In the Journals

In the Journals, October 2021, Part 2

Social Studies of Science

Cultivated co-production: Sexual health, human rights, and the revision of the ICD
Steven Epstein

STS scholars frequently have shown how science and sociopolitical arrangements are ‘co-produced’, typically tracing how scientific actors themselves keep ‘science’ and ‘politics’ far apart. Revealing co-production is therefore deemed the work of the STS analyst, who unearths linkages that the actors might be unaware of, or might ignore or deny. By contrast, the creation of a new chapter on ‘sexual health’ in the recent revision of the International Classification of Diseases (ICD) offers a case of what might be termed ‘cultivated co-production’. Neither oblivious to the linkages between science and politics nor invested in obscuring them, the designers of the sexual health chapter sought support for their work by demonstrating, transparently, how science, ethics, and human rights might properly be aligned. The intentional and visible character of co-production in this case indicates awareness of the need to manage the contested nature of gender and sexuality at a transnational level. It also reflects two changes in the organization of medical politics and medical classification: a widespread recognition of the necessity of reaching out to lay stakeholders and advocates, and the rise of an emphasis on ‘conventions’ as the backbone of transnational biomedical consensus processes.

Imperfect diagnosis: The truncated legacies of Zika testing (open access)
Koichi Kameda, Ann H Kelly, Javier Lezaun, Ilana Löwy

When the Zika virus burst onto the international scene in the second half of 2015, the development of diagnostic tools was seen as an urgent global health priority. Diagnostic capacity was restricted to a small number of reference laboratories, and none of the few available molecular or serological tests had been validated for extensive use in an outbreak setting. In the early weeks of the crisis, key funders stepped in to accelerate research and development efforts, and the WHO took responsibility for steering diagnostic standardization, a role it had successfully played during the West Africa Ebola virus outbreak. Yet when the WHO declared the end of the Zika Public Health Emergency of International Concern in November 2016, diagnostic capacity remained patchy, and few tools were available at the scale required in the countries that bore the brunt of the epidemic, particularly Brazil. This article analyses the limited impact of global R&D efforts on the availability of Zika diagnostic options where they were most needed and for those most vulnerable: women who might have been exposed to the virus during their pregnancy and children born with suspected congenital Zika syndrome. The truncated legacies of testing during the Zika crisis reveal some of the fault lines in the global health enterprise, particularly the limits of ‘emergency R&D’ to operate in geopolitical contexts that do not conform to the ideal type of a humanitarian crisis, or to tackle technical issues that are inextricably linked to domestic struggles over the scope and distribution of biological citizenship. Diagnostic shortcomings, we argue, lie at the heart of the stunning transformation, in less than two years, in the status of Zika: from international public health emergency to neglected disease.

Toxic remains: Infrastructural failure in a Ugandan molecular biology lab (open access)
Sandra Calkins

This article complicates romances of infrastructural improvisation by describing infrastructural failures that expose researchers to hazardous chemicals in a Ugandan molecular biology lab. To meet project deadlines, to make careers and to participate in transnational collaborative projects, Ugandan biologists have to stand in for decaying or absent infrastructures with their bodies. Ugandan biologists hide such sacrifices from their international scientific partners and direct the blame elsewhere. An unclear culpability results precisely from the ways in which power works and is distributed across transnational scientific infrastructures.

Improvising care: Managing experimental animals at a Japanese laboratory
Wakana Suzuki

Japanese scientists and technicians are expected to adhere to international standards of humane animal experimentation, but their understandings of human-animal relationships and their ways of caring for laboratory animals do not always fit neatly with global norms. Under the loose and eclectic regulations that govern animal testing in Japan, animal ethicists, scientists and technicians behave improvisationally to deal with tensions and discomfort. This article focuses on how these actors bring various ‘moves’ to this improvisational care, such as everyday eating and spiritual practices. I develop the concept of ‘chains of improvisation’. In contrast with the more commonly used notion of ‘tinkering’, this concept helps to articulate a case where care is continuously destabilized and remade through encounters with otherness. By paying attention to how members of this laboratory question what good care for laboratory animals entails, this case provides an opening for rethinking the cost-benefit logic that underlies global discourses around laboratory animal ethics.

