This month’s highlight – just going open source on Global Public Heath:
Ryan Whitacre, Adeola Oni-Orisan, Nadia Gaber, Carlos Martinez, Liza Buchbinder, Denise Herd & Seth M. Holmes
The COVID-19 pandemic has overwhelmed health systems around the globe, and intensified the lethality of social and political inequality. In the United States, where public health departments have been severely defunded, Black, Native, Latinx communities and those experiencing poverty in the country’s largest cities are disproportionately infected and disproportionately dying. Based on our collective ethnographic work in three global cities in the U.S. (San Francisco, Los Angeles, and Detroit), we identify how the political geography of racialisation potentiated the COVID-19 crisis, exacerbating the social and economic toll of the pandemic for non-white communities, and undercut the public health response. Our analysis is specific to the current COVID19 crisis in the U.S, however the lessons from these cases are important for understanding and responding to the corrosive political processes that have entrenched inequality in pandemics around the world.
Tine M. Gammeltoft
Endurance is a key term used by women in contemporary Vietnam to characterize the moral persistence that their marital lives demand. Accounting for women’s endurance requires, as fieldwork in Hanoi indicates, ethnographic attention to how kinship can be temporally and spatially capricious, exceeding the immediately manifest. The concept of spectral kinship aims to capture these latent aspects of kinship and their groundings in people’s imaginative lives. Defining relatedness as an imaginal accomplishment, an analytic of spectral kinship draws attention to aspects of social existence that are neither “real” nor “delusional” yet socially powerful nevertheless. Approaching Vietnamese women’s endurance through the lens of spectral kinship highlights the invisible, imaginal efforts that women make to cope with the vulnerabilities and contingencies of kinship, thereby bringing into analysis crucial yet often undervalued forms of gendered kin-work. [domestic distress, endurance, gender, imaginal, hauntology, kinship, spectrality, Vietnam]
Across bureaucratic contexts, “objectivity” is a dominant conception of appropriate conduct. But what does it mean for bureaucrats to work “objectively”? For staffers of the Israeli government’s Committee for Health Care Services, objectivity is understood as a key bureaucratic virtue, one that promotes the ethical goal of fair resource allocation. To them, objective decision-making is based on adopting an “unemotional” attitude. Aware of the life-and-death implications of committee decisions, they attempt to work “unemotionally” by engaging what I term a moral sensibility for unemotionality, a tendency to avoid exposure to patients’ subjective experience. Cultivating this sensibility has concrete effects on the committee’s decisions and on patients’ place in medical decision-making. Examining “objectivity” as a morally desired disposition, rather than as a static construct, yields its reconceptualization as an enduring intersubjective achievement. This approach offers another way to examine the workings of power and politics in state bureaucracies. [objectivity, bureaucracy, virtue ethics, morality, emotion, social welfare, health care, Israel].
This paper explores how wellbeing is cultivated inside of domestic bomb shelters on Israel’s contested and heavily militarised northern borders with Lebanon and Syria. It draws from ethnographic research conducted during what is locally referred to as being a time between wars, or a ‘period of quiet’, in the ongoing regional conflicts affecting these borders. Contrasting the upkeep and organisation of shelters situated in two private homes on the same street, the paper explores how shelters are used to foster a localised sense of wellbeing in a time of ‘quiet’, as well as who is seen to demonstrate wellbeing in this context. Each shelter is a place where the temporal position of being between past and future war is visceral. Memories of past wars, present uncertainty and the anticipated threats of future war are easily encountered in each shelter, although in varied ways. Yet, the arrangement of each shelter reflects how their owners make sense of the time they understand themselves to inhabit, while allowing them to re-organise and edit out what is problematic, uncomfortable or threatening about dwelling in a present between wars. A sense of wellbeing comes from the thoughtful, creative and aspirational ordering of past, present and future inside of each shelter, and through an ordering of one’s position in time. These observations contribute to the broader conceptualisation and pragmatic study of wellbeing, a term that is often illusive and abstract.
