Search

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]

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]

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]

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]

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]

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]

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]

This paper examines how Task Force votes were central to the development of Diagnostic and Statistical Manual of Mental Disorders (DSM-III and DSM-III-R). Data were obtained through a literature review, investigation of DSM archival material housed at the American Psychiatric Association (APA), and interviews with key Task Force members of DSM-III and DSM-III-R. Such data indicate that Task Force votes played a central role in the making of DSM-III, from establishing diagnostic criteria and diagnostic definitions to settling questions about the inclusion or removal of diagnostic categories. The paper concludes that while the APA represented DSM-III, and the return to descriptive psychiatry it inaugurated, as a triumph of empirically based decision-making, the evidence presented here fails to support that view. Since the DSM is a cumulative project, and as DSM-III lives on through subsequent editions, this paper calls for a more socio-historically informed understanding of DSM's construction to be deployed in how the DSM is taught and implemented in training and clinical settings. [ABSTRACT FROM PUBLISHER]

This paper deals with the emotional challenges encountered by doctors and nurses caring for heart and lung transplant patients. Organ transplantation enables body parts from the dead to become usable in patients with no other life-saving option. These exchanges are not possible without transplant professionals carefully selecting, guiding and interacting with organ recipients before, during and after the transplant. Based on anthropological fieldwork at a Danish heart and lung transplant unit, the paper explores how doctors and nurses experience and handle the emotional challenges of their working life. By focusing on the everyday life of the transplant unit which, contrary to public understanding of transplant miracles, is sometimes characterised by sad cases and devastation, this paper argues that transplant professionals operate in the presence of death. Medically and emotionally they are at risk. They must take the difficult decisions of whether to admit critically ill patients onto the organ waiting list; face the distress of post-transplant sufferings and deaths; and deal with organ recipients who do not behave according to post-transplant recommendations. Drawing on a familiar metaphor for donated organs, it is suggested that transplant doctors and nurses are ‘guardians of the gift’. Attention to the emotional burdens and rewards of this particular position enables new understandings of the practices of transplant medicine, of gift exchange theory, and of the role of emotion in medical practice. [ABSTRACT FROM PUBLISHER]

Acupuncture and other forms of so-called alternative treatments, originating outside the West, have increasingly become an integrated part of the repertoire of medical practices widely used in health care remote from their places of origin. The main aim of this paper is to elucidate the cultural translation of Chinese medical concepts in a Western, acupuncture setting located far from China. Drawing on material from ethnographic fieldwork in acupuncture schools in Norway, this study discusses how concepts used in Chinese acupuncture are taught and interpreted for biomedically oriented students. The paper concentrates on the concept of jingluo ('circulation tracts', 'meridians') which the schools considered to be vital in order to conduct acupuncture. Similar to several other Chinese medical concepts, jingluo presents claims about the body that significantly differ from biomedical assumptions. The paper adds novel resources and insights to the research concerning medical conceptions, in that it applies the perspective of 'finitism' as developed in the field of sociology of knowledge by Barnes, Bloor and Henry (1996) in its analysis. It presents an analysis of five empirical examples demonstrating how a variety of interpretations of jingluo - many of them from different fields and some of them contradictory - were involved in establishing jingluo. Finally, by examining examples of Chinese concepts of the body, the paper seeks to contribute to the wider field of the anthropology of the body as well as to add to our understanding of the ways in which medical pluralism and globalisation of acupuncture unfolds. [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]

Despite the recent growth of social science literature concerning the traditional medicine industry in Asia, insights into the contemporary dynamics of so-called ‘classical formulae’ remain relatively scant, as do studies of small-scale, less capitally intensive and technologically advanced modes of production. This paper seeks to address these gaps by considering a single Sowa Rigpa (Tibetan medicine) formula known as Samphel Norbu, or ‘wish-fulfilling jewel’, which appears in numerous texts and is today among the most popular Tibetan medicines in the world. Drawing primarily upon long-term fieldwork in Himalayan India, the paper follows Samphel Norbu's rise from exclusivity to popularity and examines the ways it has been transformed in the process, both materially and in its economic, social and clinical significance. The paper shows how Samphel Norbu acts as a marker of inequality between different groups of healers, and examines the role the medicine played in the development of commercial pharmacy and the proliferation of complex medicines. Tracing out wide variations in the medicine's formulation, composition, mode of production and pattern of circulation places the issue of multiplicity at the centre of analysis, and leads to a questioning of the assumptions that underpin the category ‘classical formula’. The paper reflects upon the repositioning of such formulae within emergent configurations of knowledge, power, industry and market, and on their transformations and transformative effects both over time and in the present moment. [ABSTRACT FROM AUTHOR]

