of angiosarcoma was related to direct or indirect contact with vinyl chlorideare. Tumor suppressor TP53 and K-RAS gene mutation is found to be responsible for more than 60% of angiosarcoma. The most common mutation sites are axon 1 of K-RAS, and exons 5, 6, 7 and 8 of the TP53 gene. However, gene mutations in angiogenesis signaling are also found to occur in nearly 40% of angiosarcoma, which would reinforce the therapeutic hypothesis to target angiogenesis signaling in angiosarcoma.

Clinical Features

Different from studies that there are more male patients than female, the cases included 24 males and 28 females [7], aged 2 years old [8,9] to 89 years old, the average age at presentation is 54.5 years, with a median age of 49 years. There was a statistically significant difference in the mean age at presentation between females (57 years) and boys (46 years). The most two youngest patients were 2 years old and 7 years old, there were no significant radiation or chemical exposure, gene mutations may play a more important role for these two patients.

The clinical manifestations of PSA vary significantly [10], we made a summary of clinical features of primary splenic angiosarcoma which included 52 cases (Table 1). The most common symptoms at presentation include left upper quadrant pain /abdominal pain (n=33, 63%), chronic weight loss/anorexia/anemia/fatigue (n=22, 42%), complete or incomplete spleen rupture (n=12, 23%). Other less common symptoms include gastrointestinal tract bleeding (n=4, 8%) hemoptysis (n=1, 2%), right flank pain (n=1, 2%). Thrombocytopenia occurs in case 32 and 37; both patients had bone metastasis and moderate to severe anemia.

Table 1: Clinical features of primary splenic angiosarcoma (52 cases).
We included and analyzed 24 males and 28 females, aged 2 years old to 89 years old, with an average age of 54.5 years at presentation (median, 49 years). The mean age at presentation for females was statistically significantly older (57 years) than men (46 years). The most two youngest patients were 2 years old and 7 years old, there were no significant radiation or chemical exposure, gene mutations may play a more important role for these two young patients.
The clinical manifestations of PSA vary significantly. The most common symptoms at presentation include left upper quadrant pain /abdominal pain (n=33, 63%), chronic weight loss/anorexia/ anemia/fatigue (n=22, 42%), complete or incomplete spleen rupture (n=12, 23%). Other less common symptoms include gastrointestinal tract bleeding (n=4, 8%) hemoptysis (n=1, 2%), right flank pain (n=1, 2%). Thrombocytopenia occurs in case 32 and 37; both patients had bone metastasis and moderate to severe anemia.
Physical examination revealed splenomegaly in 29 patients and hepatomegaly in 7 patients. Spleen rupture occurred in 12 patients (n=12, 23%). The most common physical finding was splenomegaly (71%). 17 of 21 patients were reported to have anemia. There were 9 patients without obvious physical findings on admission. The most common metastatic sites in descending order were to the liver (31/52), lung (24/52), lymph nodes (19/52), bone (15/52), adrenal glands (6/52), gastrointestinal tract (6/52), brain (4/52). Diaphragm and stomach were less involved compared with the listed above, 4 patients were found to be widely metastatic at diagnosis.

Case no.