Technology and Culture

“Contagion by Telephone”: Print Media and Knowledge about Infectious Diseases in Britain, 1880s–1914
Amelia Bonea

Communication technologies have long generated anxieties about physical and mental well-being. From the 1880s until World War I, concerns about “infection by telephone” in the British press prompted medical authorities and the National Telephone Company to investigate whether using the telephone, especially in public places, increased the possibility of contracting infectious diseases such as tuberculosis and diphtheria. This article reconstructs for the first time these transnational debates and the associated medical experiments. In contrast to previous scholarship, which has conceptualized health concerns associated with the telephone primarily within the framework of a nervous modernity, this article argues that the anxieties about “infectious telephones” also reflected the complex negotiations surrounding the emergence of new telecommunication networks and medical theories. It demonstrates that state and commercial actors, medical knowledge, and print media all shaped notions of public health risks and how to contain them.

Transforming Anthropology (Special Issue in Honor of Leith Mullings)

Bodily Burdens: Physical Abuse, Workplace Injury, and Understanding Intersectionality through the Experiences of African Immigrant Direct Care Health Workers
Yolanda Covington-Ward

This article uses Leith Mullings’s intersectional approach to health disparities combined with a novel focus on the impact of direct care jobs on workers’ bodies in order to illuminate the everyday experiences of African immigrant direct health care workers in the Greater Pittsburgh metropolitan area. The research for this article is based on thirty interviews with African immigrant direct care workers conducted in 2014. Specifically, by examining direct care workers’ experiences of being physically and verbally abused by patients, and by exploring the impact of extremely high rates of physical injury on the job, this article aims to show the bodily burdens, the physical embodied costs, that direct care workers bear and carry for the larger society related to caring for the elderly and cognitively and physically disabled patients. A focus on the body shows how American labor sectors, including direct care, are shaped by racialized and gendered social orders that immigrants must face after their arrival in the United States.

Anthropological Quarterly

Liquid Metal Masculinity: The New Man, Will, and US Military Pharmacological Supersoldiers
Andrew Bickford

My focus in this article is on the connections between masculinity, “will,” ideology, and biomedical and pharmacological enhancements designed to make soldiers—either the New Man of modernity or the emergent pharmacological “supersoldier” of the current era in the United States—more effective and resilient on (and off) the battlefield. The body is, as we know, a site for expressing political ideals; for fascism and communism, the armored body of the New Man was to be the ultima Thule of commitment and love of the party, and all the party represented. For the emergent US pharmacological supersoldier, the body is the site for expressing the goals of neoliberalism: the military body is a site of protection, salvation, and enhancement, as well as a site of ever-expanding research and production. But all conceptions of the New Man deal with the ideas of internal armor and steel. I examine the tension between the “belief” or “will” armor of fascism and the embedded biomedical armor of US military performance enhancement research programs. As points of comparison, I examine the similarities between German and Italian fascist and Soviet discourses and aesthetic representations of the internally-armored, “mechanical” body and US military discourses, conceptions and research projects concerned with the development of pharmaceutical interventions designed to protect and enhance US soldiers in combat. All of these conceptions of the soldier’s body focus on the internal armoring of the soldier, and the ways in which biomedicine and “will” or “belief armor” can be manipulated to produce reliable, resilient, combat-ready, and combat-willing soldiers.