Based on fieldwork among Danes with a diagnosed risk of type 2 diabetes or cardiovascular disease, this paper investigates how the technological possibilities of diagnosing and monitoring invisible risks shape understandings of health and form subjectivity. It focuses on the experiences of being diagnosed with a risk condition in the form of high blood pressure or elevated blood glucose and the ensuing use of measuring devices. It argues that measurements of these conditions can be seen as ‘formative processes’ that produce and maintain a view of health as something that can best be known through the use of medical technology. The numerical values such measurements yield are seen as true indicators of health, and doing something about risk conditions is felt to be a personal imperative. The formative processes illustrated in this paper are motivational and thought provoking. The informants do not experience new symptoms after being diagnosed; rather they reflect upon their health in a new way and numbers become associated with personal responsibility and morality. However, because numbers influence subjective experiences, they can come to take up too much space in everyday life. Therefore, people have reservations about how often they should measure their values at home. The formative processes of being diagnosed with a risk condition are thus about subjectivity both in the sense of being subject to the demands of living with an illness and of being a subject who acts to keep life from being colonized by concerns about health. [ABSTRACT FROM PUBLISHER]

The everyday lives of contemporary youths are awash with drugs to boost pleasure, moods, sexual performance, vitality, appearance and health. This paper examines pervasive practices of chemical ‘self-maximization’ from the perspectives of youths themselves. The research for this paper was conducted among male, female and transgender (male to female, so-calledwaria) sex workers in Makassar, Indonesia. It presents the authors’ ethnographic findings on how these youths experiment with drugs to achieve their desired mental and bodily states: with the painkiller Somadril to feel happy, confident and less reluctant to engage in sex with clients, and contraceptive pills and injectable hormones to feminize their male bodies and to attract customers. Youths are extremely creative in adjusting dosages and mixing substances, with knowledge of the (mostly positive) ‘lived effects’ of drugs spreading through collective experimentation and word of mouth. The paper outlines how these experimental practices differ from those that have become the gold standard in biomedicine. [ABSTRACT FROM AUTHOR]

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]

This paper is an ethnography of a four-year, multi-disciplinary adolescent sexual and reproductive health intervention in Bolivia, Nicaragua and Ecuador. An important goal of the intervention – and of the larger global field of adolescent sexual and reproductive health – is to create more open parent-to-teen communication. This paper analyzes the project's efforts to foster such communication and how social actors variously interpreted, responded to, and repurposed the intervention's language and practices. While the intervention emphasized the goal of ‘open communication,’ its participants more often used the term ‘confianza’ (trust). This norm was defined in ways that might – or might not – include revealing information about sexual activity. Questioning public health assumptions about parent–teen communication on sex, in and of itself, is key to healthy sexual behavior, the paper explores a pragmatics of communication on sex that includes silence, implied expectations, gendered conflicts, and temporally delayed knowledge. [ABSTRACT FROM AUTHOR]

