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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]

This paper explores the moral implications of treatment of young people with functional somatic symptoms. Based on an ethnographic field study at a Danish pain clinic for youngsters (age 8 to 18), the paper seeks to unearth the cultural, moral values that clinical practice steers by and upholds, and the implications this has for the assessment and management of ill body-selves. Through an exposition of the general practice of the clinic and an investigation of two specific cases of youngsters, it is found that the assessment of symptoms and selves and the goals of treatment are informed by cultural ideals of 'the good self' and 'the good life' in which agency and work ethic – both pertaining to the notion of individual responsibility – figure as prevalent virtues. The study underpins the findings of other researchers who have found that ideals of individual autonomy and responsibility for own life and health permeate the Western health care system and the discourses of ill individuals. The contribution of this article is to portray in ethnographic detail how such a cultural ethics manifests in practice and what implications this have for the treatment of young people with functional symptoms at a specific location and in specific cases. The two cases illustrate that the underlying norms and values can give rise to very different moral assessments of symptoms and selves within the same diagnostic category. [ABSTRACT FROM AUTHOR]

Drawing on the work of Ivan Illich, our special issue reanimates iatrogenesis as a vital concept for the social sciences of medicine. It calls for medicine to expand its engagement of the injustices that unfold from clinical processes, practices, and protocols into patient lifeworlds and subjectivities beyond the clinic. The capacious view of iatrogenesis revealed by this special issue collection affords fuller and more heterogeneous insights on iatrogenesis that does not limit it to medical explanations alone, nor locate harm in singular points in time. These papers attend to iatrogenesis' immediate and lingering presences in socialities and structures within and beyond medicine, and the ways it reflects or reproduces the racism, sexism, and ableism built into medical logics. [ABSTRACT FROM AUTHOR]

In public health there is increased focus on evaluating 'complex' interventions for health improvement, examining how their multiple components interact dynamically with the contextual system in which they are delivered. Amid this complexity framing are calls for methodologies that can facilitate contextual understanding as part of the evaluation process, including ethnography. However, while ethnography's attention to 'context' has been recognised as valuable for evaluation, few questions have been raised about the possible tensions of aligning what are quite different expectations for knowledge making in evaluation and in ethnography. This paper introduces a special section illustrating empirical examples of conducting ethnography for and with evaluation of 'complex' health interventions. Central to these experiences, this paper argues, are the concepts of time and temporality through which experience, change and knowledge making are invariably structured. It considers the different expectations for time and temporality in ethnographic and evaluation research, and how the 'long conversation' of ethnography aids interpretation of an intervention's interaction with the pasts, presents and possible futures of people's health experiences. Furthermore, in understanding time not as linear and constant but experienced through a series of encounters, ethnography highlights the spaces in between action and change, vital for understanding the complex dynamics of a health intervention in context. Through temporality, this paper and the related empirical papers present an intricate exploration of the challenges and productive opportunities posed by the use of ethnography for and with evaluation. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus is a condition that both results from and produces social and psychological suffering. As 'diabetes' increases among low income patients in poorer nations, new challenges arise that drive, co-occur, and result from the condition. In this article, we describe how social suffering produces diabetes by way of addressing the varied social, psychological, and biological factors that drive diabetes and are reflected in diabetes experiences among patients seeking care at a public hospital in Nairobi, Kenya. We recruited a non-probability sample to participate in a cross-sectional study of 100 patients (aged 35–65 years), where half of the participants sought care from a diabetes clinic and half sought care from the primary healthcare clinic. We obtained informed consent in writing, and collected life history narratives, surveys, anthropometrics, and biomarkers. This paper evaluates survey data using frequencies and regression tables. We found that social factors as opposed to disease factors were major drivers of psychological distress among those with and without diabetes. Psychological distress was associated with female gender and feelings of financial and personal insecurity. We also found insulin resistance was common among those undiagnosed with diabetes, suggesting that many seeking primary care for other health conditions did not receive a routine diabetes test (most likely because it is an out-of-pocket cost, or other competing social factors) and therefore delayed their diagnosis and care. Thus, social and economic factors may drive not only emotional distress among people with diabetes but also delayed care seeking, testing, and self-care as a result of cost and other social challenges. [ABSTRACT FROM AUTHOR]