Social Science & Medicine

“I talked to a couple of friends that had it”: Informal feminized health networks and contraceptive method choices
Cristen Dalessandro, Rachael Thorpe, Jessica Sanders

Scholars recognize that social networks can influence a number of health behaviors, including women’s contraceptive method choices. However, the gendered dynamics underlying the process of using non-medical information sources to make decisions about contraception has received less attention. Using 30 semi-structured interviews with women enrolled in a contraceptive initiative in the western United States, we explore how women use gendered understandings of medicine and feminized social networks to make decisions about contraceptives. Frequently categorizing their experiences in medical settings as unsatisfactory, women often turn to social support networks of other women—what we call “informal feminized health networks”—to gather information about the effects of contraceptives on women’s bodies and to make decisions about which contraceptives are best. While informal feminized health networks are useful, women utilize them in light of unsatisfactory experiences in clinical settings. Working to uproot the paternalistic legacy of institutionalized medicine and improving provider-patient communication will enhance contraceptive access and help women reach their reproductive goals.

Examining policy intentions and actual implementation practices: How organizational factors influence health management information systems in Uttar Pradesh, India
Ankita Meghani, Daniela C. Rodríguez, Huzaifa Bilal, Anand B. Tripathi, Vasanthakumar Namasivayam, Ravi Prakash, David H. Peters, Sara Bennett

This study investigates the implementation of a recent health management information systems (HMIS) policy reform in Uttar Pradesh, India, which aims to improve the quality and use of HMIS data in decision-making. Through in-depth interviews, meeting observations and a policy document review, this study sought to capture the experiences of district-level staff (street-level bureaucrats) who were responsible for HMIS policy implementation. Findings revealed that issues of weak HMIS implementation were partly due to human resources shortages both in number and technical skill. Delays in recruitment and the presence of inactive staff overburdened existing staff and weakened the implementation of HMIS activities at the block- and district-levels. District staff also explained how inadequate computer literacy and limited technical understanding further contributed to low HMIS data quality. The organizational culture was even more constraining: working within a very rigid and hierarchical organization was challenging for district data staff, who were expected to manage day-to-day HMIS activities, but lacked the discretion and authority to do so effectively. Consequently, they had to escalate minor issues to district leadership for action and were expected to follow their supervisors’ directives– even if they contradicted HMIS policy guidelines. High performance pressures associated with achieving top district rankings deviated focus away from HMIS data quality issues. Many district-level respondents described their superiors’ “fixation” with becoming a top-ranking district often resulted in disregard for the quality of data informing district rankings. Furthermore, the review of district rankings only partially encouraged district-level leadership to investigate reasons for low-performing indicators. Instead, low district rankings often resulted in punitive action. The study recommends the importance of incorporating the perspectives of district staff, and recognizing their discretion, and authority when designing policy implementation processes, and finally concludes with potential strategies for strengthening the current HMIS policy reform.

Long Covid – The illness narratives (open access)
Alex Rushforth, Emma Ladds, Sietse Wieringa, Sharon Taylor, Laiba Husain, Trisha Greenhalgh

Callard and Perego depict long Covid as the first illness to be defined by patients who came together on social media. Responding to their call to address why patients were so effective in making long Covid visible and igniting action to improve its care, we use narrative inquiry – a field of research that investigates the place and power of stories and storytelling. We analyse a large dataset of narrative interviews and focus groups with 114 people with long Covid (45 of whom were healthcare professionals) from the United Kingdom, drawing on socio-narratology (Frank), therapeutic emplotment (Mattingly) and polyphonia (Bakhtin). We describe how storytelling devices including chronology, metaphor, characterisation, suspense and imagination were used to create persuasive accounts of a strange and frightening new condition that was beset with setbacks and overlooked or dismissed by health professionals. The most unique feature of long Covid narratives (in most but not all cases) was the absence, for various pandemic-related reasons, of a professional witness to them. Instead of sharing their narratives in therapeutic dialogue with their own clinician, people struggled with a fragmented inner monologue before finding an empathetic audience and other resonant narratives in the online community. Individually, the stories seemed to make little sense. Collectively, they provided a rich description of the diverse manifestations of a grave new illness, a shared account of rejection by the healthcare system, and a powerful call for action to fix the broken story. Evolving from individual narrative postings to collective narrative drama, long Covid communities challenged the prevailing model of Covid-19 as a short-lived respiratory illness which invariably delivers a classic triad of symptoms; undertook and published peer-reviewed research to substantiate its diverse and protracted manifestations; and gained positions as experts by experience on guideline development groups and policy taskforces.