This paper examines the biopolitics of HIV and labour migration from Pakistan (a country classified by UNAIDS as at ‘high risk’ of a generalised epidemic) to the countries of the Gulf Cooperation Council (GCC). The remittances by the labour migrants in the Gulf are an invaluable source of foreign exchange for Pakistan and a large number of households are entirely dependent upon them. At the same time, the National AIDS Control Programme regards Gulf migrants as a key risk factor for an HIV epidemic. The majority of HIV positive people in clinics comprise Gulf returnee migrants and their family members. This paper suggests that in the process of migrating, prospective migrants are subjected to structural violence that increases their HIV vulnerabilities. In this process, they are subjected to regimes of medical inspection, reduced to their certifiable labour power, inscribed with nationalist ideologies identifying HIV as a disease that strikes ‘the other’, and exposed to exploitation that increases their vulnerabilities. After migration, they are made to undergo compulsory periodic medical examinations in the GCC and, if found to be HIV positive, they are forcibly deported without papers, proper diagnosis or healthcare – only to return as ‘failed subjects’. Taking a disaggregated view of the state, the paper argues that, in order to be effective, debates on structural violence and the HIV epidemic must make explicit the role of the state in producing migrants’ vulnerabilities. [ABSTRACT FROM PUBLISHER]

Organ donation is constructed in the UK as a public responsibility, but more particularly as an obligation for members of minority ethnic communities. This paper draws attention to the ways in which ‘ethnicity’ has been made problematic by the allocation practices of transplant medicine, health promotion discourses and policy developments. Taken together, they have served to culturalise and racialise the procurement of organs. As the problem of organ donation is as much made inside medicine as outside it, this paper argues greater attention ought to be paid to these institutional practices and processes. Drawing on ethnographic work in the north of England, and with a specific focus on the organ consent encounter, this paper shows how categories of ethnicity in organ transplantation are an outcome of biopolitical and institutional practices. It argues that organ donation is best thought of, less as a discrete temporally-bounded act of decision-making, and more as a set of variegated situated practices that, in all manner of ways, problematically produce the publics that transplant medicine has come to rely upon so profoundly. [ABSTRACT FROM PUBLISHER]

Engaging recent social science work examining the truth making claims of science and biomedicine, this paper explores how biology is being localised in Brazilian cancer genetics. It draws from ethnographic fieldwork in urban regions of southern Brazil working with and alongside patients, families and practitioners in cancer genetic clinics. It examines how different sorts of ‘local biologies’ are articulated in the context of research, clinical practice and among implicated patient communities and the way these can ‘recursively’ move across different spheres and scales of social action to extend and transform the meaning of the biological. It shows how the mattering of the biological in Brazilian cancer genetics is fundamentally informed by questions of inequity and care, even while multiple local biologies may obscure rather than reveal the biopolitics of cancer. In an era of epigenetics this raises new opportunities and challenges for anthropological analysis as intervention. [ABSTRACT FROM PUBLISHER]

Obstetric fistula, a maternal childbirth injury that results in chronic incontinence, affects an estimated one million women in the global south. In the course of media and donor coverage on this condition, fistula sufferers have been branded as ‘child brides’ who, following the onset of their incontinence, become social pariahs and eventually find physical and social redemption through surgical repair. This narrative framing pits the violence of ‘culture’ against the potency of biomedical salvation. Based on over two years of ethnographic research at fistula repair centres in Niger and Ethiopia, this paper challenges this narrative and argues that most women with obstetric fistula remain embedded in social relations, receive continued familial support, and, unexpectedly, experience ambiguous surgical outcomes. This paper interrogates the existing logics of the fistula narrative that have had the unintended effects of obscuring global structural inequalities and diverting attention away from systemic health access reforms. [ABSTRACT FROM PUBLISHER]

This paper examines how physicians determine the quality and quantity of time to devote to each patient, and how these decisions are taught to physicians-in-training as part of the ‘hidden curriculum’ in medical education. The notion of moral economy is used to analyze how judgments of patient worth come to guide and influence interactions among physicians and physicians-in-training and patients, and how these interactions impact medical care. However, this paper also questions the notion of the hidden curriculum as a static or reified concept. Instead, the paper uses participant narratives to show how physicians-in-training are not simply passive recipients of the hidden curriculum but also actively resist judging patients based on perceptions of worth, even as they learn to operate within a moral economy of care. [ABSTRACT FROM PUBLISHER]