Despite decades of research on India's plural health care market, the practices of many local health traditions outside the allopathic and codified traditions are under-studied. Drawing on interview and observational data, this paper explores the space in which indigenous traditional Khasi healers in Meghalaya state, northeast India, practice. Khasi indigenous healers describe themselves as doktor sla, plant doctors, to distinguish themselves from doktor kot, or book doctors. This distinction operates as a rhetorical resource, utilised to carve a distinct sphere of expertise in relation to the allopathic sector, and to mark claims for the specifically local appropriateness of traditional practices within a shifting market of state-sponsored provision. Khasi healers are a heterogeneous group who treat a wide variety of conditions, including physical ailments which have no obvious correlates in biomedical systems, and musculoskeletal disorders, with which they have recognised expertise. In addition to claiming these discrete strengths, healers also present themselves as accommodating deficiencies in biomedicine, including inherent generic weaknesses of allopathic care as well as specific local gaps in rural health care provision. Thus, the expertise niches of traditional healers have evolved through their interactions with, and the needs of, the community, but also through managing a shifting boundary with biomedical practitioners, who are explicitly sceptical of their efficacy, but tacitly accepting of the ways in which they manage the gaps in biomedical provision. While codified non-biomedical traditions in India have engaged in universalising professionalising projects, in this setting at least, non-codified practitioners have instead utilised discourses of localism. [ABSTRACT FROM AUTHOR]

Reducing the maternal mortality rate (MMR) is an important part of Mexico's commitment to the Millennium Development Goals, and the country has made great strides towards achieving this goal. However, researchers have questioned to what extent the focus on improved MMR and other indices of maternal health has contributed to an emphasis on improved statistics rather than quality care, and the effect this has had on the quality of reporting. While public health officials and hospital administrators alike agree that improved obstetric reporting is necessary, there is little discussion regarding the accuracy of the data that are submitted and the institutional pressures that may contribute to the production of inaccurate data. Using ethnographic research collected in Tulum, Quintana Roo, this paper explores how biomedical childbirth functions as a source of legitimization for the state while simultaneously providing the means for the presentation of an ideal subjecthood, one that situates birthing women and healthcare personnel as properly attenuated to the norms and needs of the modern Mexican state. By highlighting the point of disjuncture between women's experiences and the formal ‘reality’ created through hospital texts, this paper explores the place of biomedical birth as a producer of and legitimization for Mexican public health policy. [ABSTRACT FROM PUBLISHER]

Blood transfusions belong to standard and commonly utilised biomedical procedures. Jehovah's Witnesses' transfusion refusals are often referred to in bioethical and medical textbooks. Members of this globally active religious organisation do not, however, challenge biomedical diagnosis and treatment as such. A result of both their trust in and their interpretation of the Bible, they question only this medical treatment. In spite of the global presence of this religious community and its uniformly practised teachings, including those pertaining to blood, experiences and choices of Jehovah's Witness patients have been understudied. Drawing on a nine-month fieldwork with Jehovah's Witnesses and physicians in Germany (mainly in Berlin) between 2010 and 2012, the paper addresses treatment choices made by Witness patients and their relationship with physicians. In light of the long tradition of 'medical heterodoxy' established in German culture and society, Germany constitutes an ideal point of departure for such a study. By utilising the concept of 'medical landscape' it is argued that Jehovah's Witnesses in my field site find themselves at the intersection of different medical landscapes: in the 'immediate' surroundings of the German healthcare system that is open to different 'treatment modalities', and that of the United States, which favours biomedicine. The paper also argues that Jehovah's Witnesses' position towards blood transfusions can further be used as a lens to shed light on the German (bio)medical landscape itself. [ABSTRACT FROM AUTHOR]