Health decisions amidst controversy: Prenatal alcohol consumption and the unequal experience of influence and control in networks
Elaine M. Hernandez, Jessica McCrory Calarco

Individuals avoid stigma by looking to members of their networks for guidance on how to behave. Health controversies complicate this process by exposing people to inconsistent norms, influence, and control within their networks. To understand this process, we meld perspectives on networks and social psychology. Using the case of light/moderate drinking during pregnancy, we examine how people make health decisions in the face of controversy. Through in-depth interviews with first-time pregnant individuals and their health care providers, we reveal that individuals’ decisions about controversial health behaviors depend on 1) the consistency of the influence and control they encounter, 2) their status relative to enforcers, and 3) the strength of their ties to enforcers. These processes give people from higher social positions more power to resist influence and control. These findings illuminate how medical recommendations and public health interventions should account for the unequal experience of influence and control within networks.

The dynamics of TCAM integration in the Indian public health system: Medical dominance, countervailing power and co-optation
Gupteswar Patel, Caragh Brosnan, Ann Taylor, Surekha Garimella

Hierarchies of power among healthcare professionals are well documented, nonetheless, power remains neglected, understudied and under-theorised in health systems analysis and policy discussions, especially in the domain of Traditional, Complementary and Alternative Medicine (TCAM). Sociological and public health scholarship has documented the persistence of medical dominance in the health system, theorised as the limitation, subordination, exclusion and incorporation of other professions. This paper explores how interprofessional power dynamics shape the integration of TCAM into Indian primary healthcare centres, as part of a nationwide policy of TCAM integration and medical pluralism implemented since 2005. We conducted interviews (n = 37) with health system administrators, nurses, pharmacists, TCAM and biomedicine doctors, and observed day-to-day activities of primary healthcare centres for six months in Odisha state, India. Thematic analysis enabled the identification of themes and exploration of sub-themes. The analysis revealed multilayered forms of medical dominance within the primary healthcare system and identified multiple sites where everyday power is mobilised. Biomedicine practitioners exercised authoritative power and restricted TCAM doctors’ access to facility-level resources, i.e. financial and workforce support, which inhibited the integration policy implementation. Significantly, TCAM doctors were ‘ordered’ to practice biomedicine at primary healthcare centres, which was beyond the scope of the integration policy. However, TCAM doctors were also able to exercise countervailing power in their day-to-day activities in the primary healthcare centres and sought to assist patients’ health behaviour change through their authoritative knowledge about ‘how to live a healthy life’. The health system actors involved in policy implementation hold a range of forms of power specific to the circumstances, influencing the integration processes. We explain these dynamics in relation to existing theories of medical dominance and countervailing power, while introducing a previously unreported dimension of dominance: ‘co-optation’, which enrols TCAM practitioners in the practice of biomedicine.

Demanding devices – Living with diabetes devices as a pre-teen
Regitze Anne Saurbrey Pals, Pernille Hviid, Bryan Cleal, Dan Grabowski

Diabetes technology is an integral part of the lives of children with type 1 diabetes (T1D). However, children’s experiences with these technologies are often overlooked. Furthermore, little is known about psychosocial aspects of technology use during children’s transition to adolescence. The aim of this study was to explore how children with T1D perceive, make sense of and handle diabetes technologies in their everyday lives. Data were obtained from interviews with 18 children with T1D aged 10–14 years (pre-teens). The interviews were conducted between March and August 2019 in Denmark. Photos were used as probes to facilitate discussion and reflection about issues pre-teens found important. The study was informed by a technology-in-practice perspective to articulate how diabetes technologies were embedded in practices of use. The analysis focused on insulin pumps and technologies for continuous glucose monitoring (CGM). We found that these technologies introduced tensions regarding dependence and independence, wanted and unwanted attention, worries and peace of mind, treatment and care, visibility and invisibility as well as control and loss of control. We synthesized the tensions into the following three themes which characterized the pre-teens’ relationship with diabetes technology: 1) demanding devices, 2) the social context of using diabetes technologies, and 3) care and support through data. Our findings indicate the need for researchers and clinicians to engage with the social and emotional dimensions of living with diabetes technologies. Importantly, this includes recognizing the norms underlying diabetes technologies and how these inform care in pre-teens with T1D.

