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This paper examines how HIV policies are sustained amid the “destruction of the State” in Argentina. Drawing on ethnography, it follows state agents, health workers, and activists’ reliance on discretion, relations, and creativity to preserve HIV care and prevention despite institutional erosion.

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This paper examines how HIV-related prevention and care public policies are sustained in Argentina under Javier Milei’s administration whose political project explicitly promotes the “destruction of the State”, dismantling public health structures and undermining institutions that historically guaranteed access to health and other social rights. Within the National HIV Directorate, drastic budget cuts, the elimination of key programmatic areas, and the dismissal of a large proportion of professional staff, have weakened support and coordination of nationwide HIV-related interventions.

The paper explores how, amid shrinking institutional capacity, State agents, healthcare professionals, and activists continue to make HIV prevention and care possible. Drawing on ethnographic research, it brings together participant observation and interviews conducted in a long standing LGBTQ+ civil society organization (forced to close due to defunding) alongside in-depth interviews with actors positioned across municipal, national, and international health arenas, including program directors and consultants from global health agencies.

In a political environment marked by sexually conservative, anti-human rights and anti-social rights politics, certain public health interventions (including HIV/STI prevention and healthcare) face heightened scrutiny or imminent shutdown. To protect policies formerly legitimized through a human-rights framework, actors now rely on discretion and partial visibility: renaming interventions, limiting public communication or downplaying the scope of certain actions, aim to keep them “under the radar”. Approaching policy in-the-making, this paper examines situated practices involving creativity, improvisation, ethical commitment, and forms of mutual recognition rooted in long-standing relationships. In this context, affect, friendship, trust, and credibility emerge as central in sustaining HIV-related policies.

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This paper explores care as a temporal practice, showing how Emergency Care and Recovery Centres (ECRCs) in South India respond to psychosocial distress rooted in structural vulnerability, balancing rapid routines, discharge pressures, and needs that predate institutional care.

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Emergency Care and Recovery Centres (ECRCs) in South India respond to acute psychosocial crisis among people experiencing homelessness, engaged with psychiatric care. Organised as short-term inpatient interventions, they operate through a bounded temporal logic in which crisis is identified, stabilised, and resolved within a limited clinical window. They are also mandated to facilitate access to social entitlements, embedding care within longer bureaucratic processes.

Ethnographic engagement across three centres suggests distress and care rarely unfold along a single temporality. Chronicity here is not framed as a psychiatric condition but as enduring psychosocial distress shaped by structural vulnerability. Drawing on fieldwork, we explore how care is practised amid coexisting temporal demands. Clinical work moves rapidly through medication titration, observation, and measurable improvement, while bureaucratic processes follow an uneven tempo shaped by documentation and thresholds. Alongside these, care is organised around sustained attentiveness to bodily and psychosocial needs: turning bed positions, feeding, unpredictable demands for presence or reassurance. This work is structured by regular intervals yet continually disrupted by psychosocial distress, producing a tempo that is neither cyclical nor episodic.

Rather than treating these temporalities as coherent or hierarchical, the paper explores how care emerges within them. Interruptions, delays, and waiting are central to sustaining life in the ECRCs. These moments rarely enter records or outcome metrics, yet they shape who remains in care, who is discharged, and who becomes suspended between institutional categories. The paper asks how care unfolds when chronic distress must be made legible through time-bound forms of clinical knowledge.

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This paper examines mental health claims-making as key to shaping mental distress and chronicity in fractured health systems and social worlds. Based on ethnography in Chile, it shows how claims become sites where care, social recognition, and belonging are negotiated and continually conditional.

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This paper examines claims-making as a key process shaping experiences of mental distress, chronicity, and care within fractured health systems and social worlds. It draws on ethnographic research from my doctoral fieldwork in Chile (2018–2019) on mental health claims within occupational health insurance and state regulatory agencies, alongside ongoing analytical engagement with psychiatric deinstitutionalisation and community-based care.

Rather than treating claims as a formal system, the paper approaches applications, certifications, and related medical and administrative practices as situated and relational forms of engagement embedded in Chile’s neoliberal health system, a fractured welfare landscape, and ongoing sociopolitical transformations that reshape moral expectations of care and responsibility. In this context, trajectories of care and recognition are dispersed and repeatedly interrupted across poorly coordinated public and private medical and administrative infrastructures. As cases move across institutions, people encounter delay, uncertainty, and persistent suspicion regarding the legitimacy of their claims.

