Monday, December 12, 2011

New Adventures in Malnutrition and the Poop on Thorsten Hagerstraand...

Photo from The Health Success Site

A time-space web model, in the sense of a flow of life-paths controlled by given capabilities and moving through a system of outside constraints, which together yield certain probability distributions of situations for individuals, should, in principle, be applicable to all aspects of biology, from plants to animals to men.  Torstein Hagerstraand, 1970.

The Problem...

Whenever I come to Indonesia I end up losing weight....a lot of weight.  Generally during the course of a three month stay I lose about 20 lbs, which, upon my return to Hawai'i, I quickly gain back.  Normally the weight loss is caused by a change in diet; I eat a lot of food from street vendors and places that would make your average health inspector descend into a cataleptic trance.  The food is good and somewhat nourishing, but frequently it comes with a post-meal bonus that is often euphemistically referred to as "Montezuma's Revenge".  This time however I've lost a bit more than that; so much that I had to cut a new hole in the belt I've been wearing for the past 10 years.  The "normal" symptoms, which I'm used to dealing with, turned into an debilitating 2-week long trial which sapped my energy and motivation to work.  I'm not a big fan of scatological humor, but to make a long story short, my intestines were leaking like the old Polish navy.

I described my symptoms to my tiger-chasing friend, who has lots of first-hand experience with various ailments.  "It sounds like you might have a mild case of amoebic dysentery", she told me.

"Dysentery?  That's AWESOME!  I was hoping I'd get dysentery or beri-beri or something like that."

"What's awesome about it?  Dysentery has killed thousands of people over the years", she cautioned.

"Yeah but do you know how much field cred you get for tropical diseases?  It's almost as cool as surviving a tiger attack.  I can brag about it to all the lab researchers when I get back home".

"Yeah but it could damage your liver pretty severely," she warned.

"Liver, schmiver.  I can get a new one of those.  David Crosby did it three times".

Nevertheless, she recommended that I seek medical treatment.  The next working day I made my way down to the "hospital" to talk to a doctor and check out the nurses.  As I sat in the consultation room discussing the intimate inner-workings of my intestines, I noticed a number of non-medical people peering in the windows and doors, including the parking attendant, a young man around 18 years of age.  I realized that soon everyone in Kerinci Valley was going to know about me and my "problem", and that I'd be subject to the potty-themed taunts of ojek drivers for the next 8 months unless I asserted myself.

"What are all these people doing here?" I asked the nurse.

"Oh, you're a foreigner, so they are curious about you."

"Don't my insides work the same as yours?" I asked somewhat rhetorically.  Then I turned to the guy peering in the window: "Scram, you little bastard.  This is between me and the nurses".

After a while the doctor arrived on the scene.  Dealing with all the "curious parties" put me in something of a persnickety mood, and so my carefully concealed wiseass American nature emerged from within.  The doctor examined me and then gave me some nutritional advice.

"Usually problems like this are caused by diet".

"That's a real revelation, Doc".

"You need to eat three meals a day..."

"What a novel concept..."

"And avoid Indomie (instant noodles)..."

"Well what am I going to eat then, Doc?"

"I suggest rice..."

"Where am I going to find rice around here?"

I left the hospital with four types of medication: Tyran (ranitidine), Diadium (loperanide), Lapikot (trimethoprim and sufamethoxazole), and Scopamin Plus (hyoscine-n-butylbromide and paracetamol).  I'm happy to report that after a week my innerds are functioning like clockwork, and I've got a lot more energy.  I don't know if I had amoebic dysentery or not since I didn't get any labwork done, but I did get to ruminating on the applications of geographic theory to the squirts.

A Pioneer in Time-Space Geography....

It was primitive economics to assume that banks should worry about the identity of coins.  Is it advanced or primitive social science to disregard the identity of people over time in the same fashion?  This is what we do in most cases when we treat a population as a mass of particles almost freely interchangeable and divisible-- Thorsten Hagerstraand, 1970.

The more I thought about my gastrointestinal challenges, the more I realized that it is an quintessentially geographic problem, because my debilitated condition created not only a spatial constraint, but a temporal one as well.  Most people realize that geographers are interested in how things are arranged on the landscape, but we are also interested in the temporal dimension as well.  I thought back to the work of the legendary Thorstein Hagerstraand, a brilliant Norwegian geographer who is regarded as one of the pioneers of incorporating time into geographic theory and analysis.  Hagerstraand's body of work is expansive, but in his 1970 presidential address to the European Congress of the Regional Science Association, he unveiled the seminal concept of time-space prisms.