Drawing on ethnographic fieldwork in Trinidad, this paper examines how the framing of a particular apocalyptic future provided a moral commentary and model for wellbeing in contemporary everyday life. Changing social, political, and economic circumstances and relations had brought a range of new risks and anxieties into daily life. These more recent problems originating from beyond the village (such as climate change, criminality, inequality, pollution, neglect by the State) could not be resolved through working with obeah spirits as might have been used previously for more local issues, or through the long-established Catholic and Anglican churches. Instead evangelical Christian cosmology and practices gave a means of making sense of such issues and for protecting oneself. The development of a strong individual relationship with God connected individuals to a greater power and a global community, framing such problems not only as the work of the Devil but as evidence of the coming of the End of Days. Political protest or attempts at wider change were futile therefore; individuals should focus on their own practices to develop a strong relationship with God. Health and wellbeing relied on an individualised and deep relationship with the Holy Spirit. This was developed through practices that both drew on, and helped create, a type of neoliberal logic and global subjectivity to understand and live within current times, evangelical Christianity promoting ways of living without anxiety in the present through understandings of an apocalyptic future.
James Andrew Whitaker
This paper examines bodily transformation and well-being within the context of a millenarian movement that emerged during the 1840s in the area surrounding Mount Roraima at the periphery of Brazil, Guyana (British Guiana at the time), and Venezuela. The site of this movement was Beckeranta – meaning ‘Land of the Whites’ – where up to 400 Amerindians were reportedly killed in a quest that is described in its sole historical account as centred around a goal of bodily transformation into white people. In examining this movement, the paper engages with longstanding debates in medical anthropology concerning the body, as well as conversations among Amazonianists concerning the social formation of bodies, and examines sorcery and shamanism as practices that go ‘beyond the body’. Notions of bodily transformation in Amazonia, which are often activated by strong emotions, facilitate conceptual expansions of the body in medical anthropology. The paper suggests that bodily transformations tied to sorcery and shamanism are in some contexts, such as at Beckeranta, associated with desires for well-being.
Louis Herns Marcelin, Richard Dembo, Toni Cela, Catherimarty Burgos, Morris Copeland, Bryan Page
The increasingly intractable nature of many social problems has given rise to cross-institutional and interdisciplinary collaborations in order to respond to social problems that no single entity can resolve on its own. One value of anthropology lies in its capacity to provide culturally tailored strategies for successful collaboration between different stakeholders in communities, across disciplinary fields, among public policymakers and practitioners. In this article, we revisit the emergence of a collaborative initiative to support at-risk youths of Haitian descent and their families. This work was undertaken by university researchers, juvenile justice professionals in Miami-Dade County, and community-based practitioners. Guided by a holistic anthropological perspective and a multidimensional approach to collaboration, we provide a processual analysis of almost two decades of opportunities and challenges posed by our collaboration and illuminate the importance of collaboration in identifying evidence-based solutions to social problems. While not all collaborative teams experience the same processes or operate within the same sociocultural contexts, we argue that there are some fundamental principles to establishing effective collaboration: a shared common goal, shared objectives, and time.
Katherine T. McCaffrey, Mindy Thomson Fullilove
In this essay, we tackle the challenge of adapting the dominant way we think about health in the United States—through an individualistic, technocratic, biomedical lens—to address social problems rooted in structural inequality. As scholar activists, the authors participated in a coalition effort to improve community health in a postindustrial New Jersey city. Adopting a social determinants of health perspective, we describe efforts to move discourse away from wellness and toward a deeper understanding of the role of education and learning in building a “culture of health.” The essay discusses how this structural analysis of health competed with much more narrow cultural understandings of education and health rooted in a pervasive wellness ideology. Coalition success hinged on correctly identifying the obstacles to health and learning in the community as understood by community members: violence emerged as a pressing obstacle that impeded both learning and health. Once we clarified a shared understanding of health as learning and a common understanding of violence as the most immediate obstacle to health as learning—our coalition was energized and made progress.