Age/gender Admission symptoms Physical findings Sites of metastasis treatment

follow-up OS

1 36/M LUQ Pain HSM Liver/Lung/LNs Surg Chem 5 mo
2 73/M Abd pain/fatigue/GI bleeding HSM,F GI tract Surg 2 mo
3 76/F LUQ Pain SM Liver/Lung/LNs/Bone Surg Rad 7 mo
4 51/M Abd pain/fatigue/fever NONE Liver/Lung/LNs Surg 9 mo
5 73/F LUQ Pain SM Liver[1]/Lung Surg Rad Chem 3 mo
6 45/F Abd pain/Spleen rup SM Lung/LNs/Bone/Adrns Surg Rad Chem 4 mo
7 60/M Abd pain/fatigue SM Liver/Lung/Adrns/Diaphragm Surg Rad 4 mo
8 33/F Abd pain/Spleen rup SM Liver/Lung/LNs Surg Rad 4 mo
9 29/M Abd pain/fever SM Liver Surg 4 mo
10 50/M Abd pain/Spleen rup SM Liver/Lung/Adrns/Stomach Surg 24 mo
11 75/F Fever/weight loss/fatigue NONE Liver/Lung/LNs/Brain Surg Rad 10 yrs
12 68/M LUQ Pain NONE Widely metastasis Surg 8 mo
13 27/M LUQ Pain SM Lung/LNs/LNs/Bone/Adrns Surg Rad 3 mo
14 89/F LUQ Pain/fatigue SM Liver/Bone NONE 29 mo
15 46/M Abd Pain/fever/fatigue/hemoptysis HSM Widely metastasis Surg 1 mo
16 85/F Abd pain/Spleen rup SM Liver/Lung/LNs/Stomach /Brain Surg 1 mo
17 32/M Spleen rup/Fever/weight loss/fatigue SM Liver/Lung/LNs Surg 27 mo
18 55/M Found during lymphoma work-up SM Liver Surg 8yrs
19 56/M Abd pain SM Liver/Lung/Bone/Brain /Stomach Surg Rad 25 mo
20 68/M Abd pain/weekness/weight loss SM Liver/Lung/Bone/LNs Surg Rad 21 mo
21 59/M LLQ Pain/fatigue/spleen rup SM Widely metastasis Surg 29 mo
22 64/F Anorexia LUQ Pain Not alaviable Not alaviable Not alaviable
23 65/M Abd pain/weekness NONE Liver/Lung/Bone/LNs/Soft tissues Surg Rad 22 mo
24 62/F Asymptomatic NONE Widely metastasis Surg 1 mo
25 64/F LLQ Pain/fatigue /spleen rup NONE Liver/Lung/Bone/Brain[2] Surg 9 mo
26 68/F Abd pain/weekness NONE Liver/Lung/LNs/Adrns/Brain Surg 1 mo
27 69/F LUQ Pain/weekness/spleen rup SM Liver/Lung/Bone Surg 12 mo
28 49/M LUQ Pain/asthenia SM Liver/Lung/LNs Surg 8 mo
29 45/F LUQ Pain/Anemia SM Liver/Lung/LNs Surg 5 mo
30 46/F LUQPain/anorexia HSM Liver/Lung/Bone/LNs Surg 3 mo
31 55/M LUQ Pain/hemorrhagic ascitis HSM Fever Liver/Lung/Bone Surg 35 days
32 26/F LUQ Pain/severe anemia/thrombocytopenia HSM Fever Liver/Lung/Bone Surg 12 mo
33 65/F Asyptome NONE Lung/Bone Surg 13 yrs
34 77/F Abd Pain Spleen rup SM Liver/Lung/LNs Surg 2 weeks
35 13/F LUQ Pain Anemia SM No metastasis Surg 18 mo
36 25/F Anemia SM Bone/LNs Surg 12 mo
37 61/M Anemia Leukocytosis Thrombocytopenia SM Liver/Bone /LNs Surg 5 yrs
38 82/F Left Pleural effusion SM Diaghpram Surg 8 mon

LUQ, left upper quadrant; LLQ, left lower quadrant; Abd, abdomen; GI, gastrointestinal; rup, rupture; HSM, hepatosplenomegaly; SM, splenomegaly; LNs, lymph nodes; Adrns, adrenals; Surg, surgery Chem, chemeotherapy Rad, radiotherapy

Upon physical examination, 29 individuals had splenomegaly, while 7 patients presented hepatomegaly. Spleen rupture occurred in 12 patients (n=12, 23%). Spleen rupture can be further classified into complete and incomplete subcapsular rupture. Complete spleen rupture often leads to fetal hemorrhagic shock, whereas incomplete subcapsular rupture may not be obviously detected on admission and may not be that fetal. This could be the reason for the lack of a correlation between spleen rupture and clinical result. Splenomegaly accounted for 71% of all physical findings. Anemia was found in 17 out of 21 individuals.

There were 9 patients without obvious physical findings on admission. The most common metastatic sites in descending order were to the liver (31/52), lung (24/52), lymph nodes (19/52), bone (15/52), adrenal glands (6/52), gastrointestinal tract (6/52), brain (4/52). Diaphragm and stomach were less involved compared with the listed above, 4 patients were found to be widely metastatic at diagnosis. This might be explained by tumor cells transferred through the blood to most common distant organs like liver, lung, adrenal glands, and bone marrow [11,12] etc. A more concise summary of the detailed clinical features of 52 spleen primary angiosarcoma patients was made (Table 2).

Table 2: The most common symptoms at presentation for patients of primary splenic angiosarcoma.
This table concisely summarizes the detailed clinical features of 52 spleen primary angiosarcoma patients. The most common symptoms at presentation include LUQ Pain/ abdominal pain (n=33,63%), chronic weight loss/anorexia/anemia/fatigue (n=22,42%), complete or uncomplete spleen rupture (n=12,23%). Other less common symptoms at presentation include GT tract bleeding, hemoptysis, thrombocytopenia.

Symptoms at presentation

Number (n)

Percentage (%)

LUQ Pain/abdominal pain

33

63

GT tract bleeding

4

8

Complete or uncomplete Spleen rupture

12

23

Chronic weight loss/anorexia/anemia/fatigue

22

42

Hemoptysis

1

2

Thrombocytopenia

2

4

Asymptomatic

1

2

Total

52

100

Thrombocytopenia occurs in case 32, 37, both with bone metastasis and moderate/severe anemia. LUQ, left upper quadrant; GI, gastrointestinal.