Village dwellers in Central Ukraine have access to various types of therapy that comprise diverse medical landscapes. Patients' movements within these landscapes are possible thanks to each person's web of relations. Medical landscapes are not fixed, but vary and dynamically change for each person, depending on their fluid and interchanging, hierarchical webs of mutual relations with other people, personal bodies, institutions, discourses, political powers, other non-human organisms, or objects such as medicines. This paper was inspired by the medicoscape concept (H€orbst and Krause 2004) as well as Ingold's idea of meshwork analyses of relations between various actors: in this case, patients, healers, a weak state, official healthcare providers, pharmacists and medicinal plants, in the context of patients' therapeutic choices. Self-medication based on herbal remedies is a very important feature of people's medical landscapes in Central Ukraine and usually the first therapy choice for most interlocutors. That is why this paper is focused on the presentation of the means through which people acquire knowledge about medicinal plants, and the ways they interact with plants and plants interact with them. In this way, showing the complexity of villagers' webs of relations is possible. The analysis is based on ethnographic research conducted between 2009 and 2013 in the Vinnytsia region (Central Ukraine). [ABSTRACT FROM AUTHOR]

This paper introduces the notion of 'risky encounters', referring to the way in which contacts with doctors are commonly perceived by the inhabitants of Bishkek, the capital city of Kyrgyzstan. The author's research conducted between 2011 and 2013 revealed that most people were extremely critical of biomedical personnel, despite positive assessments of healthcare reforms expressed by experts. Owing to the prevailing distrust of doctors, their interventions are often considered risky to one's health, which strongly influences people's health-related strategies in the context of medical diversity. This perception of risk is deeply embedded in feelings of uncertainty and anxiety, which should be viewed from the more general perspective of the political, economic and social uncertainties resulting from the difficulties of the period of post- Soviet transformation. It is evident that medical diversity in Bishkek provides people in need with many non-biomedical treatment options, and a distrust of doctors significantly contributes to the popularity of complementary medicine. Economic constraints and local concepts of health, illness and efficacy are among the many other factors that play a role in therapeutic choices. However, the current paper focuses on risk, uncertainty and trust, as emotions that are central to an understanding of the health-related strategies and tactics used by the inhabitants of present-day Bishkek. [ABSTRACT FROM AUTHOR]

The category of community health worker applied within the context of health intervention trials has been promoted as a cost-effective approach to meeting study objectives across large populations, relying on the promotion of the concept of ‘com-munity belonging’ to encourage altruistic volunteerism from community members to promote health. This community-based category of individuals is recruited to facilitate externally driven priorities defined by large research teams, outside of the target research environment. An externally defined intervention is then ‘brought to’ the community through locally recruited community volunteers who form a bridge between the researchers and participants. The specific role of these workers is context-driven and responsive to the needs of the intervention. This paper is based on the findings from an annual evaluation of community health worker performance employed as community counsellors to deliver semi-supervised HIV self-testing (HIVST) at community level of a large HIV/TB intervention trial conducted in urban Blantyre, Malawi. A performance evaluation was conducted to appraise individual service delivery and assess achievements in meeting pre-defined targets for uptake of HIVST with the aim of improving overall uptake of HIVST. Through an empirical ‘evaluation of the evaluation’ this paper critically reflects on the position of the community volunteer through the analytical lens of ‘failure’, exploring the tensions in communication and interpretation of intervention delivery between researchers and community volunteers and the differing perspectives on defining failure. It is concluded that community interventions should be developed in collaboration with the population and that information guiding success should be clearly defined. [ABSTRACT FROM PUBLISHER]

This paper addresses the working practices of a mobile mental health outreach team in a large French city, one that ‘targets’ homeless people with severe psychiatric disorders who are considered ‘hard to reach’ by the public health authorities and medical services. Analysis of the team's work – where acts of curing and caring are closely tied – reveals the importance of moving beyond a polarized vision ofcureandcare. The paper departs from much of the literature on the medicalization of social problems by arguing that medicalization is not only a means of social control, but has ethical value as well. In examining the practices of frontline health workers, it aims to show that integrating the methods and theoretical approaches of social work in medical practice is necessary to address the specific problems of homeless people, to enable health professionals to pursue medical cures, and to challenge the shortcomings of public policy. [ABSTRACT FROM AUTHOR]