The modern instantiation of migrant family detention in the United States has resulted in the creation of carceral spaces in which conflict and care intermingle in everyday encounters. While legal advocates traversing these spaces offer critical aid to the detained, asylum-seeking parents and children confined within, legal advocacy is rarely recognized as caregiving work. Drawing from my ethnographic research with voluntary legal advocates working at family detention facilities in South Texas, this article demonstrates the potential for deploying a lens of care to such encounters, which I ultimately frame as “legal care.” I argue that cross-disciplinary conceptualizations of care, which emphasize its interdependency, relationality, and contested terrains (Puig de la Bellacasa 2017), as well as its practices as being marked by a continuous tinkering (Mol 2010), offer windows to reconfigurations of care and power that reside amid both the mundane and unpredictable frictions that characterize these environments.
Daniel White, Hirofumi Katsuno
This essay analyzes the organization of Buddhist memorial services for robot pets in Japan against the backdrop of emerging markets for robots equipped with artificial emotional intelligence. It demonstrates how an evocative “sense of life” (seimeikan) becomes both a target of design for robotics engineers and an affective capacity of robot users who care for and through companion robots. Documenting how users cultivate a sense of amusement toward robots that neither neglects nor negates analytical distinctions between the artificial and the living but rather playfully holds them together in the figure of a living robot, the article illustrates how practices of care become affective tools for understanding life altered by developments in AI. Such findings render animacy as an open and exercisable capacity, responsive to technoscientific change, and generative of theoretical inspiration for how anthropologists might similarly exercise affect as a particularly productive method of fieldwork within machine-inclusive multispecies societies.
Kevin Hall and Meike Wolf
Public health authorities in Germany regard communication as a crucial part of infectious disease prevention and control strategies. Communication becomes even more important during public health crises such as pandemics. Drawing on Briggs and Hallin’s concept of biocommunicability, we analysed the German National Pandemic Plan and key informant interviews with public health experts, critical infrastructure providers and ambulance services. We examined the projected expectations towards the behaviour of the audiences and the projected ways of information circulation informing public health communication strategies during a pandemic. Participants shared the expectation that the population would react towards an influenza pandemic with panic and fear due to a lack of information or a sensationalist media coverage. They associated the information uptake of their target audience with trust in their expertise. While our informants from public health conceptualised trust in terms of a face-to-face interaction, they sought to gain trust through transparency in their respective institutional settings. Our analysis suggests that this moved health information into a political register where their medical authority was open to debate. In response to this, they perceived the field of communication as a struggle for hegemony.
Marika Franklin, Karen Willis, Sophie Lewis, Anne Rogers, Lorraine Smith
Self-management is a contemporary model of chronic condition care that places expectations on, and roles for, both patients and health professionals. Health professionals are expected to form partnerships with their patients, and patients are expected to be active participants in their own care. In these new roles, control and responsibility for self-management are shared between people with chronic conditions and their health professionals. We still have limited knowledge about how these new roles are enacted in self-management support. In this article, we examine how health professionals perceive the roles of patients and professionals in chronic condition self-management, drawing on Bourdieu’s concepts of field, doxa and capital. In this qualitative study, 32 in-depth interviews were conducted with 11 health professionals in Sydney, Australia. Data were analysed thematically. Three themes were derived. First, there was incongruence between how participants characterised and enacted their roles. Second, participants compartmentalised clinical and non-clinical aspects of self-management support. Finally, the roles of health professionals entwined with emotions and judgements of patienthood revealed that the provision of self-management support was linked to a fit between individuals’ cultural health capital and the expectations governing the field. We argue that ‘taken for granted’ assumptions about self-management and self-management support must be challenged to mitigate negative social representations and unrealistic expectations placed on patients and health professionals, particularly those patients with less capital, who are more marginalised within clinical interactions.
Grace Spencer, Sophie Lewis, Megan Reid
Young people’s experiences of living with a long-term health condition have been largely investigated from the perspective of developing autonomy and optimal self-management of treatment regimens. Little existing research explores how young people adjust to the experience of chronic illness within everyday social contexts. Drawing on sociocultural theories of healthism, in this article, we examine the everyday strategies students employed to manage their health condition at university. Data were drawn from a qualitative study with 16 undergraduate students in Australia. Findings from interviews highlight how participants took up discourses of the (hard-working, diligent) Self to discursively position themselves as ‘health conscious’ and ‘in control’. This positioning was maintained through separating the controlled Self from the (uncontrollable) body. The unpredictability of the body posed a threat to young people’s abilities to maintain control and denied them opportunities to exercise personal agency. Yet, participants also described a number of subversive strategies in order to take back control and resist the experience of ill health. These potential agentic practices often held unintended consequences, including loss of optimal medical control or (self) exclusion from university life – offering new insights into the differing ways young people concomitantly take-up, rework and resist the pursuit of healthism to ‘successfully’ manage their health conditions.