Increasingly, people employ the term ‘allergy’ to define various pathological conditions, although the biomedical community lacks a consensus on a definition of the term. It has become a widespread and convenient label for diverse conditions, often going beyond biomedical diagnosis. The aim of this paper is to explore how allergic people narrate their illness experiences, focusing specifically on the relationship between words, senses and bodies. This paper is based on an ethnographic study in a medium-sized north Italian city conducted from 2004 to 2008, starting in a public hospital Allergy Unit, and then developing through snowball recruitment and referral methods. Interviews were conducted with 37 allergic people, four allergologists and four nurses. Allergic people's narratives constantly drew upon two main concepts: weakness and pollution. These are interpreted as sensorial dimensions expressing a conflicting relationship with the outside environment. It is argued that in times of marked individualism and social transformations, bodily states are of fundamental importance and the mobilisation of sensory concepts is an attempt to give order and meaning to a world that is perceived as constituted by threatening aspects, polluted and out of order. [ABSTRACT FROM PUBLISHER]

This paper seeks to understand the outbreaks and the development of grisi siknis, a form of mass spirit possession among the Miskitu of north-eastern Nicaragua. Earlier documented outbreaks typically involved a few adolescents, however, in recent years, violent large-scale epidemics have taken place, involving many people of all ages. This has coincided with recent developments in Miskitu society marked by conflicts, contradictions and tense social relations. The anthropological field technique of participant-observation was used. The research took place during 11 months from 2005 to 2008 in the port town of Puerto Cabezas. A total of 38 informants were interviewed. Group discussions, narratives and informal and semi-structured interviews were carried out, as well as participation in healing rituals. The paper shows that socio-economic, cultural, personal as well as environmental factors all contribute to outbreaks of grisi siknis. The affliction has previously been considered a ‘culture-bound syndrome’ only occurring among the Miskitu. However, when viewed in a more contemporary context and cross-cultural perspective, grisi siknis shows similarities with other forms of involuntary mass spirit possession, particularly in the ways it is manifested, experienced and appears to be spreading. The paper argues that the phenomenon should no longer be considered a ‘culture-bound condition’ but in fact a Miskitu version of involuntary mass spirit possession. Further research that seeks to understand other forms of involuntary mass spirit possession should emphasize the social, personal and environmental context as well as cross-cultural comparisons in order to encompass fully the role of culture in relation to illness and suffering. [ABSTRACT FROM PUBLISHER]

The present paper deals with the parents' narratives of sickness and misfortune of their children among the Beja people in the Red Sea Hills, Northeastern Sudan. Drawing on fieldwork focusing parents' health‐seeking behavior related to child sicknesses through 1993–95, and combining participant observation and interviews, the aim is firstly to elucidate how markers of uncertainty is a pronounced trait of Beja sickness narratives, inviting listeners to actively engage in the stories, adding to a still scarce but growing literature on narration and uncertainty. Secondly, it aims at relating this narrative style to wider contexts of Beja culture and society, a type of analysis seldom undertaken within the field of medical anthropology. It is argued that although some facets of the lives of Beja people have changed since the time of the fieldwork, the changes are not pronounced and have not changed the cultural environment so as to make the analysis and conclusions of this paper less valid. [ABSTRACT FROM PUBLISHER]

This paper examines family planning in Brazil as biopolitics and explores how the democratization of the State and of reproductive health services after two decades of military dictatorship (1964–1984) has influenced health professionals’ and family planning users’ discourses and practices. Do health professionals envisage family planning as a ‘right’ or do they conceive it, following the old neo-Malthusian rationale, as a ‘moral duty’ of poor people, whose ‘irrational’ reproduction jeopardizes the family's and the nation's well being? And how do their patients conceptualize and embody family planning? To answer these questions, this paper draws on 13 months of multi-sited ethnographic research undertaken between 2003 and 2005 in two public family planning services in Salvador da Bahia, where participant observation was undertaken and unstructured interviews were conducted with 11 health professionals and 70 family planning users, mostly low income black women. The paper examines how different bio-political rationalities operate in these services and argues that the old neo-Malthusian rationale and the current, dominant discourse on reproductive rights, gender equality and citizenship coexist. The coalescence of different biopolitical rationalities leads to the double stigmatization of family planning users as ‘victims’ of social and gender inequalities and as ‘irrational’ patients, ‘irresponsible’ mothers and ‘bad’ citizens if they do not embody the neo-Malthusian and biomedical rationales shaping medical practice. However, these women do not behave as ‘docile bodies’: they tactically use medical and non-medical contraceptives not only to be good mothers and citizens, but also to enhance themselves and to attain their own goals. [ABSTRACT FROM PUBLISHER]