The aim of this paper is to convey the relevance of a Gramscian perspective in medical anthropology, stressing his anti-essentialist way of reasoning about ‘nature’. The author claims that Gramsci's understandings of the bodily life of the state can deconstruct naturalized realities in ways that are helpful for the ethnographer engaged in the political anthropology of embodiment and the management of health, persons, and life itself. The paper is presented in three parts. An attempt is made, first, to frame the relevance of Gramsci for Italian medical anthropology and second, to explore the components of the Gramscian concept of ‘second nature’ within the perspective that he himself calls ‘an anthropology’. Third, an example is given of how the proposed Gramscian insights could inform an ethnography on the biopolitical aspects for the early detection of Alzheimer's disease, which is currently being carried out in Perugia. [ABSTRACT FROM PUBLISHER]

This paper describes the birth (or rebirth) of Italian medical anthropology around the middle of the 1950s, and its subsequent complex development up to the present. During this fairly long process, the author played a role that was probably of some importance, that of both a direct witness and active participant. Here these developments are briefly reviewed, in an attempt to single out some of the stimuli and the most significant occasions that have happened, their theoretical and methodological reference points, the main lines of research that have been tackled along the way, as well as the ‘social demand’ and the ‘social use’ that have integrated and oriented the practice of the new discipline within the horizon of some of the more general problems of Italian society. In outlining here the profile of and the various events in Italian medical anthropology, this paper takes into account the fact that, although a medical anthropology with that name and the disciplinary set-up that are now internationally attributed to it began in Italy only in the mid-1950s, important lines of research to which we would today attach that name had been undertaken long ago. [ABSTRACT FROM PUBLISHER]

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]

Studies of care-seeking behaviour have generally focused only on the medical facilities that are available within a country's national boundaries. However, a growing number of patients worldwide are pursuing medical services outside of their own countries. The burgeoning literature on 'medical tourism' tends to offer the perspectives of the treatment destinations, not the experiences of patients. This paper examines the international medical travel of patients from the capital-poor country of Yemen. Families in Yemen often sacrifice greatly to seek the advanced, trustworthy technological medicine that is unavailable locally. The paper draws on interviews conducted with 71 Yemeni medical travellers in India and Jordan, as well as a survey of 205 doctors in Yemen about their disclosure practices regarding terminally ill patients. While perhaps an attractive option in today's global world, the use of medical services abroad affects local perceptions: it perpetuates a lack of trust in local capabilities, invites criticism of the government for not providing care to its citizens and fosters the hope that a cure exists somewhere in the world. [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]

Based on fieldwork and archival studies carried out since 1995, this paper is an analysis of the dialogue between the Jarwas and the outside world. The Jarwa tribal community on the Andaman Islands has a long history of voluntary isolation and pronounced hostility towards outsiders. This situation only started to change in the mid-1990s, when a young Jarwa was successfully treated at a local hospital. The Jarwas’ sudden fascination with modern medicine was less to do with its therapeutic powers than the fact that, on each visit, hospital staff gave them food, clothes, and various consumer items. This paper describes events in the Jarwas’ ‘junket to modernity’. Before discussing recent events, the paper first retraces the history of relations between the Jarwas and the outside world during the second half of the 19th century, when life on the Andaman Islands was dominated by a British Penal Settlement. In the face of epidemic outbreaks of pneumonia, malaria, and measles, tribal health has become a major concern for the Indian authorities. The paper discusses continuities and discontinuities in medical concerns with the tribal body, and argues that ‘marginalization’ must be understood as a practice of mutual constitution. [ABSTRACT FROM AUTHOR]

This paper explores the potentials of applying Michel Foucault's notion of 'self-care' to issues in medical anthropology. While Foucault's writings on regimes of power/knowledge have had an enormous influence on medical anthropologists, his late works on the ethics of the self have not yet received much attention. This paper discusses Foucault's notion of self-care in relation to Ayurvedic interpretations of digestion in Kolkata (formerly Calcutta, India). In Kolkata, it is a widely held belief that attentive care of the self, and especially for the stomach, can set a person free from dependencies. Yet at the same time, 'modern' people are seen as unable to live up to the ethics of self-care. The parallel between bodily sovereignty and cultural/political sovereignty produces a discourse on 'lack of self-control' as one of the main reasons for continuing dependency in all spheres of life. [ABSTRACT FROM AUTHOR]