Lisa Dawson, Jo River, Andrea McCloughen, Niels Buus
This article explores the implementation of an innovative approach to mental health care in a private health setting. Open Dialogue is a recovery-oriented approach to mental health that emerged in Finland, which emphasises family involvement, interdisciplinary collaboration and a flexible, needs-adapted approach. Early research is promising; however, little research has explored Open Dialogue outside Finland. This study aimed to explore the introduction of this approach at a private, inpatient young-adult mental health unit in Australia. Drawing on data from a long-term ethnographic field study that included 190 hours of observation and qualitative interviews, the findings show that despite staff members being inspired by and supportive of Open Dialogue, the existing ideology and organisational structures of the unit conflicted with the integration of Open Dialogue principles. Dialogical ways of working were challenged by medical dominance and emphasis on economic efficiencies. This study emphasises the importance of a ‘good’ fit between organisational cultures and innovations. It also highlights the challenges of moving towards recovery-oriented and family-focused models of care in the Australian neoliberal health care context. There is a need for organisational and ideological change in health services that is receptive to, and meaningfully supports, efforts to implement recovery-oriented care.
Dang Nguyen, Michael Arnold, Richard Chenhall
This paper describes how spatial understandings of the internet (i.e. the internet is a ‘space’) enable the persistence of marginalised medical practices. By tracing different accounts of the internet as space among practitioners and followers of diện chẩn – an emergent Vietnamese unregulated therapeutic method – we show how the logic of space circumscribes an alternative techno-social site for marginalised medical practices, transforms the private experience of being alone with technology into being-in-space, spiritualises the internet as a conduit of healing power, and mediates transnational health mobility among the Vietnamese diaspora. Drawing on interviews and ethnographic participation in Vietnam and the US, we demonstrate how the internet can be understood as non-biomedical milieu – a field of determination that conjoins heterogenous interventions on health-related eventualities outside of structured and institutionalised biomedical practices. This in vivo conceptualisation of the internet as space offers a point of convergence against the bifurcation of information as abstract and technology as concrete. A spatial conceptualisation highlights the embeddedness of health knowledge on the internet and shows how techno-social interrelations produce different spaces of multiplicity, which constitute a favourable milieu for medical practices outside of the biomedical institution to persist.
Pleuntje Jellema, Margo Annemans and Ann Heylighen
Liminality captures the passing stages in transitioning from one sociocultural status to another. As its spatial dimension remains under-examined, we analyse this in experiences of people affected by cancer. We review liminality in cancer-related literature and juxtapose this with empirical material. Analysing interview data (with eight patients) and participant-made photos highlights why places may be experienced differently throughout a period of illness and how places of diagnosis and care ‘stretch’ across locations. We conclude that exploring liminality’s spatial dimension has implications for people ‘living beyond’ cancer, advances sociological understandings of (cancer) illness, and may inform healthcare facility design.
Volume 23, 2021, Issue 3-4
Bert de Graaff, Jenske Pal & Roland Bal
The start of the COVID-19 pandemic early 2020 has confronted healthcare sectors with risks and uncertainties on an unprecedented scale in recent history. Healthcare organisations faced acute problems, the answers to which had to be provided, and recalibrated, at short notice and informally. University hospitals played a pivotal role in providing these answers and in (re)calibrating institutional arrangements. Based on ethnographic research in an elite university hospital in the Netherlands, in this article we explore the concrete practices of governing risks and uncertainties that COVID-19 posed for the organisation of healthcare. Our fieldwork consisted of the observation of meetings at the level of the hospital boards, the staff, and the regional level. We collected relevant documents and interviewed key-actors. This approach offers us a large dataset on acute risk governance ‘from within’ and allows us to offer a layered ethnographic account of managerial practices. In our analysis we focus on conceptualising the work-as-done in the university hospital as risk work. We show how the risk work of our participants is generally characterised by high speed and delineated by scarcities. We differentiate between three modes of risk work: working on numbers, working on expertise and working on logistics. This risk work appears innovative, but our analysis stresses how participants’ work happened in interaction with traditional institutional logics and routines.