Drawing on critical medical anthropology and the anthropology of the state and citizenship, the paper argues that circuits of mental health claims-making constitute a central site where not only care and welfare resources are obtained, but where people experiencing mental distress, health professionals, and state agents negotiate and contest social recognition and belonging, rendering them continually conditional. Claims-making thus emerges as a site where belonging is chronically tested rather than secured, revealing how fractured health systems and broader social polarisation reconfigure whose suffering matters and who is deemed worthy of social inclusion and care.

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Across psychosis care in Uganda and sickle cell care in Liberia, this paper traces how chronic care is reshaped by uncertainty and structural abandonment, and explores how families and communities craft forms of ethical, improvisational and relational care when treatment cannot be sustained.

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Drawing on long-term ethnographic engagement with South Sudanese refugees living with psychosis in Palabek refugee settlement, northern Uganda (2019–2020), and additional fieldwork with people living with sickle cell disease in Liberia (2025), this paper examines how chronic care becomes improvisational, relational, and ethically reparative when treatment itself is structurally difficult to sustain.

I take medications - and particularly their effects and the sociopolitical structure that govern their efficacy and availability - as the start of my analysis: antipsychotics within a humanitarian emergency in Palabek, and hydroxyurea in Liberia. In both settings, treatment is rendered unsustainable, but through different mechanisms. In Palabek, medication produces hunger, weakness, and exhaustion amid profound food insecurity, while mobility becomes necessary for survival: refugees are often forced to return to South Sudan to work, exposing themselves to insecurity and the risks of interrupted care. In Liberia, hydroxyurea is often unaffordable and intermittently available, making therapeutic continuity dependent on strained diaspora networks and everyday clinical ethics in Liberia, including professionals who donate their own blood during acute pain crises.

Across these cases, I explore how care is relationally performed when chronic conditions are lived through recurring interruptions and uncertainty, and the dilemmas of health, morality, and personhood emerging when treatment cannot be reliably maintained. I show how families and communities craft relational forms of care that exceed biomedical adherence and foreground active participation in forms of suffering, and propose to understand this ethical labour as an effort to remain 'moral persons' in the face of structural abandonment.

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This paper examines the changing professional identity of medical doctors in India amid growing polarisation and rising violence in the healthcare sector. It interrogates the erosion of the historic social/moral contract between the professional and the society.

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The medical doctor has long embodied the moral ideal of professional modernity in India, commanding social respect and reverence. In recent decades, however, hospital spaces have increasingly become sites of tension, marked by rising instances of verbal and physical violence against practitioners. According to the Indian Medical Association (IMA), nearly 75% of doctors have experienced some form of violence during their professional lives. Younger practitioners now recognise that medicine no longer guarantees a “quality life,” and themselves caution others against entering a vocation they once idealised. India’s doctor–patient ratio stands at approximately 1:811, surpassing the WHO’s recommended standard. Yet this apparent numerical adequacy coexists with stark rural–urban disparities and the absence of institutional guarantees of safety, dignity, or stability in everyday medical work. Against this backdrop, this paper asks what it means—socially, affectively, and materially—to be a doctor in contemporary India amid changing political regimes and precarious healthcare environments. This dissonance between symbolic reverence and lived precarity signals a significant transformation in the profession.

Drawing on ethnographic fieldwork in a government teaching hospital in South India, supplemented by archival and discourse analysis, the paper argues that the historic social/moral contract between doctors and society has become strained. It examines the rise of “defensive medicine,” wherein clinical practices and pedagogies are shaped by fear of violence, litigation, and mistrust. By tracing shifts in how doctors perceive their work, the paper situates these changes within broader transformations in state imaginaries of development, public expectations of care, and everyday experiences of medical practice.

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The paper examines how transformations of political values both shape and are reflected in health reform policies in post-war Sierra Leone. It traces policy trajectories and everyday care to show how citizenship, gender, and justice are negotiated within a shifting global and local political order.

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The paper presents the first results of an ongoing ethnographic research project that examines the relationship between political values, governance patterns, and health system reform in post-war Sierra Leone, with a particular focus on recent efforts to introduce universal health coverage (UHC) alongside the national social health insurance scheme (SLESHI). Although both initiatives have featured prominently in policy documents since 2018, UHC in Sierra Leone remains largely aspirational.