Older adults’ embodied experiences of aging and their perceptions of societal stigmas toward sexuality in later life
Lauren B. Towler, Cynthia A. Graham, F. L. Bishop, Sharron Hinchliff

Sexuality is an important part of life for many older adults, and research is beginning to demonstrate the diversity of sexual agency and sexual expression in middle and later life. There is a lack of qualitative research, however, on the lived experiences of older adults concerning this topic. The aim of this study was to explore older adults’ embodied experiences and perceptions of aging in relation to sexuality, and whether differences based on gender and/or sexual orientation exist amongst this participant group. Thirty-one United Kingdom adults aged 66–92 years (M age 74; 16 women and 15 men) completed in-depth semi-structured interviews; these were analysed using reflexive thematic analysis. Three themes were generated. Changing Body; Media and Society; and “I still feel the same inside.” Older adults reported being seen as “past it” and irrelevant, but some saw this as freedom from societal expectations. Health and functional aspects of their bodies were prioritised over aesthetics and “overly glamourous” older celebrities were rejected as appropriate role models. Aging “well” meant resisting decline, but outward appearances did not always align with internal perceptions and experience. Many of our participants had internalised narratives of “successful aging” that centred around retaining youth. Findings support affirmative aging narratives. Aging as a time of difference without a sense of loss or decline. Implications for how later life is presented in advertising and service provision are discussed.

Safety net, gateway, market, sport, and war: Exploring how emergency physicians conceptualize and ascribe meaning to emergency care (open access)
Yu-Che Chang, Nothando S. Nkambule, Xaviera Xiao, Roy Y. L. Ngerng, Lynn V. Monrouxe

Metaphorical expressions and conceptualisations are widely used in medical discourse to convey complex and abstract concepts. Our study uses a novel way to examine the spontaneous use of metaphors by emergency physicians as they articulate their experiences of practicing emergency care. These co-constructions shed light on the values and beliefs that shape their emergency care practice. We invited 25 Taiwanese emergency physicians to participate in one-to-one semi-structured interviews. Drawing on social constructionism theory, systematic metaphor analysis method and Metaphor Identification Procedure (MIP) we identified metaphorical linguistic expressions in their talk, grouping them into five-overarching conceptual metaphors. We argue that these metaphors underpin emergency physicians’ experiences of practicing emergency medical care: Safety Net, Gateway, Market, War, and Sport. The Safety Net, Gateway, and Market conceptualisations highlight physician-patient relationships and the social mission, resource allocation, and consumerism aspects of emergency care practice. The Sport and War conceptualisations highlight the physician–physician relationship and the demanding, team-based nature of emergency care practice. We propose that the choice of metaphorical conceptualisation deployed by emergency physicians has implications on their embodiment of professional identities. This discussion of using metaphors to study professional identities contributes to the literature concerned with finding creative and innovative ways to research identities. Future studies may utilize metaphors to gain a comprehensive understanding of physicians’ professional identities in other specialties.

The crafting of hope: Contextualising add-ons in the treatment trajectories of IVF patients (open access)
Manuela Perrotta, Josie Hamper

The proliferation and popularity of additional treatments in IVF, also known as add-ons, has generated widespread discussion and controversy in the UK, where concerns have addressed the lack of evidence to support the efficacy and safety of these treatments, their cost, and their connection to a wider context of privatisation of fertility treatment. Drawing on 42 interviews with IVF patients, this article explores the role of hope in the appeal of add-ons from the patient perspective. The analysis is presented in two parts: firstly, we investigate the role of hope in patients’ decision-making on treatment, contextualising add-ons in the broader trajectory of their IVF experience; secondly, we examine how patients navigate the offer of add-ons, focusing on the role of hope in how they rationalise their decisions on whether to include them in their fertility treatment. Our analysis shows how patients craft their hope to navigate the increasing number of available options in their quest to find the treatment(s) that will “work” for them. We suggest that the imperative for patients to explore all options is intensified with the emergence of add-ons, which produces a novel context and version of a “hope technology”.