Diagnosis

The benign lesions found in the spleen include hemangiomas, hematomas, and sclerosing angiomatoid nodular transformation. Primary and metastatic lesions comprise a variety of malignant conditions, including lymphoma, angiosarcoma, and pleomorphic sarcoma. Metastases and lymphomas are included in this study because of their variety and importance, despite their tendency to exhibit hypo enhanced lesions in in comparison to the surrounding parenchyma. Littoral cell angiomas, formerly considered benign, are now being individually investigated due to recent research indicating their potential malignancy [4].

Splenic lesions are frequently observed and frequently occur by chance. Hemangioma, hematoma, lymphangioma, extra- medullary hematopoiesis (EMH), and sclerosing angiomatoid nodular transformation (SANT) are all examples of benign splenic vascular neoplasms [13]. Among the uncommon splenic entities are focal EMH, focal myeloma, angiomyolipoma, and SANT. The most prevalent malignant non-hematolymphoid malignancy of the spleen is primary spleen angiosarcoma. Other malignant conditions that affect the spleen include lymphoma, myeloma, and metastases. We’ll discuss on the clinical manifestation, important imaging results, and correlations of benign, neoplastic, and malignant conditions that might affect the spleen [14].

T. Langerhans initially described spleen angiosarcoma in 1879. The variability of clinical symptoms and diagnostic values related to splenic angiosarcoma is considerable. However, a significant proportion of the patients (75%) have stomach pain, while approximately 25% to 33% exhibit rupture of the affected organ [15,16].

Angiosarcomas are high-grade vascular tumors associated with poor prognosis due to their aggressive nature [17,18]. Because they tend to be aggressive, angiosarcomas are high-grade vascular tumors with a bad prognosis. A timely splenectomy and cytotoxic chemotherapy after an early diagnosis may be useful treatment options, according to anecdotal findings.

Splenomegaly was observed in 85% of patients during macroscopic examination. Distinct lesions were observed in 88% of patients upon sectioning, exhibiting a range of characteristics including well-defined solid nodules as well as poorly characterized areas of necrosis and bleeding related to cystic spaces. The tumors exhibited heterogeneity at a microscopic level, although all instances exhibited a focal vasoformative component that was bordered by atypical endothelial cells. The study revealed the presence of solid sarcomatous, papillary, and epithelioid development patterns. In two cases, the component of the solid sarcomata had similarities to fibrosarcoma, whereas in one case, it displayed similarities to malignant fibrous histiocytoma. Frequent observations included hemorrhage, necrosis, hemosiderin, extramedullary hematopoiesis, and intracytoplasmic hyaline globules.

The findings from a series of immunohistochemical experiments indicated that a significant proportion of tumors had immunoreactivity for a minimum of two markers associated with vascular differentiation (CD34, FVIIIRAg, VEGFR3, and CD31), as well as at least one marker indicative of histiocytic differentiation (CD68 and/or lysozyme) [19]. In all cases, metastases occurred at some point throughout the disease’s course [20-22]. After the last follow-up, only two patients remained alive, one with disease after 8 years and the other without disease at 10 years. Of the 26 patients, 26 died of their condition despite rigorous therapy. [23]. In summary, primary spleen angiosarcoma is a highly aggressive tumor that, in nearly all cases, results in mortality [24]. According to immunohistochemistry study, most of the spleen angiosarcomas co-express histiocytic and endothelial markers, indicating that some tumors may arise from spleen lining cells [25].

The diagnosis was based on histopathological results. Microscopically, the tumors were heterogenous; hemosiderin, hemorrhage, necrosis, and extramedullary hematopoiesis were frequently identified [26]. Differentiating benign vascular tumors from malignancies with modest atypia was typically challenging. The ability of tumors to generate blood vessels was frequently impaired in cases of severe atypia [27]. Only instances with moderate or severe cytology abnormal exhibited the presence of peculiar tumor giant cells. The immunohistochemical analysis demonstrated that tumor cells exhibited immunoreactivity for markers associated with vascular differentiation, including CD34, FVIIIRAg, and CD31. Additionally, vimentin was found to be commonly positive, while S-100 protein and cytokeratin were generally observed to be negative. Abnormal laboratory findings included anemia, leukocytosis, and thrombocytopenia. Moderate to severe anemia and thrombocytopenia would indicate bone metastasis on most occasions. Many tumor markers, including AFP, CEA, CA-125, and CA19-9, were either slightly increased or within normal ranges. Radiologists should take note of an enlarged spleen that shows low attenuation on computed tomography, as well as a single or numerous heterogeneous nodular masses in the liver.

Imaging Manifestations

The imaging results showed an enlarged spleen with lobules, as well as heterogeneous nodules that had significant and uneven enhancement following contrast injection and spontaneously hyper dense regions [28]. Bone lesions with visible veins and arteries were present, in addition to metastases to the liver and lungs [29,30]. Lymphoma and metastases often exhibit hypo-enhancing lesions compared to the surrounding tissue [4]. The CT and MR imaging results indicated that the lesions had a hemorrhagic character and contained higher levels of iron [31].