The paper investigates how shifting local and global political agendas shape health reforms, and how these reforms (or their spectral manifestations) are experienced by those most affected—especially low-income women and girls whose livelihoods depend on the informal economy. Tracing policy trajectories from central institutions to frontline health facilities, the research brings together the perspectives of policymakers, health workers, and service users: women of modest income.

By situating everyday encounters with care within broader political processes, the project explores how health becomes a key arena in which questions of responsibility, citizenship, and social justice are negotiated. In doing so, it also analyses how changes in health governance reflect the reconfiguration of state–society relations from post-war democracy-building under massive international intervention to the current moment of global power shifts and democratic crisis.

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This paper examines how limited access to high-cost SMA medications in Chile fragments care infrastructures and citizenship, showing how judicialisation reshapes state relations, health coverage inequalities, and experiences of suffering.

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This article examines how the introduction and limited accessibility of medications for Spinal Muscular Atrophy (SMA) in Chile reconfigure infrastructures of care, trajectories of chronicity, and the ways patients and families understand their right to health, citizenship, and life itself. In a context of high inequality and sociopolitical polarization around health, these treatments —approved by the Chilean Institute of Public Health but without state coverage— reveal a fragmented state that authorises biomedical technologies without guaranteeing the material and institutional conditions necessary for access, thereby deepening the gap between therapeutic promise and everyday experiences of care.

Drawing on fourteen months of fieldwork and qualitative analysis of legislative, institutional, civil society, and biomedical research documents, we argue that the emergence of these medications in the absence of a stable infrastructure of access produces new forms of vulnerability and agency. More specifically, we propose that the judicialization of access to high-cost medications generates fragmentation at multiple levels: within relations between branches of the state, as judicial intervention reshapes decision-making over access to treatment; within the health system, by producing significant differences in access according to the type of health coverage; and within experiences of suffering, embedded in the life trajectories of people living with SMA and their families.

This triple fragmentation shapes the everyday lives of patients and caregivers, redefining relations between citizenship and the state and turning life into a moral and political tool through which access to high-cost medications is contested and the state is addressed as a guarantor of rights.

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Ethnography among migrant and South African women shows how fractured healthcare systems, discrimination and chronic insecurity obstruct contraception, abortion and mental health care, producing layered forms of reproductive vulnerability.

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This paper examines how sociopolitical and institutional polarisation fractures healthcare infrastructures and reshapes reproductive care trajectories in South Africa. Drawing on ethnographic research in Lorentzville and Mqanduli, the analysis shows how women encounter chronic barriers in accessing contraception, abortion services, antenatal care, and mental health support. Clinic gatekeeping, documentation requirements, erratic service availability, and moral judgments create unstable therapeutic pathways that exacerbate long-term reproductive vulnerability. For undocumented migrant women, fear of arrest or deportation deepens this fracture, deterring engagement with formal healthcare and reinforcing parallel informal routes to care. These dynamics are intensified by broader structural conditions, including food insecurity, insecure housing, and intimate partner violence, making reproductive care an ongoing negotiation of risk, worthiness, and belonging. Engaging critical medical anthropology and structural vulnerability, the paper illustrates how chronicity in this context is produced not by disease alone but by enduring political, bureaucratic, and moral fractures that shape who receives care, how, and under what conditions. Women respond through collective strategies, escorting one another to clinics, circulating advice, and mobilising informal networks that reveal reparative practices emerging within scarcity. By foregrounding lived experience from a Global South perspective, the paper offers insight into how healthcare systems become sites of exclusion, struggle, and creative reorganisation in a polarised world.

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This paper examines female community health workers in Eastern DR Congo as frontline infrastructures of chronic care. It explores how care is negotiated amid conflict, political neglect, and global health regimes in a context of chronic crisis.

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This paper examines the moral and material entanglements of female Community Health Workers (CHWs) in South Kivu, Eastern DR Congo, a region shaped by protracted armed conflict, political neglect, and fragmented health infrastructures. Drawing on ethnographic fieldwork, it approaches care not only as a response to illness but as a chronically sustained practice within polarised and unstable health systems.

