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Despite heavy patient caseloads and limited resources, psychiatric professionals of North Indian public teaching hospitals aspire to deliver psychosocial interventions along with pharmaceutical or biologic treatments. However, significant obstacles stand in the way of the success of these interventions. This paper discusses how the relative social and political status differences between elite professionals and their non-elite patients and patients’ families render problematic many of the psychosocial interventions employed. Data were collected in the form of observations of practitioner-patient-family attendant interactions at the Outpatient Department, and interviews with patients, patients’ family members, and psychiatric professionals at the Inpatient Department 2001–2004. Analysis found that many of the professionals’ verbal interventions attempted to promote egalitarian styles of communication and relating among patients’ family members. Psychiatrists perceived mental health problems as stemming from structural violence inherent in the North Indian institution of the family, which they described as organized hierarchically according to gender, age, and generation. One strategy evident in interventions deployed ‘traditional’ values, beliefs, and maxims irreverently in an attempt to re-order or level hierarchical differences. Another strategy invoked the concept of individual rights in an effort to empower weaker family members and enlighten powerful members regarding the destructive impact of relational styles predicated on inequality. Unfortunately, the professionals experienced their psychosocial interventions as unsuccessful. The paper suggests that rigid interactional norms across class statuses, an emphasis on liberal individual rights versus community rights, and a harsh exhortative style, contributed to the sense that the interventions alienated non-elite patients and family attendants. [ABSTRACT FROM PUBLISHER]

The global HIV epidemic confronts pregnant women with hard reproductive choices. This paper offers a theoretically innovative and ethnographically sensitive exploration of the social processes through which 20 HIV positive women living in Northern Vietnam decide whether to continue or terminate their pregnancies. Arguing that human agency must be seen as an outcome of intersubjective engagements in shared social worlds, this paper explores how these women came to the decisions that they had to make and shows that women's choices were configured through everyday social relations, shaped through intimate engagements with husbands, parents, siblings, and in-laws. Based on the findings, it is recommended that pregnancy counseling is offered not only to the woman herself, but also, if she desires, involves members of her extended family. [ABSTRACT FROM AUTHOR]

The analysis presented in this paper is part of a larger study, the aim of which is to describe the GPs’ everyday taken-for-granted working life. The study is based on multi-sited anthropological fieldwork in Danish general practices. This paper analyses consultations where children are vaccinated and the analysis shows the way these consultations differ from other consultations in relation to flow and communication. Neither parents nor doctors question the value of the vaccination, but the manner in which they talk about it and handle it in the flow of the consultation points to them experiencing it as being problematic. Taking inspiration from Mary Douglas’ theory on cultural classification the injection is interpreted as ‘matter out of place’. The analysis identifies the infliction of pain and the discomfort this brings to the doctor and the parent as problematic as well as a breach of the doctor–patient relationship. The aim of vaccination is to prevent potential diseases in the future, but its function in the consultation, besides being fulfilment of national guidelines, is not immediately apparent. It has no real function in the consultation and this makes it problematic in the present, causing the ambiguity that both doctors and parents express. [ABSTRACT FROM PUBLISHER]

This paper is a comparative ethnography of the therapeutic practices at two different spa locations: Caldas da Imperatriz, SC, Brazil, and Termas da Sulfurea in Cabeco de Vide, Portugal. The comparison reveals the existence of contrasting 'explanatory models' held by the spa-goers as well as by the official medical systems. In the Portuguese context this model is highly medicalized; in the Brazilian case, spa treatments are viewed as 'alternative' or 'complementary' therapy and are also related to religious philosophies. Each model corresponds to a different idiom expressing certain experiences and world views, one focusing on 'pains' (dores) and the other on 'energy' (energia), the former leading to the rationale of 'curing', the latter to the notion of 'energizing'. In this paper the author intends to analyze and contrast the categories found in these models, which originate from different conceptions of health, illness and healing for Brazilian and Portuguese spa-goers. [ABSTRACT FROM AUTHOR]

This paper examines the grid of sentiment that structures medical travel to India. In contrast to studies that render emotion as ancillary, the paper argues that affect is fundamental to medical travel's ability to ease the linked somatic, emotional, financial, and political injuries of being ill 'back home'. The ethnographic approach follows the scenes of medical travel within the Indian corporate hospital room, based on observations and interviews among foreign patients, caregivers, and hospital staff in Mumbai, New Delhi, Chennai, and Bangalore. Foreign patients conveyed diverse sentiments about their journey to India ranging from betrayal to gratitude, and their expressions of risk, healthcare costs, and cultural difference help sustain India's popularity as a medical travel destination. However, although the affective dimensions of medical travel promise a remedy for foreign patients, they also reveal the fault lines of market medicine in India. [ABSTRACT FROM AUTHOR]

The Bangladeshi diaspora in East London exists in a rapidly changing social geography. Drawing on fieldwork conducted with Bangladeshi mothers in East London over a period of 18 months (2003-2004), this paper explores the different ways in which becoming a mother is conceptualised, and examines the cultural claims that mothers make through their narratives of motherhood. The research focuses on health and motherhood because they are important points where personal experience, social institutions and notions of 'culture' all intersect. Through examination of the different sources of information these women used to build their narratives, debates around ethnicity and class are brought into sharper focus, as are the potential challenges in providing services to mothers that successfully deal with both with diversity and social inequality. In investigating the complexity and possible contradictions within personal narrative, this paper also highlights some of the practical challenges involved in providing services for diverse populations in a manner that recognises difference at both a community and an individual level. Finally, by utilising biographical research more fully, this paper argues that it is possible to investigate critically the role of ethnicity in the provision of services more generally. [ABSTRACT FROM AUTHOR]

