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In thinking about care, much research has focused on kin relations, family-related care, and formal (medical) or informal care providers. Yet, how do we understand care responsibilities in contexts where kin care is absent despite being a desired social norm, and people turn to other community sources or practices? This paper draws on ethnographic research in a Sufireligious shrine in western India well-known for providing succor to those in distress, including those with mental illness. Interviews were conducted with pilgrims who had left homes due to strained relationships with kin members. For many of them, the shrine emerged as a sanctuary, even while not entirely a safe one, allowing women to live alone. While both academic research on mental health institutions and state responses have delved into the abandoned or 'dumped woman' in long-stay institutions or care homes, this paper argues that 'abandonment' is not a straightforward condition, but rather a dynamic discourse that works in different ways. For women bereft of kinship ties, narratives of being abandoned by kin became ways of justifying long (and sometimes permanent) residence in religious shrines, which were able to absorb such 'abandoned' pilgrims who had nowhere else to go, even if half-heartedly so. Importantly, these alternative forms of living made possible by shrines reflect women's agency, enabling women to live alone even while belonging to a community. In a context with limited social security options for women in precarious family situations, these care arrangements become significant, even if they are informal and ambivalent forms of care. Keywords: kinship; abandonment; agency; care; religious healing. [ABSTRACT FROM AUTHOR]

Previous research on the stigma associated with cutaneous leishmaniasis, a vector-transmitted parasitic disease, focuses on aesthetic appearance affectation as the leading cause of stigmatisation. However, Indigenous populations in the hinterland of Amazonian Ecuador trigger stigma expressions by recognising (muco)cutaneous leishmaniasis, primarily through atypical smell, followed by the odd voice sound, appearance and taste. This empirical way of recognising symptoms relies on embodied forms of identifying a disease, contrasting the Western supremacy of visuality and demanding to be understood via multi-sensorial anthropology. Through ethnographic research and data retrieved from eighty-three semistructured interviews and fifteen focus groups in seven Ecuadorian ethnic groups – including six Indigenous groups in the Amazon region – this paper analyses how the sensorium is a health thermometer. Findings reveal that differentiated cultural responses to a sense of peril, contagion and social (self)rejection, understood as stigma expressions, are linked to the holistic approach to health (or well-being) shared by Indigenous populations. In forest societies, well-being is explained through successful (non-)human relationships, and disease permeates through bodies that lack balanced relations. [ABSTRACT FROM AUTHOR]

Since the introduction of the Improving Access to Psychological Therapies (IAPT) programme in NHS England, psychological therapy has gained traction as 'evidence-based' and 'effective' in both clinical and economic terms. In the process, psychotherapeutic care has been reconstituted as highly manualised, standardised, and quantifiable. Drawing on anthropological fieldwork with mental health practitioners, this paper examines some common tensions that practitioners experience in their daily work where psychotherapy is sought within the framework of evidence-based medicine (EBM). For therapists working within IAPT, extensive monitoring and practices of accountability have come to undermine psychotherapeutic efforts to care for patients as 'people'. As a result, many practitioners now feel that they are working in a 'factory of therapy' whereby psychological treatment is recast in the service of outcome measures, and by which critique of the IAPT service, as well as caring relations within it, have been precluded. [ABSTRACT FROM AUTHOR]

In early 2020, when the first COVID-19 cases were confirmed in Switzerland, the federal government started implementing measures such as national stay-at-home recommendations and a strict limitation of health care services use. General practitioners (GPs) and their at-risk patients faced similar uncertainties and grappled with subsequent sensemaking of the unprecedented situation. Qualitative interviews with 24 GPs and 37 at-risk patients were conducted which were analyzed using thematic analysis. Weick's (1993) four sources of -resilience – improvisation, virtual role systems, attitudes of wisdom and respectful interaction – heuristically guide the exploration of on-the-ground experiences and informal ways GPs and their at-risk patients sought to ensure continuity of primary care. GPs used their metaphorical Swiss army knives of learned tools as well as existing knowledge and relationships to adapt to the extenuating circumstances. Through improvisation, GPs and patients found pragmatic solutions, such as using local farmer apple brandy as disinfectant or at-home treatments of clavicle fractures. Through virtual role systems, GPs and patients came to terms with new and shifting roles, such as "good soldier" and "at-risk patient" categorizations. Both parties adopted attitudes of wisdom by accepting that they could not know everything. They also diversified their sources of information through personal relationships, formal networks, and the internet. The GP-patient relationship grew in importance through respectful interaction, and intersubjective reflection helped make sense of shifting roles and ambiguous guidelines. The empirical analysis of this paper contributes to theoretical considerations of sensemaking, resilience, crisis settings and health systems. [ABSTRACT FROM AUTHOR]

Laparoscopic tubal ligation is the most prevalent method of contraception amongst India's rural and urban poor. Drawing on 18 months of ethnographic fieldwork in rural Rajasthan in 2012–2013, this paper investigates how rural women's perceptions of a biomedical instrument—the laparoscope—influence their perceptions of sterilization, a procedure often entrenched in coercive, target- and incentive-driven population control programme. By investigating how a laparoscope is entangled in global exchanges, national policies, institutional arrangements, and local moral worlds, this paper demonstrates that while wider biomedical discourses perpetuate the narrative of safety and convenience, people's everyday lives inform their understandings of technology that is widely known but rarely seen. [ABSTRACT FROM AUTHOR]