In contexts where state healthcare provision is limited and humanitarian interventions are intermittent, CHWs often function as key infrastructures of long-term and chronic care, mediating between global health regimes, local moral expectations, and everyday survival. While officially positioned as volunteers, they assume enduring responsibilities for maternal health, malaria prevention, and community surveillance, navigating affective relations marked by trust, fear, frustration, and moral obligation.

Engaging critical perspectives on care, chronicity, and moral economies (Fassin 2007; Fraser 2016), and building on the concept of chronic crisis (Vigh 2008), the paper argues that care itself becomes a site where sociopolitical polarisation is lived and negotiated. CHWs inhabit the fractures between humanitarian ideals and material scarcity, between notions of citizenship and abandonment, and between institutional mandates and community demands.

By foregrounding the everyday labour of CHWs, the paper contributes to anthropological debates on how chronic care trajectories are reconfigured in polarised settings of the Global South, highlighting both the limits of care and the solidaristic practices that emerge amid enduring instability.

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This paper argues that urban health-seeking is shaped by moral worlds: public care as “deserved" as the durable infrastructure of survival; private care as an aspirational benchmark. Institutional identities are sensed through classed expectations; generics as medicine of the poor.

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Based on three years of ongoing work in low-income urban neighbourhoods across three Indian states, this paper examines how chronicity is routed through a fractured landscape and how the urban poor inhabit public and private healthcare as distinct moral worlds rather than as a single health system. Policy and popular accounts often explain care-seeking through a cost–efficiency rationale: private providers are preferred for acute illness because they reduce waiting and enable a rapid return to wage labour, while public facilities are used for chronic conditions because they are “affordable” over time. We argue that this account may misrecognise the logics that organise everyday healthcare pathways and the valuations through which people make long-term illness livable. Chronicity is endured and coped with from within distinct moral worlds of healthcare: a need that must be sustained within classed constraints. Public primary care is not simply the cheaper option but is perceived as what one “deserves” as the durable infrastructure of survival. Private care, conversely, functions as an aspirational benchmark characterised by branded pharmaceuticals, attentive treatment, and the promise of efficacy, yet also as a reminder of poverty. Low-cost private clinics, in turn, may be read as proximate to the state, sometimes even mistaken for government facilities, showing institutional identities are sensed through classed expectations. Within this landscape, what policy and research name “fragmentation” is not experienced or perceived by the poor as the breakdown of an integrated plural health system but as a set of discrete service providers without shared pathways.

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Sociopolitical polarization in Chile fragments trans* healthcare. Trans* identity is framed as a chronic condition to access specific healthcare, public debates contest trans* healthcare and identity, and consequently, care trajectories are affected and reinvented.

Paper long abstract

We critically examine how sociopolitical polarization surrounding trans* healthcare in Chile affects and fragments emerging care institutions and protocols, and contributes to the emergence of new care strategies among trans* community.

We argue that trans* identity is framed as a chronic condition by healthcare institutions operating within a contentious and constantly disputed sociopolitical environment. Indeed, access to healthcare for the trans* community relies on the declaration of an identity considered problematic by society, which labels it with the biomedical diagnosis of "gender dysphoria".

To map the controversial sociopolitical context of public disagreements, we analyze how experts make use of the public sphere to contest the scope of government programs, social rights and even the ontological status of trans* people. As an example, we discuss the effect of this public debate on the continuity of the Chilean Government’s Gender Identity Support Program for trans* youth (PAIG, for its name in Spanish). Ethnographic findings regarding the first year of the PAIG’s implementation (2024) allow us to illustrate how shifting policies and the persistent dispute over full citizenship have a direct and long-term impact on trans* people’s care trajectories, which are situated within the sociopolitical environment of the Global South.

As part of an ongoing research project, we propose further ethnography to discuss how the volatility of sociopolitical environments and shifts in policy affect -and are contested by- the trans* people’s strategies to access, manage, and produce their own care.

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This paper examines menopausal care in India’s health system as a shift from reproductive citizenship to chronic neglect. Based on 18 months of ethnographic fieldwork in rural North India, it shows how polarisation renders menopausal suffering invisible and pushes women toward informal care.

