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- Convenors:
-
Rikke Sand Andersen
(University of Southern Denmark)
Bernhard Hadolt (University of Vienna)
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- Formats:
- Panels
- Sessions:
- Thursday 23 July, -, -
Time zone: Europe/Lisbon
Short Abstract:
This panel invites participants to discuss ongoing transformations in care practices and the moving terrains of what is considered of relevance to (bio)medicine. We invite papers that take us on ethnographic journeys through specific historical or local moments documenting these transformations.
Long Abstract:
Over the last three decades, new mobilities and reconfigurations of health systems have affected the domains of care and biomedicine in profound ways. An intensification of global interconnectedness, which has conditioned new socialites and biotechnological entanglements across national and regional borders, calls for scholarly attention to shifting notions of what constitutes biomedicine and care. The significant structural reconfigurations in healthcare systems worldwide, which have been fostered by new diagnostic, therapeutic and prognostic developments, often have a massive impact related to neoliberal reform processes and globalizing funding arrangements. Conceptually, we have witnessed a proliferation in attention to care work and how the domain of biomedicine is made and re-made. In the Global North as well as in the Global South diagnostic technologies make possible for an increasing overlap between 'the home' and 'the clinic', and the implications of health care reforms (often in the form of austerity politics) have impacted the distribution of care resources. This has consequences for those in need of care as well as for those providing care. A growing body of literature explores the intersections of technologies, healthcare infrastructures and care practices. This panel invites papers which explore these ongoing changes and asks how medical anthropologists have responded to the complex ethical and political challenges implied by these "moving terrains". It also highlights the position of vulnerable groups and the affective dimensions of care in theses transformations.
Accepted papers:
Session 1 Thursday 23 July, 2020, -Paper short abstract:
This paper examines medicine as an ever-shifting affective field that is shaped by socio-political processes that structure healthcare systems, health vulnerabilities, the embodied experience of health and illness, and the possibilities for health justice.
Paper long abstract:
This paper makes a case for examining the culture of medicine as an affective field that is structured by transformations in healthcare systems, socio-political processes that influence health vulnerabilities, shifting imaginings of the 'good life' and the possibilities for health, and the responses that health practitioners themselves bring to these processes. I draw on two contrasting case studies from my ethnographic fieldwork: a) widespread public fear of doctors in the Indonesian province of Aceh; and b) medically-trained midwives in the Special District of Yogyakarta, who are widely respected by the public but under continual scrutiny from authorities. After examining the socio-political processes and health systems issues that have shaped the affective dynamics of these two contrasting case studies, I make a case for an approach to global health anthropology that is aimed at improving health justice through greater awareness of how healthcare systems operate as an affective field that is directly shaped by socio-political histories and structural transformations in health systems.
Paper short abstract:
Entering a hospital to seek help puts patients in a vulnerable situation. At the same time, health professionals working in hospitals across the world have reported incidents of violence against them more. This ongoing project evaluates the measures taken against violence in an Austrian hospital.
Paper long abstract:
People with ill health are in a vulnerable situation when they enter a hospital in search of help. Health professionals are trained to diagnose and treat illnesses and offer care according to the local health system's resources. Studies from the last twenty years show high incidents of violence against health professionals in eight countries and question measures against it. International initiatives show the same high amount of incidents in EU member states over the last few years and show us that this problem needs to be addressed from different perspectives. As stories of incidents in Austrian hospitals were being reported more frequently, we started a pilot project with a systematic literature review and qualitative research in cooperation with a hospital. The presentation shows results from these first studies that give an insight into the staff's experience (interviews), the hospital's measures (field visits) to protect them, and the evaluation of these measures. Anthropological knowledge is used to analyse the context of the incidents and the cases themselves. The taboo against talking (and reporting) about violent incidents and the organisation, undergoing a change management process during the study, are challenging the researchers in a very fast-changing work environment. Demographic factors (age, gender, ethnic background, years of work experience) among health professionals play a central role in changes in how to deal with incidents. One conclusion is that educational programs for health professions need to include individual training and awareness of risk factors to prevent incidents and protect the health of workers.