Treatment Options

Early clinical symptoms for spleen primary malignancy are not typical [13]. Most patients were diagnosed at an advanced stage and had poor prognosis. Considering the treatment options, timely identification and immediate removal of the spleen before it ruptures and peritoneal dissemination is crucial for long-term survival, so early detection is a hot topic for angiosarcoma [5]. There have been controversies on the use of chemotherapy and radiotherapy in primary spleen angiosarcoma. Adjuvant cytotoxic chemotherapy can be effective treatment options for multiple metastases that cannot be excised. Kamocki [15] reported a 57-year-old woman with spleen angiosarcoma and liver metastasis received 8 rounds of weekly-based paclitaxel before undergoing metastatic liver resection; this was followed by a pathological full response. But overdose chemotherapy may impair immune function and acerate progression of tumors, in our 52 cases, there were four patients survived more than 9 years, none of them received chemotherapy or radiotherapy. This might e ascribed to complete resection of tumor. Radiotherapy is helpful for doubtful regional resection; radiation on bone metastasis is helpful for the relieving pain.

We reported a case of a 46-year-old female patient who had liver metastases and primary splenic angiosarcoma (PSA); she died soon 35 days following surgery. Clinicians can obtain a thorough review from this case report, the systematic review, and the in-depth analysis of 52 instances. When the patient exhibits symptoms such as upper abdomen pain and abnormalities in the blood cell count (such as anemia, leukocytosis, thrombocytopenia, and/or high erythrocyte sedimentation rate), it is advisable to consider the possibility of PSA. Furthermore, imaging evaluation is crucial for the timely detection of PSA.

Availability of Data and Materials

The data generated in the present study may be requested from the corresponding author through 109274952@qq.com

Authors’ Contributions

Conception and design were performed by Rui Wang. Data analysis and interpretation were performed by Yuan Fang and Jingqiu Zhang. Manuscript writing was performed by Rui Wang and revised by Jingqiu Zhang. Final approval of manuscript was performed by all authors who read and approved the final manuscript.

Acknowledgement

None

Grant Support

Rui Wang is founded by China Scholarship Council (202206920039). This research was supported by funds from Natural Science Foundation of Suqian Science and Technology Bureau (K201903, Z2018076, Z2018213 and Z2022065). Jiangsu Association for Science and Technology (JSTJ-2022-004).

Ethics Approval and Consent to Participate

The patient reported in this study was told for the purpose and process of this study and had written informed consent according to the guidelines of the hospital’s human associated research.

Patient Consent for Publication

Not applicable.

Competing Interests

The authors indicated no potential conflicts of interest.

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fig 3

The Role of Women’s Participation in a Solar Energy-Agriculture-Gender Equality Nexus towards Mitigating Poverty among Farmers in India

DOI: 10.31038/AWHC.2024714

Abstract

Energy transition should encompass social and economic decision along with achievement of sustainable development goals (SDGs). In developing countries like India, impoverished sectors like agriculture, suffer from economic and gender disparities which make the achievement of climate action a strenuous activity. This paper proposes a solar-agriculture-gender framework nexus that is capable of poverty mitigation (SDG 1), gender inequality mitigation (SDG 5), affordable and clean energy introduction in agriculture (SDG 7), economic and food quality improvement (SDG 9) and climate change mitigation (SDG 13). By introducing solar power into the agricultural mix for irrigation in the fallow lands of poverty-ridden minority communities, a set of life-cycle assessment tools are introduced in this framework package that can guide a sustainable energy transition in the agricultural sector of developing countries.

Keywords

Sustainable agriculture, Gender equality, Poverty, Farmers empowerment, grivoltaics, Food production

Introduction

While net-zero targets are the center of energy policy in recent years, transition from fossil fuels (FF) to renewable energy (RE) is a very gradual process, specifically for developing nations. It is estimated that it will take more than 15 years for China to produce 50% of its power from “green” sources, while it is more than 20 years for India . On the other hand, several developed countries and states have already reached more than 50% non-FF electricity generation, such as Norway, France, California, New Zealand, Denmark, etc. In order to accelerate energy transition and meet net-zero targets, participation of all sectors and all demographics is imperative. This is tantamount for a country like India, which despite being a very fast-growing economy, suffers from a large portion of the population being below poverty line (BPL) and a substantial lack of women’s participation in the workforce. It is the backward classes of the economic spectrum that are employed in the primary sector of the economy, which happens to be the most emission intensive sectors across all developing countries. In these sectors, decision-making has been homogeneous and hierarchical, specifically in methods of operation (that includes energy-use). Thus, not only does the social aspect of energy transition involve socioeconomics, it also involves equity, justice and inclusion as part of the energy-society nexus [1-11].