Ebru Kayaalp Jurich
Through an online ethnographic analysis of a Facebook allergy group in Turkey, this article investigates how mothers carry out the daily process of managing risks and making decisions relating to the diets of babies with food allergies. Where allergy-management advice provided clinically by doctors tends to take the form of a relatively uniform and future-oriented risk-management process, parents making dietary decisions for babies with food allergies often need immediate advice that doctors cannot provide. To meet this need, many mothers complement the advice they receive from doctors with the knowledge and expertise of strangers online in making decisions about their children’s diet. Through a focus on how mothers engage with issues of allergy-related risk in an online community, this study demonstrates the different layers of temporality mothers navigate and the different strategies they employ in responding to allergy-related risk and how these co-exist, often complementarily, with the clinical management of allergies.
Deepak Sartaj, Vijay Krishnan, Ravindra Rao, Atul Ambekar, Neeraj Dhingra, Pratap Sharan
The Hijra community is a cultural and gender grouping in South Asia broadly similar to western transgender communities, but with literature suggesting some differences in gender experience and patterns of psychosocial adversity. The present study aims to describe patterns of mental illness and psychoactive substance use in Hijra subjects and study their association with gender experience and psychosocial adversity.Fifty self-identified Hijras availing HIV-prevention services in New Delhi, India, were interviewed. Data on mental disorders, psychoactive substance use, quality of life, discrimination, empowerment, violence and gender identity were assessed using structured instruments. Subjects were mostly in their mid-twenties, and had joined the Hijra community in their mid-teens. More subjects (46%) were involved in begging than in traditional Hijra roles (38%). Sex work was reported by 28% subjects. The rates of lifetime mental illness was 38%, most commonly alcohol abuse (26%); others had anxiety or depressive disorders (8% each), somatoform disorders (6%) and bulimia nervosa (n = 1). Disempowerment was mostly experienced in domains of autonomy and community participation; 52% had experienced sexual or psychological violence. Discrimination was attributed to gender (100%), appearance (28%) or sexual orientation (28%). There were negative correlations between the physical domain of WHO-QOL and physical violence and depression scores; and between discrimination and WHO-QOL environmental, physical and psychological domains. This Hijra group showed high rates of mental disorder and substance involvement, related to QOL domains and experiences of discrimination and disempowerment.
Research in science and technology studies has analyzed how patients’ groups engage in practices that connect biomedicine and patient experience in order to become involved in the shaping of biomedical research. However, there has been limited attention to the affective dimensions of such practices. Based on ethnographic fieldwork with a gynecological cancer patients’ group in Sweden, this article focuses on practices that aim to influence researchers and research institutions to prioritize biomedical gynecological cancer research. It analyzes how “affects” are woven through these practices and pays attention to the entanglements of affects, biomedical research, and lay experience they involve. The article explores the relation between the gynecological cancer patients’ group and biomedical research as a set of material-semiotic practices of “moving evidence.” These practices of moving evidence (1) enact gynecological cancer as under-researched; (2) collect and produce new “evidence”; (3) “mobilize” the evidence at public events, in interactions with biomedical researchers, and in different online settings; and (4) entangle affects with biomedical and experiential evidence to enact (a lack of) gynecological cancer biomedical research as a matter of concern.