Research in the field of Global Mental Health has stoked hopes that 'task-shifting' to community workers can help fill treatment gaps in low-resource settings. The fact that community workers inhabit the same local moral worlds as their clients is widely framed as a boon, with little consideration of the social and ethical dilemmas this might create in the care of chronic, stigmatized conditions. Drawing on 14 months of ethnographic research focused on psychosocial interventions in Nepal, this paper traces how the multiple roles community workers occupied with respect to their clients - clinician, neighbour, and at times kin - came to bear on the care they provided. In-depth case studies are used to explore two divergent logics of care informing Nepali community workers' practice. While formal psychosocial care guidelines emphasized clients' autonomy, calling for non-judgmental and non-directive forms of emotional support, everyday efforts to 'convince' neighbours and relatives in distress often involved directive guidance oriented toward the restoration of moral personhood and social relations. These approaches could be mutually supportive, but tensions arose when community workers invoked moral standards linked with mental health stigma. This analysis highlights the challenge of mobilizing communities' strengths and resources without inadvertently reproducing their exclusions. It suggests the deployment of community workers to address psychosocial care gaps may entail not only leveraging existing relationships within communities, but also reconfiguring the very terms of relatedness. [ABSTRACT FROM AUTHOR]

Private primary care providers are usually the first site where afflictions come under institutional view. In the context of poverty, the relationship between illness and care is more complex than a simple division of responsibilities between various actors--with care given by kin, and diagnosis and treatment being the purview of providers. Since patients would often visit the provider with family members, providers are attuned to the patients' web of kinship. Providers would take patients' kinship arrangements into account when prescribing diagnostic tests and treatments. This paper terms this aspect of the clinical encounter as 'kin testing' to refer to situations/clinical encounters when providers take into consideration that care provided by kin was conditional. 'Kin testing' allowed providers to manage the episode of illness that had brought the patient to the clinic by relying on clinical judgment rather than confirmed laboratory tests. Furthermore, since complaints of poor health also were an idiom to communicate kin neglect, providers had to also discern how to negotiate diagnoses and treatments. Kinship determined whether the afflicted bodies brought to the clinics were diagnosed, whether medicines reached the body, and adherence maintained. The providers' actions make visible the difference that kinship made in how health is imagined in the clinic and in standardized protocols. Focusing on primary care clinics in Patna, India, we contribute to research that shows that kinship determines care and management of illnesses at home by showing that relatedness of patients gets folded in the clinic by providers as well. [ABSTRACT FROM AUTHOR]

This article shows how, within a caregivers' self-help group in Emilia-Romagna, Italy, the narrative of caring fatigue was mobilised to question and negotiate local normative discourses and social norms on affective states and family care responsibilities. The neoliberal discourse on family caregiving in Italy assumes that it comes from authentic affective states and mutual understanding. By showing how intergenerational obligations and shifting parent-child hierarchies constrained the building up of caregiving relations, the narrative of caring fatigue allowed participants to explain the ambivalence they perceived about their filial responsibilities. Therefore, this narrative legitimised the choice of preserving caregivers' wellbeing and delegating aspects of care. This paper argues that stories of caring fatigue contradict the ideal model of family care that shapes academic and institutional discourses. Nevertheless, they play an important role in sustaining caregiver endurance. [ABSTRACT FROM AUTHOR]

Anthropologists have critically examined a range of reforms from education and land to finance and health. Yet the predominant way of looking at reforms has been through a lens focused on neoliberal governance. For example, prior studies of health reforms focus on insurance, financing, and access to care. Yet, seeing reform in this way fails to attend to other types of cultural work at play when calling a policy or law a reform. In this paper, we draw on ethnographic research on health policy reforms in Israel and Bolivia to examine the concept of reform and the work it does within national movements. We argue that while the language of reform often signals change or novelty, reforms also carry forward historical continuities and reifications of the past. By delving into the past and its relationship with ongoing health reforms, we attend to how reforms can reinforce and maintain health inequities in some cases, while creating a national language for new possibilities in others. Reform, as we will discuss in this paper, is not only about political ideology, neoliberal governance, or on-the-ground policy implementation, but centrally it is about representations of aspirations, and about crafting relationships between past, present, and future. [ABSTRACT FROM AUTHOR]

This paper explores how Catholic women in Argentina use assisted reproduction technologies (ARTs), and particularly the way in which they resort to biomedicine and religion as complementary sources of knowledge, support and assistance during reproductive treatments. It is concerned about the role of the Catholic religion in local reproductive itineraries, seeing that Catholicism has such significant social, political and cultural influence in the country. Drawing on a qualitative and ethnographic study of Catholic spaces of worship, a maternity hospital and in-depth interviews with former users from three metropolitan areas in Argentina, we examine how reproductive itineraries involve the users' agency in building health resources from religion, with reference to biomedicine. The data reveal that women address religion as an affective, social and therapeutic recourse intertwined with biomedical power. These findings highlight the multiple and complex forms reproduction acquires in specific social, cultural and normative contexts, and contribute to discussing the complementarity between religion and biomedicine in health experiences. [ABSTRACT FROM AUTHOR]