Barriers and facilitators to father involvement in early child health services: A qualitative study in rural Mozambique
Joshua Jeong, Marilyn N. Ahun, Lilia Bliznashka, Daan Velthausz, Rotafina Donco, Aisha K. Yousafzai

Engaging men and increasing their involvement as partners and parents can improve child health and development. Despite the increasing global evidence and advocacy around father involvement and caregiving, there remain few father-inclusive interventions for promoting early child health, especially within primary health systems in low- and middle-income countries. In this study, we explored community perspectives regarding fathers’ roles in early child health services during the first three years of life to identify the barriers and facilitators to father involvement in Monapo District in northern, rural Mozambique. A qualitative sub-study was embedded within a qualitative intervention implementation evaluation conducted in October–November 2020. In-depth interviews were conducted with 36 caregivers, 15 health facility providers, 12 community health providers, 4 government officials, and 7 non-governmental partner organizations. Data were analyzed using inductive thematic content analysis. Results revealed that fathers were generally uninvolved in early child healthcare services. Primary barriers to fathers’ involvement included the absence of fathers in many households; opportunity costs associated with fathers’ accompanying children to health facilities; long waiting times at facilities; negative health provider attitudes towards fathers; and patriarchal gender norms. Respondents also highlighted facilitators of father involvement, which included fathers’ broader engagement with their child at home; fathers’ desires to support their partners; parental awareness about the importance of father involvement in child healthcare; and community outreach and sensitization campaigns targeting fathers directly. Our study highlights opportunities for enhancing the focus, design, and delivery of child health services so that they are more inclusive and responsive to fathers. Future research should assess the feasibility, acceptability, and effectiveness of father-focused child health interventions on caregiving and early child health and development outcomes. These strategies should holistically address not only individual and household factors, but also broader structural and sociocultural determinants at the health system and community levels.

“What are you signing up for?”: Pre-medical students’ perception of physicians’ risk and responsibility during COVID-19 (open access)
Jenny K. Leigh

Though there has been growing attention to the impact of the coronavirus pandemic on the career trajectories of current health care workers, research remains sparse on how those in earlier stages of medical education have been affected by the pandemic. To better understand the pandemic’s influence on pre-medical students’ professional trajectories, this study draws on 48 interviews with freshmen and sophomore pre-medical students at a private university in the northeastern United States. For many students, witnessing physicians’ role during the pandemic made them more aware of both the vulnerability of physicians and the limits of their power in the medical field and society at large. Notably, students primarily explained the risks that physicians confronted as an individual professional expectation rather than a structural concern in the medical system. Despite acknowledging these risks, students emphasized that the pandemic had reinforced their interest in becoming a physician by validating their perception of the vital role that physicians play in society. Additionally, they expressed greater concern about meeting expectations for admission to medical school in light of additional barriers due to COVID-19. This study builds upon existing literature on the medical profession by both centering earlier stages of education and examining processes of socialization during times of crisis. More broadly, these findings indicate a need for greater attention to the normalization of health care workers’ sacrifices, as well as the potential exacerbation of existing inequities in pre-medical education during the pandemic.