Alena Kamenshchikova, Marina M. Fedotova, Olga S. Fedorova, Sergey V. Fedosenko, Petra F. G. Wolffs, Christian J. P. A. Hoebe, Klasien Horstman
Antimicrobial resistance control programmes often aim to “fix” the behaviour of antibiotic users and prescribers. Such behavioural interventions have been widely criticised in social science literature for being inefficient and too narrow in scope. Drawing on these criticisms, this article analyses how political programmes for fixing antibiotic behaviours were adapted into the practices of health-care professionals and patients in Russia. In 2018, we conducted interviews with medical doctors, pharmacists and patients in a Russian city; focusing on their practices around the policy requirement introduced in 2017 which obligated medical prescriptions of antibiotics. We conceptualised the obligatory medical prescription as a political technique which sought to change practices of self-treatment and over-the-counter sales of medications by establishing doctors as an obligatory passage point to access antibiotics. Our analysis shows that the requirement for medical prescriptions does not fulfil the infrastructural gaps that influence antibiotic practices. By navigating the antibiotic prescriptions, doctors, pharmacists and patients informally compensate for the gaps in the existing infrastructure creating informal networks of antibiotic care parallel to the requirement of obligatory prescriptions. Following these informal practices, we could map the inconsistencies in the current policy approaches to tackle AMR as a behavioural rather than infrastructural problem.
Regitze Anne Saurbrey Pals, Imelda Coyne, Timothy Skinner, Dan Grabowski
For children with type 1 diabetes, the period of adolescence is associated with higher blood glucose levels and increased psychological distress compared to other age groups. Focusing on pre-teens (9-12 years) with type 1 diabetes and their families has been suggested as key to understanding and reducing these challenges. The aim of this study was to explore: 1, how diabetes affects family life, 2, experiences of and needs for support and 3, how care responsibilities are negotiated among pre-teens with type 1 diabetes and their families. Data were obtained from four interactive workshops with pre-teens (n = 17), their parents (n = 26) and their siblings (n = 14). Dialogue tools, for example quotes and picture cards, were used to facilitate discussion and reflection concerning family life with type 1 diabetes. Data analysis resulted in three themes: 1, diabetes takes up ‘a lot of space’, 2, giving and receiving support and 3, balancing control and flexibility. While diabetes took up significant space in the families, family members protected each other from their respective frustrations. The findings point to the significance of considering all key family members and their interactions in diabetes interventions. This includes balancing control and flexibility, negotiating responsibilities and building trust.
Maram Khazen, Nurit Guttman
This qualitative study focuses on self-medication with antibiotics as it relates to gender roles and traditions in the Arab society in Israel, a collectivist minority with defined traditional gender norms. Its findings draw on the analysis of 116 face-to-face interviews with 60 pharmacists, 27 primary care physicians and 29 community members, mainly mothers and unmarried women, from different geographical localities. The findings describe how mothers are assigned the role of the family health caretakers, expected to abide to a hierarchical power structure, and listen to the advice of ‘senior mothers’. These expectations can lead to mothers self-medicating their children and themselves with antibiotics. Traditional constraints associated with sexuality were also found to compel unmarried women to self-medicate. The findings point to a duality of power in family relations: women submit to having limited power in traditional gender roles but are accorded power as medical experts in health-care decision-making. The study concludes with recommendations for considering sociocultural factors of hierarchy, traditions and collectivist orientation when researching self-care patterns and developing interventions to curtail antibiotics overuse. It also points to the importance of recognising pressures exerted on unmarried women and enabling them to use health-care resources in their community for managing sexual health.
Although patients who undergo weight-loss surgery (WLS/bariatric surgery) must follow severe eating restrictions in a manner similar to that of dieting, professionals strive to demarcate distinctions between the approaches and methods of WLS and diet. Drawing from ethnographic research, this study focuses on the content and interpretative dimensions of professionals’ boundary work as well as its meaning and implications for patients. The post-surgical body is revealed as a site of dispute. Professionals portray the logic of diet as one that assumes individuals ought to discipline themselves – and not ‘give in’ to pleasure – in order to achieve an ideal body. In contrast, WLS is depicted as a more advanced and balanced method that negotiates pleasure and control. Professionals construct boundaries by shifting the causes for obesity from the individual to the context, by expanding the meaning of success and by portraying food as healing. These findings join recent critical literature that shows that the lived experiences of care practices contest the prevailing framing of obesity care as solely about exerting disciplinary power and control. WLS professionals negotiate fat stigma and question dominant discourses regarding body size, thin ideals and responsibility.