The time-space prism deals with the range of possible activities that can be achieved by an individual in a given timeframe.  In 1970 Hagerstraand was concerned that people were being treated like objects in planning processes.  He reasoned that for people, in addition to spatial coordinates, a given location also has time coordinates.  He distinguished this from previous studies of locational analysis because the movement of materials is most important when considering inanimate goods.  In the diagram to the right you can see the basic concept.  In the y direction you have time, whereas in the x dimension you have space.  It helps to visualize the model in three dimensions, with the diamond representing a prism (hence the name).  Hagerstraand assumes that most people have to return to a home base at the end of the day; home base is a place to store goods and to sleep.  As you can see the prisms get bigger if you change the mode of transport, because bikes, cars, and planes enable us to cover greater distances in the same amount of time.

Within the prism we encounter obstacles or limitations.  Hagerstraand identified 3 types of constraints:

  1. Capability constraints:  "Those which limit the activities of the individual because of his biological construction and/or the tools he can command" (12).  Sleeping and eating are examples that affect all of us.  
  2. Coupling constraints: These are obligations or other requirements that limit our freedom in traversing the prism.  Going to work, going to school, appointments, and other set-time events are coupling constraints, because you have to be as a certain place at a certain time.  Hagerstraad refers to groupings of several individual paths as "bundles".  You can think of these as organized activities.  For example, the functioning of a factory depends on a lot of people being in specific places doing specific things.  
  3. Authority constraints:  Hagerstraand uses the terms "domain" and "control areas" to refer to places that have limited access.  For example, you can only go to the bank during certain hours; outside of those hours the space of the bank would be an inaccessible gray area on your time-space prism (unless, of course, you are a burglar).  

Each of these three constraints comes together in our own personal time-space prisms.  Below you can see a diagram I took from Hagerstraand's original article; it isn't as descriptive as it could be but you can probably get the idea.  The whole point of the article, though, is that planners need to take these constraints, as well as individual capabilities, into consideration when building public spaces or deciding how cities should be laid out.  As we'll see in a moment, this framework of analysis is quite useful for understanding dysentery and other nasty ailments.

The Geography of Montezuma's Revenge...

I borrowed Hagerstraand's idea to illustrate how dysentary, which would be considered a "capability constraint", altered the achievable landscape in Sungai Penuh.  The first illustration of this is the simple time-space prism to the left.  As you can see, not much time elapses before a visit to "home base" is required.  The next step was to apply these to the real landscape.  The results can be seen on the map below.  The four letters denote the four accessible places in town I know to have western-style toilets.  After more than a decade in and out of Asia I still haven't mastered the art of the squat toilet, and given the sensitive circumstances of my condition I didn't want to take any chances (you can think of this as a "coupling constraint").  So the four locations can be thought of as temporary home bases.  The buffered areas around the locations represent the estimated distance that can be covered on foot between "episodes" and should be imagined in three-dimensional space.  Here we find our last type of constraint, the "authority constraint", because there are laws that prevent one from evacuating one's bowels on the sidewalk.  The map reveals that dysentery has a significant effect on one's daily activity space.  For example, it would not be possible for me to walk to the national park HQ, where I do a lot of work.  The main market is also at the very fringe of achievable activity space, and so the more time you spend bartering and haggling, the more your space contracts.  In addition the map shows us that to get anything done, one must plan carefully, sequencing activities in several stages.

So once again we see how geography can enlighten our lives and help us make sense of the chaos around us.  The main lesson here is watch what you eat, and bring your own toilet.

References and For Further Reading

Hagerstraand, Torsten.  1970.  What About People In Regional Science?  Ninth European Congress of the Regional Science Association.  

This article is really worth reading, but you won't be able to access it unless your library has a subscription to one of Wiley's overpriced digital repositories (or unless your library has the actual print version).  UH has back issues of this particular journal, but not in the electronic format.  Since I'm in Indonesia, it's not very convenient for me to go over to Sinclair library.  I tried to find it on line, but it turns out that Wiley is holding the article hostage, and you can only look at it if you pay 35 euros.  Fortunately, however, the gods of scholarship smiled upon me and the article somehow emerged out of the ether.  If you want to read the article and can't find it, it might emerge out of the ether for you too, if you were creative enough to track down and email someone that might be willing to help you in your quest.  

1 comment:

  1. HI,
    Sorry To hear about your bad case of the “runs”. I’ve gone to other countries before and I’ve always been told be very very careful of what you buy from the street vendors as well. It’s amazing how one bad case thought me my lesson. I’m glad to see that you’re a little braver than me and still more than willing to try eating the street vendor food even after a case like yours. I’ll keep in mind that the next time that I have to lose some pounds, that instead of going on a diet I’ll take a trip to Indonesia for an extended period. Keep up the great updates.