India is the fastest-growing emerging economy [5], which is also the third highest global CO2 emitter [12], owing to heavy dependency on FF (especially coal) in the power and primary sectors. Agriculture accounts for more than 50% of the entire workforce in India, while contributing under 20% of the total gross domestic product (GDP) of India [13]. This is a major issue since agriculture also accounts for 10% of the total CO2 emissions, while consuming only 7% of the total primary energy supply (TPES). This makes agriculture the second most emission intensive sector of India, behind power generation [8,14]. This is coupled with the fact that only 55% of Indian agricultural energy consumption was electrified in 2019, compared to 38% in 1990 [4], showing the prevalence of FF in the sector. All these data are from 2019, and shown in Figure 1. The second issue of the per capita GDP being tremendously low for agriculture, is that most of the farmers are poverty-ridden. While India’s BPL population has reduced from 46% in 1993 to 25% in 2020, more than 80% of the BPL households primarily earn their living from agriculture. Additionally, Figure 2 shows that the slope of increase of the rural population is much higher than that of the number of farms, implying that per capita productivity has also reduced over the years [9,13,15,16]. Table 1 shows the calculation for monthly income and expenditure by decile for the rural agricultural population of India, where it can be seen that several households up to the 8th decile are all in negative income zones. The third issue has been highlighted by multiple previous studies, which is a direct consequence of the persisting poverty in Indian agriculture. Mechanization of agriculture has been quite under-developed in India, due to the purchasing power of farmers being sub par, and even insufficient funds to buy fuel for tractors, pumps, etc. [17-19]. Moreover, rural-farm electrification is below 60%, specifically poverty-ridden areas facing issues with access to electricity [20]. As a result, policy mechanisms, such as subsidy on agricultural fuel exist in many states of India, such as Haryana and Maharashtra [13,18], which indirectly drives the cost of fuel higher in the transportation and service sectors. This also decreases the public enterprises’ earning from fuel taxes, affecting the value of oil trade. The resultant decreased trade creates a ‘death spiral’ that increases the inflation in agriculture and transport sectors, which decreases real-GDP compared to inflated GDP [21,22].

fig 1

Figure 1: Energy source shares in Agricultural sector in India [14]

fig 2

Figure 2: Number of farms vs rural population increase in India

Table 1: Decile-wise Income-Expenditure reporting for farmers owning less than 1 hectare of land [9]

Decile Class

Total Income (Rs.) Monthly Total Exp. (Rs.) Monthly Income – Exp MPCE (Rs.)
Family 4 Family 5

Family 6

1

3870

3537 333 884.25 707.4 589.5
2 4263 4337 -74 1084.25 867.4

722.8333

3

4697 4708 -11 1177 941.6 784.6667
4 4739 4933 -194 1233.25 986.6

822.1667

5

5471 5358 113 1339.5 1071.6 893
6 5830 5515 315 1378.75 1103

919.1667

7

5703 5896 -193 1474 1179.2 982.6667
8 6122 6385 -263 1596.25 1277

1064.167

9

7430 7169 261 1792.25 1433.8 1194.833
10 12458 11107 1351 2776.75 2221.4

1851.167

In addition to the economic concerns, a critical social issue prevents the escape from poverty in Indian agriculture, which is the disparity in gender participation in the sector [11]. Notwithstanding that women in rural societies are more inclined towards family-roles, such as child-rearing, the issue is pronounced when women decide to participate in the agricultural process. The author of, highlighted that wages are consistently low for female farmers occupied in growing rice, the staple food crop for a majority of India, and especially pronounced when there is a shortfall in rainfall and irrigation water supply. Studies have also analyzed that the labor market is immature, which leads to further reduction of female labor’s wages much more than male labor wages [8,23]. This is coupled by the fact that landowners are completely dependent on productivity, which is erratic due to a lower penetration of electricity for farming. The disparity in access to clean and modern energy by farmers extends to the gender disparity issue as well, as the authors of pointed out that access to clean cooking fuel is more diminished for poverty-ridden women-run households than that of men-run households in rural India. Finally, the access to education in farming communities in rural India is also negatively skewed for women, as pointed out by multiple reports [9,11,16]. It is therefore, imperative to analyze these economic and socioeconomic issues from the lens of renewable energy and agricultural productivity in rural India.