Following the recognition that 'culture matters' in designing effective public health programs, this paper focuses on one refraction of culture within the so-called 'homosexual' community in India, to highlight how attention to local knowledge and its socio-economic underpinnings can impact the politics of health care. Drawing primarily on ethnographic fieldwork conducted from 1995-1997 and 2003 in the South Indian city of Hyderabad among hijras (the so-called third sex of India) as well as the wider community of MSM or 'men who have sex with men', the paper argues that public health framings of homosexuality often fail to pay attention to differential understandings of stigma and their socio-economic underpinnings, a failure that accounts in some measure for the ineffectiveness of prevention programs targeted at 'high risk' communities such as hijras and MSM. Focusing on the local moral economy of respect and shame as one pathway of stigma and contagion, and in particular on the differences in constructions of respect and shame between hijras and the wider community of MSM, this paper points at one small way in which understanding how culture matters can ultimately address the ineffectiveness of prevention programs and redress the inequalities in health outcomes between the various margins and centers of power. [ABSTRACT FROM AUTHOR]

Drawing upon interviews and participant observation conducted with hundreds of middle-aged and elderly Chinese women in rural and urban neighborhoods in Beijing Municipality between 1993 and 2012, this paper explores the emergence of revolutionary new narratives of self-compassion among older women in reform-era Beijing. Taught before 1949 that they should first and foremost serve their families and after 1949 that they should put their own individual needs aside and serve the party and the masses, many older Chinese women in Beijing – after the seeds of market reform were sown in the late 1970s – slowly began to focus more attention than before on themselves, their past and present experiences, sources of and solutions to past and present distress, and their own personal enjoyment of everyday life. The analysis shows how western theories of both gero-transcendence and individualization as modernization are insufficient to account for the complex cultural formations of self-care that have developed among older women in the first decades of post-Mao China. [ABSTRACT FROM AUTHOR]

This paper analyses the views of 20 Japanese mothers concerning paediatric male circumcision and penile hygiene. In Japan, routine male circumcision has never been implemented for newborns and children, and adult males are mostly circumcised at aesthetic clinics. However, media reports indicate a trend of Japanese mothers willing to have their sons circumcised. In discussing penile hygiene and male circumcision, the construct of a ‘sexual script’ becomes relevant to understanding how linguistic and gender barriers made references to male genitalia and penile hygiene largely appear as ‘vulgar’ and ‘unfeminine’ in daily life conversations. Peers were often identified as the main source of information and only mothers who have struggled with their children's penile infections have learnt about male genital hygiene, a domain of knowledge largely transmitted by men. Male circumcision becomes a double-edged sword that could help prevent penile infections but also an embarrassing conversational topic that could elicit discrimination because most Japanese children are uncircumcised. [ABSTRACT FROM PUBLISHER]

Current international debates and policies on safe motherhood mainly propose biomedical interventions to reduce the risks during pregnancy and delivery. Yet, the conceptualisations of risk that underlie this framework may not correspond with local perceptions of reproductive dangers; consequently, hospital services may remain underutilised. Inspired by a growing body of anthropological literature exploring local fertility-related fears, and drawing on 15 months of fieldwork, this paper describes ideas about risky reproduction and practices of pregnancy protection in a Cameroonian village. It shows that social and supernatural threats to fertility are deemed more significant than the physical threats of fertility stressed at the (inter)national level. To protect their pregnancies from those social and supernatural influences, however, women take very physical measures. It is in this respect that biomedical interventions, physical in their very nature, do connect to local methods of pregnancy management. Furthermore, some pregnant women purposefully deploy hospital care in an attempt to reduce relational uncertainties. Explicit attention to the intersections of the social and the physical, and of the supernatural and the biomedical, furthers anthropological knowledge on fertility management and offers a starting point for more culturally sensitive safe motherhood interventions. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) has stated that referral practices along with midwifery care are a means of heightening the quality of perinatal care and lessening perinatal mortality and morbidity. In 2002, in response to high perinatal mortality and morbidity, a referral system was instituted nationally in Greenland, transferring all at-risk pregnancies to its national referral hospital. Little or no current research has focused on evaluation of the perinatal referral system or on the thoughts, beliefs, opinions and challenges faced by women and Greenlandic families themselves. The aim of this paper is to document how women referred to Nuuk because of at-risk pregnancies narratively constructed self-understanding and defined meaning during their period of separation from family and community; and how they dealt with the challenges they were presented with. Interviews were conducted with women upon their arrival at the national referral hospital and during fieldwork over a one-year period. Narrative framework was used for analysis. Coping theory and narrative theories were the theoretical base for structuring the narratives. Through their narratives, women presented their identities as mothers, community members and caretakers. Acceptance of referral was described as a means of protecting their unborn child and was where women found an inner source of strength to deal with their own anger, joy, anxiety and loneliness. The ability to accept referral was directly connected to their family and community and the support they found therein. [ABSTRACT FROM AUTHOR]

In this paper the author explores notions of illness and health among a particular group of spirit mediums in Havana: the Sociedad de Estudios Psicologicos Amor y Caridad Universal. For its members and leaders, the development of mediumship is not just therapeutic but prophylactic. And traumas (of spirits and persons) must not simply be acknowledged but metabolised through the execution of good mediumship. More importantly, people's existences are chemically and psychologically entangled with those of their protective spirits, making of their 'selves' systems, rather than bounded essences. The author argues that such concepts of personhood offer alternative modes of understanding the self in relation to forms of otherness, including dysfunction and pathology. [ABSTRACT FROM AUTHOR]