This paper explores the use of Islamic doctrine and jurisprudence by family planning organizations in the Gilgit-Baltistan region of northern Pakistan. It examines how particular interpretations of Islam are promoted in order to encourage fertility reductions, and the ways Muslim clerics, women and their families react to this process. The paper first discusses how Pakistan's demographic crisis, as the world's sixth most populous nation, has been widely blamed on under-funding for reproductive health services and wavering political commitment to family planning. Critics have called for innovative policy and programming to counter ‘excessive reproduction’ by also addressing socio-cultural and religious barriers to contraceptive uptake. Drawing on two years of ethnographic research, the paper examines how family planning organizations in Gilgit-Baltistan respond to this shift by employing moderate interpretations of Islam that qualify contraceptive use as a ‘rational’ reproductive strategy and larger families as ‘irrational’. However, the use of Islamic rhetoric to enhance women's health-seeking agency and enable fertility reductions is challenged by conservative Sunni ulema (clergy), who seek to reassert collective control over women's bodies and fertility by deploying Islamic doctrine that honors frequent childbearing. Sunnis’ minority status and the losses incurred by regional Shia-Sunni conflicts have further strengthened clerics’ pronatalist campaigns. The paper then analyses how Sunni women navigate the multiple reproductive rationalities espoused by ‘Islamized’ family planning and conservative ulema. Although Islamized family planning legitimizes contraceptive use and facilitates many women's stated desire for smaller families, it frequently positions women against the interests of family, community and conservative Islam. [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]

This paper draws from two years of fieldwork investigating the social course of illness among Pakistani Muslims in East London, exploring how chronic illness is communicated and negotiated in local worlds disrupted by migrancy. It examines episodic short stories about dreams, premonitions and uncanny coincidences that were prominent within the illness narratives of migrant Pakistani Muslims, recalling and throwing light on complex questions concerning subjective constructions of misfortune, the personal and social meanings of illness and the relationships between narrative and selfhood. The ethnography identifies a strong normative context of communication about ill health and bad news, within which revelation through the mode of the supernatural takes on added significance. Recurrent motifs in the dreams emphasize the connectedness between family members scattered across migratory contexts, and the reawakening of moral obligations in families. Whilst medical anthropology has understood descriptions of dreams and other uncanny experiences as 'subjunctivising tactics' serving to maintain alternative plots about the source and outcome of illness, in the Islamic context the narrating of supernatural encounters can have transformative effects, re-organising praxis and conferring legitimacy to certain forms of moral selfhood. The paper therefore argues that the notion of the 'subjunctive mode' imposes the analysts' own system of logic and that there is a need to understand the interpretive frameworks present in the illness narratives in their own terms. [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]

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]

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]

Based on ethnographic fieldwork in a coastal village in south-eastern Tanzania, this paper examines how social inequalities and social suffering become embodied in the lived experiences of hunger. The paper explores local meanings of food, fertility and hunger and how these concepts interconnect and materialize on a landscape impacted by two large-scale conservation and development projects, the Mtwara Development Corridor and the Mnazi Bay Ruvuma Estuary Marine Park. Fourteen in-depth interviews Sinde villagers were conducted to elicit narratives about their food experiences in addition to 24 hour food recall and pile sort to explore local taxonomies of food. One focus group discussion with six women was also conducted. The study finds displacement from resources by the conservation and development projects has exacerbated existing food security issues of irregular rains, increasing food prices and malnourished bodies. The downward cycle of food insecurity has local villagers worried about the viability of their community's future, embodied in the health of local children and their performance in school. Increasing food insecurity is internalized within the community as infertility where the health of the landscape is connected to the health of society. [ABSTRACT FROM PUBLISHER]

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]