In the varieties of non-biomedical healing in Russia, the efficacy of treatment is based on the patient's recognition of the healer's charismatic legitimacy that translates directly into the power to change the lived reality of the ailing body. This paper considers charismatic healing power as emerging in the dyadic relationship between a healer and a patient, and analyses aesthetic and social elements of the charismatic bond between healer and patient. The paper is based on the ethnography of the multiple medical field in contemporary Russia, reflected in the narrative of a family's encounters with its various representatives in search for treatment alternatives for an incurable chronic disease. The acceptance of a healer's charisma is shown to build on an immediate embodied experience, but it is also suggested that this experience cannot be understood if divorced from its social diacritics. [ABSTRACT FROM AUTHOR]

Since the 1990s, after gaining independence by the Republic of Kazakhstan, various complementary therapies have grown rapidly there. Korean medicine in its several forms belongs among them. There is an important population of Korean deportees from Stalinist times, but this paper will show that the various forms of Korean medicine practised in Almaty, Kazakhstan's former capital, do not primarily cater for ethnic Koreans. Rather, as the paper demonstrates, it is important to see that there are different forms of Korean medicine attractive to clientele from different strata of society. Thus, there are, apart from the most traditional treatment practised at the Korean-Kazakhstani clinic in Almaty, two other newly invented modifications of Korean medicine: soo-jok and soo-ji. The paper embeds Korean medicine into the context of the drastic deterioration of the state health care system and general dissatisfaction with its services, on the one hand, and a generally supportive attitude of government authorities to complementary medicine, on the other. My empirical data suggest that in Kazakhstan people of different ethnic background, sex, age and education choose complementary therapies. The growing popularity of these therapies is not only attributed to public confidence in the methods that are perceived as 'traditional' but more importantly to the extremely difficult economic conditions which have made people search for cheaper treatment. The paper presents data that are critical of a purely culturalist interpretation of explaining the arrival of Korean medicine in Kazakhstan and suggests that it is the political economy of Korean medicine as a non-costly therapy which has made it attractive to a wide range of clients. [ABSTRACT FROM AUTHOR]

This paper focuses on the diversity in patients' experience of biomedicine and contrasts it with the normative view characteristic of health professionals. Ethnographic fieldwork among Polish migrant women in London, Barcelona and Berlin included interviews about their experiences with local healthcare and health professionals. Themes drawn from the narratives are differences between the cities in terms of communication between patients and health professionals, respect for patients' choices and dignity, attitudes to pregnancy and birth (different levels of medicalization), and paediatric care. It is argued that patients continuously negotiate among their own views and expectations based on previous experiences and knowledge from personal communication; internet forums and publications; and the offer of medical services in the countries of their settlement. Patients experience pluralism of therapeutic traditions within and outside bio-medicine. In turn, representatives of bio-medicine are rarely aware of other medical practices and beliefs and this leads to various misunderstandings. By highlighting the pluralism of medical practices in European countries and the increasing mobility of patients, this case study has useful implications for medical anthropologists and health professionals in a broader Western context, such as raising sensitivity to different communication strategies and a diversity of curing traditions and expectations. [ABSTRACT FROM AUTHOR]

The paper addresses forms of medical pluralism, studied from the microsocial perspective, among the Polish community in Misiones, Argentina. It shows different attitudes to health treatment within the field of home medicine, local non-biomedical specialists and biomedicine. It points out the relationship between the diversity of offers of medical assistance and community members' negotiations between various medical approaches. It also identifies the factors influencing these choices. While prior research examines Indigenous and Mestizo medical ethnobotany in this region, there has not been research on medical pluralism and very little study of complementary and alternative medicine among the inhabitants of Misiones. The study group comprises Polish peasants who settled in northern Misiones between 1936 and 1938 and their descendants born in Argentina. Field research was based on semi-structured, indepth and free-listing interviews. The analysis was carried out using both qualitative and quantitative approaches. The results show that Polish settlers tried to reconstruct bits and pieces of their familiar and traditional healing practices in the new environment. Phytotherapy plays the most important role among home therapies. It is at home that most treatments start. Members of the Polish community also treat folk illnesses at home and report them to local healers. The growing influence of biomedicine does not contribute to the elimination of home medicine or non-biomedical specialists in the study area. There has been a medicalization of childbirth and fractures, but folk experts such as curanderos, hueseros and naturistas are still very popular in the region. [ABSTRACT FROM AUTHOR]