The central idea of this study is to build a framework that throws light on a new energy-society nexus in India, namely, solar-agriculture-gender (SAG) nexus. The objective of this paper is to build a policy regime that utilizes the integration of solar energy into the agricultural energy mix of rural India, targeted at emission intensity reduction of farming processes and mitigation of poverty and disparity against women involved in the sector. While several previous studies have highlighted how RE integration can improve not only the energy profile of farming processes, it can also boost agricultural productivity [24]. On the other hand, RE and the involvement of women have been an active area of energy policy research and socioeconomic development [25-28]. However, most existing studies isolate the issue of gender equality in energy transition and focus centrally on the involvement of women in decision-making in the energy sectors. Moreover, most of these studies are directed at the sectors which are demographically urban and mainly limited to the power sectors. The novelty of the framework presented in this paper is that it targets at a specific sector (Indian agriculture), which is gender-inequal as a result of poverty and inaccessibility to education. This paper opens up the possibility to utilize RE integration as a tool for poverty eradication and gender disparity mitigation in poverty-ridden sectors [25-27].

Solar-Agriculture-Gender (SAG) Nexus Framework

SAG framework will be defined in this section, with its components as a policy package for the Indian agriculture sector. The most appealing characteristic of this framework is from the perspective of sustainable development goals (SDGs), as it forms a feedback loop between SDG 1 (no poverty), SDG 5 (promoting gender equality), SDG 7 (clean and affordable energy), SDG 8 (decent work and economic growth) and SDG 13 (mitigating climate change). Figure 3 shows the schematic flow of the SDG policy implementation under the SAG nexus.

fig 3

Figure 3: SDG interactions resulting from the proposed SAG framework

The first action of introducing solar plants (solar photovoltaic technology- SPV) into the agricultural mix is in line with SDG 7, which is targeted at meeting the Paris Agreement targets of India, and also towards net-zero targets (SDG 13). In addition, the policy framework can be mutated to be completely owned by the farmers, instead of centralized SPV plants. While decentralization will require a lot of awareness programs to be launched and is time-consuming from a policy implementation standpoint, it will directly be affecting SDG 1. Poverty eradication is completely looked at from increasing the earning of a farmer through two channels: (a) increasing the productivity of existing crops by providing a stable supply of groundwater irrigation, and (b) enabling the farmers to sell off the excess electricity to distributor companies (DISCOM). When agricultural productivity increases due to stable irrigation, it creates a higher economic growth for the farmers’ communities and also increases the value of the food being produced (SDG 8). SDG 8 is also achieved when participation of women increases due to the opportunity of maintaining SPV plants creates additional jobs. In fact, women-owned farms can benefit largely from this, since excess electricity sold will be determined by feed-in-tariff (FiT) mechanisms, bypassing existing problems of produce-related income shortage. This creates a feedback loop towards gender-equal labour-force participation and equal wages for women in poverty-ridden societies (SDG 5) with SDG 1 and SDG 7 achievements. Figure 4 shows the policy framework that will enable the SDG achievements of Figure 3 [29,30].

fig 4

Figure 4: The Solar-Agriculture-Gender (SAG) policy framework for sustainable and gender-equal agriculture in India.

Economic Planning Subsection

Within this part of the framework, the ramifications of the microeconomics are considered for integrating SPV power within the agricultural mix. Firstly, a community of minority-dominated farmers have to be selected in India, who mainly are concentrated in the states of Bihar and Chhattisgarh. For the test case, the community size should be between 100 and 200 persons in a rural setting. With the absence of disposable income for such farmers, it will be impossible for them to procure the SPV equipment and necessary grid interconnections. This is where subsidy-shifting mechanisms should be employed by local village governments, as they remove the subsidy on oil and equivalently apply it to the interest rates of loans on SPV-related expenditure. Several policy mechanisms like ‘PM Surya Ghar Muft Bijli Yojana’ are in action for rooftop solar schemes, which offer subsidized rooftop SPV equipment. If solar pumps can be subsidized similarly, it will incur no additional cost for the government due to removal of subsidy on oil. Feed-in-Tariffs can be fixed by banks to recover the principal and subsidized investment on SPV, which can be funded by the farmer community’s excess electricity production earning [31,32].

Secondly, it might be thought that rainfed areas are better for SAG framework installation, due to higher incidence of natural irrigation. However, the cloud cover will make SPV power production unpredictable, leading to very low FiTs for the farmers, which will defeat the purpose of the SAG nexus. Thus, rain-shadow areas are paradoxically more suitable for SPV integration into agriculture, because of two reasons: to get a higher FiT on the installed solar and SPV integration would streamline the availability of water in drought-prone areas [33,34].

Thirdly, any regional or specific crop cannot be selected for the framework. Cash crops and specific regional food crops depend not only on the soil quality, but also on the type of soil. Such soils are mostly unsuitable for any shared purpose of land, wherein previous studies have shown that integration of solar into agriculture would actually decrease the productivity of such special crops. Rice and wheat are the two staple crops of India, but wheat requires a much drier climate than rice, making wheat limited to the northern and north-western part of India. Rice is grown in more than 70% of India’s agricultural land, making it the ideal candidate for solar and agriculture integration. Moreover, due to the abundant supply of rice, it is often the minority group population that grow rice are the poorest among all farmers of India [35,36].