This paper examines how men's reproductive bodies are problematised in rural northern Malawi as access to biomedically defined diagnoses of the health of men's sperm contribute to the visibility of male infertility. Ethnographic research with infertile and fertile men explored pathways into the sexual health and fertility services offered in district hospitals, men's clinical engagements and masculine imaginaries. The research suggested that men's willingness to be referred for semen analysis is an extension of intensive and persistent help-seeking for childlessness instigated by couples and encouraged by families. Within the laboratory, acceptable social arrangements for semen sample collection are negotiated between male clients and laboratory staff, which emphasise heterosexual and marital virility. Following diagnosis, counselling by clinical officers, without any significant therapeutic interventions, focuses on compassion in marriage. This paper considers: what is the role of semen analysis within public health facilities and why do men participate? How do men experience an infertility diagnosis and what do they and their partners do with this knowledge? In addition, how do these practices shape gendered relationships in families and communities? The analysis builds on Inhorn's (2012) concept of ‘emergent masculinities’ to better understand the connections between male subjectivities, medical technologies and the globalisation of male reproductive health, as they relate to men's lives in rural Malawi. [ABSTRACT FROM AUTHOR]

The inclusion of women in clinical trials has raised a variety of ethical and practical issues in their implementation. In the recent CAMELIA clinical trial in Cambodia, the inclusion criteria included a negative pregnancy test and signature of the consent form confirming commitment to double contraceptive use as patients were given drugs contra-indicated in case of pregnancy. But despite precautions and the requirement stated in the informed consent form, 19 out of 236 enrolled women became pregnant during the trial. The current paper describes the frictions and subjectivities that emerge as new medical technologies travel to resource-poor settings – and more specifically, how trial researchers, health workers, and research subjects involved in the CAMELIA trial negotiate the injunction to avoid pregnancy while using a teratogenic drug. [ABSTRACT FROM AUTHOR]

This paper, analyzing interviews with men that donate their semen in Denmark, explores what it means to be a sperm donor. Breaking with the assumption that men have a specific and clearly identifiable motivation to become sperm donors, this paper leaves the confinement of such an accountable actor model implied in asking for men's motivations to donate semen. Instead, the author describes the experiences of sperm donors to show how the moral, organizational, and biomedical-technological context of sperm donation in Denmark makes for enactments of moral selves as well as specific embodiments of masculinity. Instead of looking for motivations that can be accounted for, the author engages with the question of how donating semen affords men the experience of moral and gendered selves. [ABSTRACT FROM AUTHOR]

The framing of HIV/AIDS as a crisis has facilitated the rollout of large-scale intervention programmes that represent an enormous effort at mainstreaming biomedical rationalities and neoliberal notions of responsibilisation and self-care. Based on a ‘logic of choice’ (Mol 2008) and ‘responsibilised citizenship’ (Robins 2005a), although veiled in a language of rights and partnership, the heavy focus on individual behaviour and a pharmaceutical ‘solution’ to AIDS shifts the burden of responsibility for the success of the heavily funded programmes onto the shoulders of the patients and conceals alternative forms of responsibility. Analysing how HIV-positive people in Tanzania navigate life with HIV and the complex treatment regimens, this paper looks beyond biomedical rationality, which places the preservation of individual biological life at the centre of its logic, and analyses people's constant struggle to negotiate the meaning of ‘responsible behaviour’ in the context of their lived realities. This repositions the notion of responsibility in the realm of the social and reveals the rationality behind apparently irrational practices. [ABSTRACT FROM PUBLISHER]

In England, health inequalities policy shifted during the Labour term (1997–2010) from initially strong commitments to tackling the ‘upstream’ social determinants of health to a technically-driven emphasis on lifestyle risk factors and healthcare access. This multi-sited study, based in and around Westminster (2006–2007), extends our understanding of how political context influences policy-making by drawing from anthropological studies of policy. Qualitative material from central government is put into conversation with theory concerning policy as zones of practices. The paper explores the bristly process through which public health, healthcare and corporate interests vied to shape the political agenda for health inequalities; the selective use of evidence by civil servants in accordance with their perceptions of what politicians conceive to be electorally palatable; the silencing of critique of the dominant narrative about evidence-based policy; and how technical aids developed a life of their own – as a result of which, health inequalities policy ended up being depoliticised. [ABSTRACT FROM PUBLISHER]