The availability of free antiretroviral treatment in public health facilities since 2004 has contributed to the increasing biomedicalization of AIDS care in Kenya. This has been accompanied by a reduction of funding for community-based care and support organizations since the 2008 global economic crisis and a consequent donor divestment from HIV projects in Africa. This paper explores the ways that HIV interventions, including support groups, home-based care and antiretroviral treatments have shaped expectations regarding relations of care in the low-income area of Kibera in Nairobi, Kenya, over the last decade. Findings are based on 20 months of ethnographic research conducted in Nairobi between January 2011 and August 2013. By focusing on three eras of HIV treatment – pre-treatment, treatment scale-up, and post-crisis – the authors illustrate how family and community-based care have changed with shifts in funding. Many support groups that previously provided HIV care in Kibera, where the state is largely absent and family networks are thin, have been forced to cut services. Large-scale HIV treatment programmes may allow the urban poor in Nairobi to survive, but they are unlikely to thrive. Many care needs continue to go unmet in the age of treatment, and many economically marginal people who had found work in care-oriented community-based organizations now find themselves jobless or engaged in work not related to HIV. [ABSTRACT FROM AUTHOR]

Little anthropological research has been conducted on the health care perspectives of homeless people in rural areas. The aim of the present study is to elicit health-care beliefs, and examine overall health experience among a sample of current or recently homeless people in rural New Hampshire. Thirteen qualitative interviews were conducted, 11 with single men. Interviews were audio-recorded and transcribed, and analyzed using thematic analysis. Despite a massive burden of disease and illness, almost all participants reported an abiding aversion to doctors, hospitals and professional health care. Participants reported numerous negative encounters with doctors and health care professionals, often of a demeaning and disparaging nature. Participants noted that these encounters resulted in frequent cases of misdiagnosis and iatrogenesis. In contrast, participants spoke more fondly of other social and voluntary services, for example homeless organizations. Like other rural New Englanders, participants made their own individual efforts to maintain and promote health, for example by pursuing hobbies or prayer. The findings are contextualized within literature suggesting that these perspectives are generally shared by other poor rural people. Consistent with this literature, the findings suggest that homelessness in rural areas is often temporary and episodic. As such, this paper brings into question the distinctiveness and overall utility of the concept: ‘the rural homeless’. The key determinant of negative attitudes to health care may not be recent homelessness. It may be entrenched socio-economic marginalization, and the resultant social stigma, that are shared amongst the rural poor, regardless of their current housing status. [ABSTRACT FROM PUBLISHER]

This paper examines how children and families of diverse ethnic backgrounds perceive, understand and treat symptoms related to functional gastrointestinal disorders (FGIDs). It is questioned how different ways of dealing with medical uncertainty (symptoms, diagnosis) may influence treatment pathways. Semi-structured interviews were conducted with 43 children of 38 family groups of immigrant and non-immigrant backgrounds. The analysis takes into account (a) the perceived symptoms; (b) the meaning attributed to them; and (c) the actions taken to relieve them. The social and cultural contexts that permeate these symptoms, meanings and actions were also examined. It is found that, in light of diagnostic and therapeutic uncertainty, non-immigrant families are more likely to consult health professionals. Immigrant families more readily rely upon home remedies, family support and, for some, religious beliefs to temper the uncertainty linked to abdominal pain. Furthermore, non-immigrant children lead a greater quest for legitimacy of their pain at home while most immigrant families place stomach aches in the range of normality. Intracultural variations nuance these findings, as well as family dynamics. It is concluded that different courses of action and family dynamics reveal that uncertainty is dealt with in multiple ways. Family support, the network, and trust in a child's expression of distress are key elements in order to tolerate uncertainty. Lastly, the medical encounter is described as a space permeated with relational uncertainty given the different registers of expression inherent within a cosmopolitan milieu. Narrative practices being an essential dynamic of this encounter, it is questioned whether families’ voices are equally heard in these clinical spaces. [ABSTRACT FROM PUBLISHER]