Agriculture and SPV (Adapted Agrivoltaics)

Agrivoltaic systems have been analyzed in a plethora of existing studies, where co-location of agricultural activity and power production benefits both the systems explored how land-use can be optimized by usage of different densities of photo-voltaic panels on farms primarily considering shading effect on the crops as well. The study specifically analyzes a full density installation and a half-density installation of solar panels in a field, and by virtue of a factor called Land-Equivalent-Ratio, wherein the productivity of land was greater in both configurations. This can be attributed to the fact that irrigation becomes streamlined by the integration of SPV. Figure 5 shows the configurations of SPV and agriculture co-location arrangements [37].

fig 5

Figure 5: Co-locating SPV and crops on the same owned land in two configurations: (left) separate land with standard-mounted SPV, (right) high-mounted SPV in-between crops.

In the high-mounted SPV shading effect of the solar panels are optimized against the growth of the plants. This configuration not only requires a higher knowledge of crops’ growth trajectories, but involves a higher SPV system cost due to expensive mounting structures and more expensive maintenance cost [37,38]. Due to the target demographic being poverty-ridden and not sufficiently aware of SPV maintenance, separate-land, standard-mounted SPV and crops co-location is recommended. This is also coupled with the fact that minority-owned agricultural land has quite a lot of fallow land [13]. Thus, the SPV system could utilize the fallow land, where no crops are grown in any case. In such a case, the fallow land-based solar powered irrigation can provide a much higher economic performance per unit area of land, compared to diesel pumps utilizing the existing land area of crops [39]. This could create opportunities for increasing the productivity of the owned land, thereby increasing the value of land in women-owned communities.

Water and Food Nexus

The first achievement of this framework is from the perspective of food security and water conservation nexus. Existing studies have already proven that Agrivoltaic systems can not only increase the efficiency of land-use, but also the utilization of water [40] showed how specifically water-use can be made efficient by usage of solar panels and planting a low-water-consuming crop like Aloe Vera together in drylands. While rice is a water-intensive crop, separated land can easily be optimized by land-use engineering, where fallow land-based SPV panels can be located at a higher elevation. The run-off water from washing of the panels can trickle down to the rice fields, making dual use of the water, increasing efficiency. This was proven by the researchers of, who showed that the food-water-energy nexus is benefitted in arid areas by agrivoltaics [40,41].

An entirely new methodology for assessment of Agrivoltaic technology was investigated by Leon and Ishihara [42]. In their paper, they assessed the life-cycle CO2 emissions of a greenhouse, used for tomato cultivation, padded with solar cells at optimum angles. They created new functional units called modified-area based and monetary-based units to assess the emissions from a collocated system. To gauge the potential of increased water and food security of the SAG framework, newer functional units are proposed that would ensure an empirical outlook of the nexus achievements. Table 2 shows the functional units for gauging the viability of the framework to deliver policy outcomes. All such functional units will be based on the life-cycle assessment of the proposed system.

Table 2: Functional units for LCA analysis of the SAG framework for empirical representation of SDG achievements

SDG Targets

LCA Nomenclature

Functional Unit Definition

SDG 8 Land area productivity Total revenue per unit area of land
Water productivity Total revenue per litre water-use
Monetary efficiency Total revenue per unit cost input
SDG 13 Food production emission intensity Total CO2 emission per kg of crops produced
Income emission intensity Total CO2 emission per unit revenue
Energy emission intensity Total CO2 emission per unit energy consumed and sold
SDG 1 and SDG 5 Poverty index Total income increased per capita of poverty-ridden population
Gender index Total women’s income increased per capita of female population
Poverty emission index Total CO2 emission per capita of poverty-ridden population
Gender emission index Total CO2 emission per capita of female population

Note: All of these LCA assessments are to be done in two scenarios: Business-as-usual without integrating SPV and SPV-integrated SAG nexus.

Poverty Mitigation and Gender-Equality Achievement

The central focus of the SAG framework implementation is improving the condition of poverty-ridden farmers and eliminating economic disparity against women in such poverty-ridden communities. Assuming that the SPV integration in the community of the farmers do not involve any exogenous addition of labour, more workers will be required for maintenance of SPV-powered irrigation pumps compared to diesel pumps. Moreover, with increased productivity due to timely availability of irrigation water from the SPV-powered pumps, the surplus crops will also need additional labour to manage. This is exactly where women can be involved in the process. For communities that are preexisting dominated by women farmers, extra unemployed workers from the same community should be assumed to be involved.