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]

Polish birthrates during the state socialist period, 1948–1989, stayed above replacement level but since 1989 fell dramatically to one of the lowest in Europe, at 1.29 in 2010. The Polish Catholic Church and the newly-elected nationalist government of Lech Wałęsa reacted by escalating pronatalist rhetoric calling on women to increase childbearing in the name of economic and nationalist causes. Reflecting the renewed dominance of the Church, Wałęsa implemented restrictions on family planning, including abortion, contraception, and sex education, justifying them in moral and demographic terms. Plummeting fertility has been portrayed by the Church, media, and state as dangerous and unreasonable – a sign of Polish women's rejection of motherhood and the embrace of selfish priorities. Simultaneously however, the state cut back motherhood-friendly policies established by the socialist regime, including subsidized childcare, maternity leave, and healthcare. This paper draws on 19 months of fieldwork between 2000 and 2007, using interviews with 55 women in four healthcare clinics in Gdańsk area, and participant-observation at the social services offices in Krakow. This paper shows that far from irrational rejection of motherhood, Polish middle-class women are guided by pragmatic reasons when delaying parenthood in order to navigate the new political landscape marked by job insecurity and gendered discrimination in employment. Yet, rather than implementing work-family reconciliation policies that have stimulated fertility elsewhere in Europe, the Church and state insist on blaming women for ‘irrational’ non-reproduction, thus betraying a lack of political commitment to gender equity in employment, reproductive health, and in the family. [ABSTRACT FROM PUBLISHER]

This paper focuses on one of the ‘child-trafficking scandals’ that occurred in Brazil in the 1990s. Ethnographic research was carried out between 2000 and 2001 within a movement of poor families formed in São Paulo to put pressure on the authorities to review the legal procedures that had led to their children being placed for national and international adoption. Fieldwork was supplemented by other data, including reports by legislative bodies, articles in the press, and case files involving the termination of parental rights. This paper explores views on international adoption among members of the Brazilian elites such as judges, agents in the field of child protection and journalists, in the context of old but persistent neo-Malthusian ideas. Although the Brazilian birth rate is now below the replacement level, it is still common to blame ‘irresponsible’ reproduction among the urban poor for violence in large cities. Drawing a parallel with the routine sterilization of women that prevailed for decades and was encouraged by Brazilian physicians, the paper examines how, in a ‘struggle against poverty’, judicial agents took it upon themselves to enforce ‘birth control’ through adoption, bypassing family consent and the law in the process. The paper concludes by arguing that discrimination against poor families who are viewed as disorganized, immoral and irresponsible – characteristics frequently associated with criminality by a sector of the elites – has contributed to the view that lower-class families do not have the right to bear children, or to keep them. [ABSTRACT FROM PUBLISHER]

In this study the author analyzes the relationship between the individual body and the body politic in a region of the north Indian state of Uttarakhand, in connection with social changes occurring at the local and trans-local level, which are impacting the status of the different healing systems. By investigating these issues, this paper aims to shed light on some of the complex ways in which practitioners and patients who take part in a local method of healing, in this case ritual healing through possession, respond to the expansion of biomedicine. [ABSTRACT FROM AUTHOR]

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 situates medication adherence among adolescents in current cultural and political-economic debates about compliance/adherence and the formation of biomedical subjectivities. Building on prior work of the authors, this paper explores the role of desire in adherence to show how subjectivities are shaped by concordant, instrumental, or conditional forms of desire. Data is used to show how parents and adolescents compare the medicated self before and after, resulting in the formation of desire. It is argued that adherence is an outcome of desire: no desire, no adherence, or varying types of desire. Moreover, adherence is not a steady state. It is produced moment to moment as adolescents confront the desires of others. The study uses interview data to construct a case study of concordant desire, which is a form most likely to produce adherence. With concordant desire the medicated come to expect a future life on medication and a life where symptoms are stripped of their social and psychological meaning and significance. [ABSTRACT FROM AUTHOR]