Paper long abstract

This paper examines how sociopolitical polarisation within India’s public health system reshapes care trajectories for midlife women experiencing menopause, producing forms of chronic neglect once reproductive citizenship ends. Drawing on eighteen months of ethnographic fieldwork conducted between 2022 and 2024 in rural North India, the study combines in-depth interviews with peri- and post-menopausal women, participant observation in primary health centres, and conversations with frontline health workers and physicians. It conceptualises menopause not as discrete biological transition but as a form of long-term, embodied chronicity that remains largely invisible within existing health infrastructures.

I argue that menopausal care is structured by competing imaginaries of health and citizenship. Biomedical frameworks that prioritise reproductive outcomes and risk-based interventions coexist with, and often override, women’s accounts of psychological distress, bodily discomfort, and social disruption. As women move beyond reproductive years, they encounter fragmented therapeutic pathways marked by dismissal, misdiagnosis, and moral judgement, revealing polarisation between medicalisation and institutional silence. These dynamics deepen epistemic, ethical, and political fractures within public healthcare, rendering menopausal suffering illegible in policy and practice.

Situating menopause within broader processes of neoliberal restructuring and gendered ageing, the paper shows how chronic care infrastructures in Global South systematically marginalise post-reproductive women. At same time, it highlights everyday practices of negotiation through households, informal networks, and local moral economies that emerge in response to institutional absence. By foregrounding menopause as a site where chronicity, care, and citizenship intersect, this paper contributes ethnographic insight into how fractured health systems are lived, contested, and reimagined.

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This paper examines how intersecting generational, territorial, and health system polarization fragments care infrastructures for young women with breast cancer in Chile, generating both structural exclusions and solidaristic resistance practices.

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This paper examines how sociopolitical polarization fragments care infrastructures for young women with breast cancer in Chile, focusing on intersecting generational, territorial, and health system exclusions within a deeply segmented public/private structure. Drawing on interviews with women diagnosed before age 40 and health professionals in urban and rural contexts of the Metropolitan Region, we analyze how this polarization operates across multiple dimensions: (1) generational polarization, where age-based protocols dismiss young women's bodily knowledge, producing diagnostic delays and advanced-stage diagnoses; (2) territorial polarization, where rural women face compounded exclusions through distance, resource scarcity, and metropolitan concentration of oncological infrastructure; and (3) public/private polarization, embodying class-based inequalities and structural extraction through mechanisms that transfer resources from the overstretched public system to private providers. From a Global South epistemological standpoint, we theorize these fractures as expressions of epistemic, territorial, and economic injustice rooted in neoliberal restructuring. Yet amid these structural violences, we document emergent solidaristic practices: community-based care webs and collective navigation strategies. These reparative practices from below reveal how more cohesive, democratic healthcare imaginaries are enacted daily by those systematically excluded, offering critical insights into decolonial health futures.

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Despite being regarded as the 'gift of life' organ donation unfolds in a polarised terrain influenced by apartheid-era racialised landscapes, institutional mistrust and unequal access, where hierarchies of bodily worth persist and western models clash with local moral understandings.

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Despite organ donation and transplantation being regarded as a ‘gift of life’, power relations and exclusions of a racialised environment has affected this particular medical intervention in South Africa. This article offers a critical anthropological analysis of organ donation from apartheid-era structures to post-apartheid understandings of the low donor rates. Drawing on understandings of Foucauldian biopower, debates on personhood and African philosophies of Ubuntu, the paper argues that organ donation in South Africa, cannot simply be understood as a lifesaving medical progression but as a site of unequal power relations and disparities.

To show how these treatments are occurring in a fractured healthcare system where socially and historically produced hierarchies of bodily worth persist, this paper investigates the history of persistent low donor rates. These disparities give rise to contemporary expressions of ‘differential bio-value’ or a hierarchical assessment of the body’s worth.

The prevailing interpretations which argue that low consent rates are ‘cultural resistance’ are challenged in this paper. Rather, the hesitation and rejection grounded with the historical experiences of institutional distrust, which have been influenced by the racialised environments of the apartheid-era. This demonstrates how Western biomedical understandings clash with local moral worlds by discussing how varying conceptualisations of personhood, autonomy and bodily integrity frequently conflict with ideologies such as Ubuntu. Therefore, organ donation occurs in a polarised environment where the body is a contested site where historical injustices, moral dilemmas and institutional structural fractures can be resolved.

Keywords: organ donation, South Africa, personhood, anthropology, biopower, body