Paper short abstract:
The paper focusses on the transformations that Italian health services have gone through, as a consequence of massive arrivals of asylum seekers and refugees in the Country. Forced migrants bring specific health needs and pose new challenges to services in terms of access and care procedures
Paper long abstract:
Since the last two decades Italy has become a main target of migratory flows of forced migrants, that is people leaving Countries characterized by strong political instability and high socio-economic inequality. Even if arrivals faced a severe reduction since 2017, the presence of asylum seekers on Italian soil is still high, with irregular distribution over the peninsula. Lombardy is one of the Italian Regions with the highest numbers of migrants hosted in local reception centres; however the procedure of health assistance in Lombardy is not regionally standardised and depends on political choices assumed locally. It translates into a fragmented sanitary offer, that might result in unequal access to care.
The paper aims to analyse the innovative outcomes of a project that took place in Lombardy since 2016 to 2018, named START "Crossing socio-sanitary services for asylum seekers and refugees". Such a project intended to develop a new model of taking charge of health needs of the target population, fostering cooperation between public services and third sector organizations. A qualitative research, which involved several actions such as interviews to local stakeholders, was undertaken with the purpose to build up a new model of governance. Both interviews and roundtables promoted among public and private actors implemented an integrated network of services. Furthermore, the project promoted training courses for social and sanitary professionals in order to develop new competences and skills on migration issues. The project's outcomes have shown the effectiveness of such an integrated model, with visible effects on migrants' taking charge
Paper short abstract:
Which new geographies of fear, worry and mistrust weave actors participating to care? To address this question my research examines the practices that determine urgency (triage) within an ER in northern Italy from the perspectives of both patients and medical staff.
Paper long abstract:
Ahmad finds himself waiting in the ER for the second time in two days, to address an unresolved face paralysis, that started while he was sleeping out in the mid-January cold. Evicted and denied social aid due to racial discrimination, he feels trapped, as he is not able to look for job, lacking clean clothes and secure shelter. Hoping for a hospital bed where to finally rest, he seats still in the ER.
Struggling to keep pace with epidemiological changes and neoliberal austerity measures, the ERs in Italy ended up absorbing the flare-ups of the increasingly chronic people's vulnerabilities. Challenging ER's understanding of urgency, people run into the ER to cope with life necessities, whose recognition is denied elsewhere. Clashing agendas of priority making intertwine in the space of the ER as staff is compact to state that people's trust in public healthcare has increasingly vanquished. Skyrocketing since the turn of the century, accountability measures, assembly line guidelines, marathon long waits for examinations and mazy bureaucracy did not improve the picture. So, which geographies of fear, worry and mistrust weave actors participating to care? Which kind of changing body politics do they enact and how do they impact the healthcare service? Addressing the different vulnerabilities patients and providers face amid care efforts, this paper will ask: how to contextually tinker and readapt what "to care for" and "how to do it" amid a general outspread of suspect?
Paper short abstract:
The controversy and contestations facing trans health over the years have shaped the treatment protocol and continue to impact the day to day experiences of clinicians and clients. In this complex context of diversely opinionated stakeholders, what might good care look like?
Paper long abstract:
While any field of healthcare has arguably changed and developed drastically since 1990, transgender-specific healthcare (the provision of gender-affirming treatments like hormones and surgery), in some respects has experienced an especially profound shift. This shift is not only within the medical care provided, but also in the processes that precede access to that medical care.
Trans health is a branch of medicine that has faced rampant contestation since its inception. A great deal of this contestation is about the path to accessing treatment, where gender clinics often mandate a mental health assessment that has been criticised for being pathologising and creating unnecessary barriers to care. Additionally, it is a field of healthcare that disrupts expected regulations and categorisations of western healthcare. This paper will thus explore how these contestations have shaped trans health over the years including how it impacts the day-to-day encounters between clinicians and their clients.
While the research for this paper took place at Monash Health Gender Clinic in Melbourne Australia, gender clinics in Europe as much as Australia, grapple with the same dilemma of providing care that abides by a heavily criticised system. A polarisation exists between the healthcare system and trans activists/advocates on what constitutes good care. As an underrepresented topic in medical anthropology, this paper seeks to explore the important question of "What is good care?" in the above described context, plus the risks of providing treatment, clinician liability and non-maleficence, and the drive, on all fronts, to improve the care provided.