While there have been literature that have addressed inclusion of women in academic and technical planning for energy transition, and from the perspective of leadership, specifically in the roles of energy justice and democracy [25,27], there are very few studies that have analyzed how discrimination of poverty-ridden women can be eliminated by their inclusion in energy transition programs. Several key bibliometric reviews point out the leadership-building initiatives for inclusion of women in rural India’s energy transition spectrum, all concluding that class and caste discrimination are considerable hurdles that need to be overcome for removing gender disparities [26,43]. Ethnographic methods in literature have also explored how women’s and men’s participation at household levels can be streamlined [44]. However, while addressing the justice issue, no existing literature has provided a framework that can uplift caste and gender issues by the specific integration of RE towards a sustainable energy transition. This is where the SAG framework addresses these deficiencies by quantifying how gender disparities can be removed while simultaneously improving the economic situation by SPV integration.

From Table 2, the poverty and gender indices are measures to assess how much income increases within the entire SAG nexus per capita. The increased income results not only from the selling of excess electricity from the grid-connected SPV, but also from the saving on oil expenditure by the farmers’ community despite the oil being subsidized. Moreover, increased productivity is estimated to also add to the income, thereby providing a comprehensive nexus performance. These indicators empirically address one of the key questions by the International Renewable Energy Agency (IRENA) on the gender perspective of renewable energy. The other two indices, poverty emission and gender emission, gives the outcome as to how sustainably the income increase happens in the SAG framework as compared to business-as-usual agricultural approach, which answers the sustainability challenge of the Asian Development Bank for gender equality achievement [45,46].

Fossil Fuel Reduction and Climate Action

The SAG nexus is designed to be an effective and inclusive policy framework that enables the achievement of net-zero targets at the lower end of the social strata. Existing agrivoltaic research has already indicated that from the perspective of an individual agricultural holding, solar-powered pumping has a much higher social and economic performance than fossil fuel-powered pumps [39]. There have been other researchers who have focused on concentrated solar power, where it was found that it had higher energy efficiency, lower heat loss and a markedly high economic viability than a traditional system employing electricity, kerosene and diesel. Along with climate benefits, the payback time for concentrated solar and SPV is quite less compared to a diesel pump, while the operational cost is much lesser for the solar plants [47,48].

From Table 2, three separate climate action benefits can be empirically determined by the SAG framework. Firstly, the food production emission intensity is vastly reduced by solar integration because of the irrigation being completely power by a non-emitting source. Apart from irrigation systems, there are multiple other farm applications of solar electricity such as, solar cooling and heating in greenhouses. Alleviation of poverty and increased income has always been associated with a higher emission intensity of increased wages. Traditional economic models have always indicated that wages are increased at the cost of the environment. The second indicator under SDG 13 in Table 2, has the potential to prove this theory wrong, and show that RE integration into poverty-ridden and minority-dominated communities has the potential to mitigate poverty and promote gender equality sustainably [49,50].

Finally, while many sectors of India have entered a decoupling phase of energy-use and production, agriculture has always suffered from not achieving decoupling at the energy source . As a result, the third indicator in Table 2 under SDG 13, will show that reduced FF-use in agricultural processes can effectively push Indian agriculture towards decoupling [2].

Conclusion

This paper proposes a framework called the Solar-Agriculture-Gender (SAG) framework that has the potential to solve three key issues in the Indian agricultural sector: poverty and gender inequality among farmers, stable food production and high emission intensity of food production. This is achieved by integrating solar power into the agricultural mix for the primary purpose of irrigation and replacing existing diesel-powered pumps. Such agrivoltaic systems will be implemented in communities of poverty-ridden and minority farmers and specifically gauge the acceptance of new and renewable energy in such communities. Through a series of life-cycle assessment indicators, the framework is expected to reveal the socio-economic and environmental achievements of this framework, to ensure that it can be readily accepted as a policy direction by existing governments or as a project by large corporations.

At the heart the central policy that the SAG framework targets is the subsidy on agricultural oil-use given by governments, which is essentially a death spiral economic policy, that not only makes agricultural markets non-competitive, but also leads to a stagnation in the awareness and wages of farmers. The incentive is expected to be firstly created with the government, wherein the subsidized oil can be given to other sectors for a higher price. At this moment, the list of indicators of this SAG framework will be the incentive for financial institutions or corporations to loan the capital for a reduced interest rate to the poverty-ridden community of farmers. Only upon the installation of solar power, and that results in higher gains, can farmers and specifically women farmers realize that higher production of food and excess electricity sold adds to their income. Thus, the incentive does not come from the farmer because of their lack of awareness of solar systems and their economic potential. This reverse incentive idea is where the SAG framework provides an effective tool for the implementation of this nexus that can result in the simultaneous achievement of 5 SDGs.

A lot of future research needs to be conducted based on the premise of this paper. The first recommendation is to conduct a ground-level data collection and selection of impoverished communities, based on which actual empirical data can be simulated. The second direction is to simulate such data at a market-level to uncover the macroeconomic potential of this type of framework, such that it can be readily adopted by policy makers.

Competing Interest

The author declares no financial or non-financial interests that are directly or indirectly related to the work.

Funding

This work was not funded by any agency.

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