This paper proposes a way of framing the study of ‘noncommunicable diseases’ within the more general area of chronic conditions. Focusing on Africa, it takes as points of departure the situation in Uganda, and the approach to health issues developed by a group of European and African colleagues over the years. It suggests a pragmatic analysis that places people's perceptions and practices within a field of possibilities shaped by policy, health care systems, and life conditions. In this field, the dimensions of chronicity and control are the distinctive analytical issues. They lead on to consideration of patterns of sociality related to chronic conditions and their treatment. [ABSTRACT FROM PUBLISHER]

This paper is about the changing shape of health tourism in a Czech spa town. The research focuses on balneotherapy as a traditional Czech healing technique, which involves complex drinking and bathing therapies, as it is increasingly being incorporated into the development of a Czech health tourism industry. Today, the health tourism industry in Marianske Lazne is attempting to 'harmoniously' combine three elements - balneology, travel and business activities. One detects subtle shifts and consequent incongruities as doctors struggle for control over the medical portion of spa hotels. At the same time, marketing groups are creating new packages for a general clientele, and the implementation of these new packages de-medicalizes balneotherapy. Related to the issue of the doctor's authority in the spa, the changes occurring with the privatization of tourism entails the entrance of 'tourists' to Marianske Lazne who are not necessarily seeking spa treatment but who are still staying at spa hotels. There is a general consensus among spa doctors and employees that balneotherapy has become commodified. Thus, while balneotherapy remains a traditional form of therapy, the commercial context in which it exists has created a new form of health tourism. [ABSTRACT FROM AUTHOR]

In exchanges between health professionals and consultants in the West African context, the word malaria is often replaced by its equivalent in the local dialect. In the Nouna health district of Burkina Faso the term malaria is regularly translated as sumaya. Acknowledging that there may be important epistemological differences between malaria, a term issued from the biomedical epistemology, and sumaya, which is borrowed from traditional medicine epistemology, the possible mismatches between these two terms have been assessed to anticipate problems that may result from their translation by different health stakeholders. By consulting various traditional healers and other members of the communities about the local meaning of the term sumaya, it has been possible to compare the conceptualisation of sumaya to the biomedical conceptualisation of malaria and assess the gap between them. An investigation based on a sample of 13 traditional healers and over 450 individuals from Nouna's health district was conducted to document the meaning of the term sumaya. This paper demonstrates that the generally accepted translation of the word malaria as sumaya is a mistake when one looks at the different systems of belief and representations given to each of these two terms. [ABSTRACT FROM AUTHOR]

Meeting and treating patients from other countries and cultures constitutes a challenge for health care. The number of immigrants and refugees has seen a rapid increase in recent years in Sweden. Expectations and experiences of health and illness often differ among these immigrant groups compared with the inhabitants of the majority society. This paper examines the situation of Somali refugees living in a multicultural suburban area of a large city in southern Sweden, and the aim was to illuminate and document their thoughts and experiences in relation to health and illness. Thirteen interviews with Somalis of different sexes and ages were conducted in the informant's homes. A hermeneutic-phenomenological approach was used in the analysis. The findings revealed an essential theme - a life in exile - that permeated every subject that was discussed and talked about. This was expressed in the following aspects: longing for the homeland, pain - a companion in exile, prejudice and discrimination, family - comfort and trouble, religion and beliefs in Jinns. Complex feelings of bi-nationality and of being uprooted were expressed. Prior knowledge about the hardships involved in a life as a refugee may allow and increase the possibilities for better communication, increased trust and mutual respect in order to achieve a meaningful encounter with health care personnel. [ABSTRACT FROM AUTHOR]