Paper short abstract:
Ethnographic research conducted with queer women and health professionals in Cape Town highlights the lack of focus on sexual health needs of queer women. This research emphasizes the importance of sexual and gender diversity in health services and the need for further training of providers.
Paper long abstract:
This paper draws upon ethnographic research conducted with queer women and health professionals about sexual health experiences in Cape Town, which was completed as part of a masters thesis in Visual and Media Anthropology at FU Berlin. Findings reveal a lack of focus on the health needs of queer women in both medical training and research, which often means that providers do not have adequate information and resources for their patients. The HIV discourse in South Africa has a strong influence on widespread understandings of sex and risk. Although there is little evidence, the prevalent notion that sex between women does not create risk for HIV has further marginalized the sexual health needs of queer women. This marginalization has resulted in a lack of discussion about queer women's sexual health and leads to issues around visibility and intelligibility within sexual health care spaces. In addition to facing erasure, participants express struggles of finding sexual health care providers who understand queer identities and diverse sexual lives. Discussing this challenge, one participant states, "my life is not orthodox, and my sexual life is definitely not orthodox. I need someone who is not going to judge these things." Findings from this research indicate that challenging the heteronormativity inherent in health care settings requires a multi-levelled approach. I discuss how health care providers need further training around sexual and gender diversity and the importance of opening a dialogue around how provider bias can impact a patient's sense of safety in health services.
Paper short abstract:
The study explores how Traditional Chinese Medicine has been changed to align with the UK context since the 1990s, while keeps its features to serve the Chinese immigrants. The results of the study reflects the impact of globalisation in medical fileds.
Paper long abstract:
With immigration from China increasing from the 1990s, Traditional Chinese Medicine (TCM) has been introduced by the Chinese to many other countries. In particular, the early colonial relationship between Britain and Hong Kong has established a channel for cultural and material exchange, which founded the basis for the promotion of TCM in the UK. Originating from family businesses in early Chinese communities, TCM has found a foothold in local UK society. TCM is now providing wider healthcare options to people beyond NHS services. On the contrary, TCM has become increasingly in demand by Chinese immigrants. TCM clinics offer multiple healthcare services to people who speak very poor English, do not have access to NHS, or consider TCM as part of their traditional customs and national identity. The aim of this research is to understand the changes in TCM practice that have been made in order to align it with the UK context, and its relationship with Chinese immigrants to the UK from the 1990s onwards.
The study conducted a literature review on the history of Chinese immigration to the UK. This has been used to provide a way to analyse the results, which comprises semi-structured interviews with TCM practitioners, staff of TCM clinics, and Chinese immigrants receiving TCM treatment. The study also included ethnographic observation for four months in the selected TCM clinic. The results of study will aid understanding of the transformation of TCM within modern UK society, and will help to improve universal health coverage for Chinese immigrants.
Paper short abstract:
MDR-TB patient's experience and treatment adherence between DOT in Kathmandu and VOT in London. How technology shapes treatment experience and meaning, in a context of vertical health policy that questions trust between patients and healthcare professionals.
Paper long abstract:
Multi-Drug Resistant Tuberculosis (MDR-TB) requires twenty months or longer treatment, often filled with side effects so painful that patients sometimes suspend their treatment. Directly-Observed Treatment (DOT) is the backbone of the World Health Organisation (WHO) policy implemented since the 1990s in the effort to ensure tuberculosis treatment worldwide. The policy suggests that patients have to be observed taking their medications, which in many countries, like Nepal, entails that patients are required to visit a healthcare centre daily to take their medications in front a healthcare professional. A routine which MDR-TB patients struggle to follow due to the painful side effects those same medications give them, other than the obvious inconvenience in time and costs. Recently, a digital health intervention called Video Observed Treatment (VOT) has been developed to support a more patient-centred approach to DOTS, allowing patients to record videos of themselves online taking medications, without having to go to a healthcare facility. This technology, which is available now only for a limited number of patients in contexts such as London, gives the opportunity to patients to manage their time and side effects by splitting the daily dosage of medication and taking them in the most convenient time and place.
Reflecting on two ethnographic fieldwork, in Kathmandu (Nepal) and London (UK), this proposal explores MDR-TB treatment adherence in the 21st century, and it questions the opportunity of technology and how patients experience it in a context, like DOTS, where trust is put to a test, if not lacking.