When parents are not present: Decision-making dynamics for young children’s health and illness in migrant-sending households in rural Cambodia
Emily Treleaven, Chanrith Ngin

As migration rates increase globally, an increasing proportion of children in low- and middle-income countries live apart from their parents. In particular, skipped-generation households are becoming more common, with grandparents serving as primary caregivers for young grandchildren whose parents migrate and provide remittance support. Yet, how families living apart make decisions for young children’s healthcare is not well understood. Processes of care seeking for children’s health are examined in Cambodia, which has high rates of internal and international migration, and an increasing number of skipped-generation households. We conducted semi-structured in-depth interviews with grandparents who are primary caregivers for children under ten in skipped-generation households in rural migrant-sending areas. Respondents discussed their family’s migration history, care seeking and decision making for grandchildren, dynamics with absent migrant parents, and sources of support. Decisions for children’s care are intimately tied to the availability of migrant remittances, which are the modality of the relationship between grandparents and parents. Additional remittance support allows grandparents to make decisions for grandchildren’s health based on convenience rather than cost, given the burdens of caring grandparents have taken on a result of the parent’s migration. Instrumental supports such as in-kind assistance and informational supports further facilitated children’s access to healthcare. This qualitative study informs and explains findings from recent quantitative studies of migration and child health.

Seeking transnational social protection during a global pandemic: The case of Chinese immigrants in the United States (open access)
Xuemei Cao, Ken Chih-Yan Sun

Drawing on in-depth interviews with Chinese immigrants in the U.S. during the COVID-19 pandemic, this article examines the construction of immigrants’ transnational social safety net and its gaps as the pandemic struck their home and host societies successively. Building upon the scholarship on transnational migration and transnational social protection, we argue that understanding how immigrants manage moments of crisis requires a cross-border optic. As we show, transnational connections can be translated into valuable material and immaterial resources. However, such protections are contingent upon the reception of their local receiving communities. The perceived hierarchy between the sending and receiving society, coupled with the U.S.’ lack of experience with infectious disease outbreaks, limits the extent to which immigrants could put their transnational knowledge and resources to use. Our analyses shed new light upon the circumstances that empower and constrain immigrants as the global pandemic unsettles their daily routines.

Time to care – An ethnographic study of how temporal structuring affects caring relationships in clinical nursing (open access)
Hanna MarieIhlebæk

This article explores how temporal structuring of clinical activities affects nurses’ establishment of caring relationships with patients, based on an ethnographic study in a Norwegian cancer ward in January–June 2017. By drawing on practice-based perspectives on time and care, the article shows how ‘medical time’, ‘patient time’ and ‘hospital time’ represent three distinct but interconnected clinical rhythms affecting caring relationships. In this way, the article provides insights into how caring relationships are established in nurses’ intermediate role as temporal agents, accommodation various temporal structures associated with the biomedical and person-centred care models. Second, it contributes insights into how caring practices are temporally structured and reproduced in a hospital context. Finally, the article describes factors that influence different ways of structuring time, emphasising the need for temporal reflexivity and flexibility in meeting patients’ care needs, and the role time to care plays in facilitating this.

“They abduct us and rape us”: Adolescents’ participatory visual reflections of their vulnerability to sexual violence in South African townships
Ndumiso Daluxolo Ngidi, Relebohile Moletsane, Zaynab Essack

The abduction and sexual violation of adolescents, especially in township contexts, has increasingly made headlines in South Africa. These incidents are evocative of jackrolling, a phenomenon that plagued townships during the apartheid upheavals in the late 1980s. The abduction of adolescents on their school journeys has been reported in several South African townships. In this paper, we report on a study in which we used participatory visual methods (i.e., cellphilms: short videos made with cellphones) to explore how 19 adolescent girls and boys living in the Inanda, Ntuzuma, and KwaMashu (INK) township precinct, outside Durban reflected on their vulnerability to sexual violence. Although the question was broad, our analysis of the visual data suggests that adolescents believed that their vulnerability to abduction and rape was almost inevitable. As such, in their cellphilms, they chose to portray their risk and vulnerability to abduction, rape, and even murder on their daily journeys to and from school. We found that through this methodology, adolescents were able to illustrate and/or articulate their fear of sexual violence. For them, violence was an inescapable reality that created fear and helplessness. This underscores the need for interventions, including the provision of safe scholar transport and visible policing in the community.