This paper explores how adult cancer in-patients feel about and make sense of their condition and therapy. Data was collected through observation and informal conversations with patients and hospital staff, over a period of 12 months, on a cancer ward in a teaching hospital in Kenya. I held in-depth conversations on multiple occasions with 42 patients. Most of them expected to recover quite fully, despite having postponed seeking medical help, and delays in referral. Long periods of suffering, prolonged diagnosis and treatment, and socio-economic difficulties shape the patients' perspectives on hospitalisation. The low position of patients in the social and medical hierarchy, and inadequate hospital resources, hamper their capacity to negotiate their care. The needs of the cancer patients can better be met when their experiences during hospitalisation are understood. This can foster co-operation between patients and hospital staff to facilitate coping with chronic illness. The patients' views highlight both material and non-material needs in cancer management in a developing country. [ABSTRACT FROM AUTHOR]

In this paper I discuss the possibilities and limitations of the ethnographer participating in the different on-going activities and events in highly specialised healthcare systems. The concept of participant observation is based on a number of assumptions, particularly that the ethnographer will become one of 'them' to be able to follow the steps belonging to the accepted ethnographic research practice of doing fieldwork. The character of fieldwork in highly specialised healthcare systems does not fit well with this assumption. I suggest that we need to rethink the concept of participant observation and I propose negotiated interactive observation as a more appropriate way to describe ethnographic fieldwork in a setting such as the hospital or the clinic. [ABSTRACT FROM AUTHOR]

Medical pluralism is a common feature in most health care systems. In this system integration and exchanges between sectors are common, thus forming complex and hybrid systems. This paper analyses such a pluralistic system, and is based on an anthropological study involving participant observation and ethnographic interviews. The research focuses on a group of healers—Los Naturistas from urban Bolivia. They are Mestizos and serve the Indian and Indian Mestizo population. The study findings suggest they integrate explanatory models from both the traditional Andean medicine and biomedicine, but are selective in the sicknesses they treat. They predominantly use herbal medicine. As a group of healers Los Naturistas are establishing their specific place in the Bolivian health care system. [ABSTRACT FROM AUTHOR]

This paper explores how culture and cultural differences are created and used to maintain power of definition in mental health care. The author argues that although in mental health care an open approach in care for immigrants is stimulated, cultural differences are strategically used to maintain the status quo of mental health care and mental health professionals. The result is that such strategies keep immigrants in a marginal position. In mental health care, immigrants belong to a classificatory anomaly or, in processual terms, to liminal personae. The author concludes that interaction in mental health care is a manifestation and reproduction of larger class, racial, ethnic and gender conflicts in the broader society. [ABSTRACT FROM AUTHOR]

Much of the social scientific work on psychiatry and mental health, from a variety of competing perspectives, has focused upon power and the social construction of 'mental illness'. Very little attention has been paid to resistance or to the various ways in which 'patients' or 'survivors' (as some now prefer to refer to themselves) have sought to socially deconstruct 'mental illness'. This paper seeks to redress that balance by way of a detailed examination of some of the key practices of resistance which have developed within the context of the UK mental health survivors movement. Using key concepts from Bourdieu's theory of practice, it examines the challenge which survivors have mounted to the symbolic power of psychiatry, and the resistance habitus which their opposition has given rise to. [ABSTRACT FROM AUTHOR]

In the sociology of health and illness, the heterogeneous field of heterodox medicine is often conceptualised as a more or less homogeneous entity. All kinds of heterodox modes of treatment are pooled together in order to discover the heterodox patient. In this way, differences between several heterodox modes of treatment are lost and the emerging picture remains vague. In this paper, we concentrate on one particular mode of treatment: Ayurveda. Based on 14 semi-structured interviews conducted with the patients of German Ayurvedic physicians, we examine the paths that lead patients to this form of Asian medicine, and how they process Ayurvedic concepts and make sense of them. It will be a story of how trust in heterodox medicine is built and confirmed, a story of how foreign knowledge is creatively received, modified and thus glocalised. We will also explore the patients' perception of their relationships with their physicians, for the success of heterodox medicine is often traced to a more satisfying, personal relationship with the physician when compared to the rather brief and technical consultations common in biomedicine. Finally, it is argued that Ayurvedic patients do not readily fit the notion that heterodox patients are active consumers. [ABSTRACT FROM AUTHOR]