Paper short abstract:

This paper will examine consequences of class and medical movement on cancer diagnostic and treatment outcomes.

Paper long abstract:

Cancer care in resource-poor settings involves both intra-country and international mobility in quests for therapy. Generally prognosis is better for clients who seek well-being beyond the confines of resource-poor settings. This paper will examine consequences of class and medical movement on cancer diagnostic and treatment outcomes. Data to support my analysis is based on qualitative interviews I conducted in 2015/2016 over a six-months period at a Ugandan national referral hospital-cancer-unit while offering care to two family members diagnosed with cancer. In the wards, I observed families and clients during their struggle to accept, manage and deal with challenges in meeting increasing costs in healthcare. I interviewed over 20caretakers to find out experiences in cancer care. Among cancer patients observed there were everyday variations in the health status. On average, this unit reported more than 4deaths per-week. Caretakers and patients engaged in treatment movements for diagnostic procedures to other-well-equipped, but expensive private-laboratories, bought medicines from pharmacies and hospitals in Kampala and beyond. Although Aghakhan hospital in Nairobi offered to take 400Ugandan clients for radiotherapy an estimated 1000cancer cases require radiotherapy annually. Consequently, there is intra treatment mobility in Uganda and also international treatment travel mostly by the political elite and middle/upper class in quests for well-being. Its these two categories of medical mobility which I aim to examine while highlighting factors promoting mobility including affordability,loss of trust in national establishments and the experience that cancer treatment has better prognosis if managed early and in well-resourced settings.

Paper short abstract:

Drawing on hospital ethnography of cancer and diabetes care in Kenya, this paper explores Non-Communicable Disease care imbalances expressed in the movements of patients, technology and health care personnel.

Paper long abstract:

The increasing burden of Non-Communicable Diseases (NCDs) in Kenya represents the historical low priority given to control of the NCDs. Help-seeking trajectories among patients indicate the difficulties of managing the diseases in the context of inadequate supply and unequal access to appropriate expertise and technology. Scarcity of qualified personnel and equipment for NCD diagnosis and treatment characterize the unfruitful care-seeking journeys and multiple referrals, particularly at the chronic stages of the diseases. NCD care movements often involve different levels of the public and private referral hospitals and beyond; including the exits of health care personnel from public to private medical facilities and externally, abroad. The medical travel phenomena worsen the experience of inadequate NCD care. Attempts by the government to bridge inequities in the provision of NCD management resources to the citizens belie the reality of a dearth of health care expertise and technology. This underlies the flow of patients for better care and the exit of public health personnel for better training or remuneration. Drawing on hospital ethnography of cancer and diabetes care in Kenya, this paper explores the embodiment of local and international NCD care imbalances expressed in the movements of patients, technology and health care personnel. The paper makes reference to the Critical Medical Anthropology theory to analyze how help-seeking trajectories among diabetes and cancer patients. Health provider movements, and inadequate accessibility to available expertise and technology manifest unresponsiveness in NCD care relative to wider socioeconomic and political contexts of the health system.

Paper short abstract:

The paper questions the process of construction of new expertise of africain and asian medicines in the domain of health and the appropriations by experts and lay people of the prevention and management of cardiovascular illnesses.

Paper long abstract:

The researches on medical pluralism put in evidence the therapeutic choices made by patients and their family during the illness of an individual (Fassin, 1992; Good, 1994). John Janzen pointed out the existence of the "therapeutic management group" (Janzen, 1987). Nowadays with the globalization process, most African countries are experiencing the promotion of "traditional medicines". Especially in poor health resources setting were chronic diseases are becoming public health issues.

This paper aims at analyzing medical pluralism how global, national and regional flows of health care resources shape management of non-communicable diseases in Cameroon such as cardiovascular illnesses. With the rise of new actors of health systems presenting themselves either as partners of the State, or concurrent of the State's delivery of health system particularly regarding prevention and the management of chronic diseases in poor health resources settlement. The paper questions the process of construction of new expertise in the domain of health and the appropriations by experts and lay people of the prevention and management of cardiovascular illnesses. How does the encounter of traditional medicines of Africa and Asia, shape professional trajectories of caregivers trained in biomedicine? What does it suggest in terms of new conceptions of body, illness and disease? How does it change the lay people's knowledge on body and medicines? What new forms of legitimacy are to take into account in the prevention and management of these diseases?

Paper short abstract:

Technology outsourcing of cancer treatment has impacted cancer patients in many ways. Whilst the approach could be expected to lead to prompt access of health care, cancer patients have interpreted this as an out-of-reach enterprise, thus affecting their health seeking behaviour.

Paper long abstract:

Globally, non-communicable diseases cause 38 million deaths annually. Specifically, cancer epidemic causes 8.2 million deaths across the world. Cancer deaths lead to 7% of total mortality in Kenya. The cancer epidemic has exposed the structural, policy and access frameworks that limit the patients' access of cancer medical care in Kisumu County of Western Kenya. Consequently, there has been 'outsourcing' of both personnel and technology in the county through organized medical camps for screening and treatment of cancer. Outsourcing of technology presents cancer treatment as something out-of-reach by local patients, thereby impacting on their overall health seeking. This paper examines how outsourcing of cancer technology and treatment influences the patients' health seeking at Jaramogi Oginga Odinga Referral Hospital in Kisumu, Kenya. It explores the patients' portrayal of cancer disease in day-to-day conversation; secondly, it investigates how perceived technology and expertise movements shapes the notion that cancer treatment is 'out-of-reach' ; and thirdly, it examines the degree to which outsourcing meets the patients' individual healthcare needs. The Theory of Reasoned Action (Ajzen and Fishbein 1980) guides the paper. Drawing on a case study of Jaramogi Oginga Odinga Referral Hospital in Kisumu the paper examines cancer patients' experience of treatment. It concludes that outsourcing of cancer technology could be constrained by the patients' underlying misconceptions and attitudes towards the model. Therefore, technology outsourcing approaches should address the patients' expectations with regard to seeking cancer healthcare