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Short abstract:

I construct a case study of MSF’s work in post-rape medical care to examine how medical-legal documentation of injury is potentially transforming the crisis logics of humanitarian response to include new, if unsettled, expectations that aid workers will provide legally admissible evidence of harm.

Long abstract:

In the 1990s transnational feminist social movements called for humanitarian aid organizations to provide specialized post-rape medical care to survivors of sexual violence during armed conflict and complex humanitarian emergencies. In response, the World Health Organization and United Nations High Commissioner for Refugees issued their first clinical guidelines on post-rape medical care that adapt medical forensic exams for sexual assault (commonly known as “rape kits”) for use with refugees. Importantly, these guidelines recommended medical documentation of injuries and issuance of medical certificates to survivors of sexual violence in order to facilitate prosecution in criminal courts. This new standard of care fundamentally transformed what constituted a human right to health in these settings. However, implementation has been contested. Médecins Sans Frontières (MSF or Doctors Without Borders) is one of the most prominent medical humanitarian aid organizations to routinely issue medical certificates that document violations of international humanitarian law. Its work in this area spans nearly three decades. Drawing on content analysis of published literature and interviews with experts and activists, I construct an historical case study of MSF’s work in post-rape medical care, the establishment of its Legal Department in the 1990s, and its directives to issue medical certificates to patients. Bringing together approaches in medical sociology, sociolegal studies, gender and sexuality studies, and science and technology studies (STS), I examine how medical-legal documentation of injury is potentially transforming the crisis logics of humanitarian response to include new, if unsettled, expectations that aid workers will provide legally admissible evidence of harm.

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Short abstract:

Repair often falls from narratives of the aftermaths of gun violence. This work focuses on trajectories of repair after gunshot injury and paralysis by following survivors in physical therapy, bullet removal, and disability to address how the healing body can reframe the politics gun violence.

Long abstract:

In the US's gun violence epidemic, most people survive being shot despite a journalistic fixation on causalities. Across various US cities -- many of them characterized by hypersegregation, poverty, and a flood of cheap unregistered guns -- individuals often expect to be shot, even multiple times during their lives. Yet paralysis (para- and quadriplegia) rarely figure in that trajectory. This paper presents on ethnographic research for those whose shooting results in disabling spinal cord injuries. It follows predominantly young black men, as they negotiate crucial days of physical therapy to regain as much mobility as possible. It asks: how do survivors tend to lingering wounds and the realities of disability and permanent mobilization? And, how does the body remember gun violence when, for instance, so many survivors have irretrievable bullets lodged in their bodies? It contrasts survivors’ constructions of their bodies and wounds with clinicians who, often through a racialized lens, see bodies deserving of their injuries through presumed gang activity. What both counts as repair, and its quality, depends on these constructions.

Apart from grief, repair often falls from narratives of the aftermaths of gun violence. Attending to repair expands understandings of the tolls of guns in America from a perspective of episodic violence (e.g., mass shootings) and death counts to center the slow violence of ongoing wound cultures. In terms of activism, how might attention to the long repair of gun violence develop new ways to conceptualize responses that move beyond the usual, ossified politics of guns?

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Short abstract:

This paper examines the production of (non)bodily injuries and the doing of "trauma work" amidst the toxic drug supply crisis. I critique the limits of thinking with "repair" in the context of the war on drugs, turning instead to the technoscientific activisms and tools of harm reductionists.

Long abstract:

Expanding on critical race, queer, and feminist engagements with trauma (Burstow, 2003; Crimp, 2002; Cvetkovich, 2003; Jaleel, 2021; Stevens, 2016), this paper attends to the blurring of "injury" and "repair" in the context of the toxic drug supply crisis and explores how mental and bodily injuries are made visible and socially meaningful in the era of overdose. This paper firstly examines how injury and repair have been conceptualised in trauma-informed policy and practice, tracing a modern genealogy of “trauma-informed care” in the U.S., from the co-emergence of trauma and addiction sciences in the 1970s to contemporary figurations of injury/repair in therapeutic frameworks. Drawing on in-depth interviews and ethnographic fieldwork in Greater Los Angeles, California, this paper then discusses how front-line harm reduction advocates and activists, peer workers, and people who use drugs sense, engage with and endure traumatic affect in their everyday organising and outreach work. Re-theorising “trauma work” as relational, I show how mental and psychic injuries, including vicarious trauma, burnout, and chronic loss, operate as diffusive categories and emerge from bureaucratic negotiations with county and state bodies that resource clinical repair, such as occupational health boards. Taking into consideration what Jaleel (2021) calls the “impossibility of repair,” this paper further suggests that technoscientific interventions like naloxone can engender new affective and embodied cultures of healing (p.47). I argue that ideas of re-animation (Campbell, 2020), made possible by such technologies, present alternatives to repair, instead demanding the collective liberation of the social body from the war on drugs.

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Short abstract:

Taking the case of a patient with traumatic brain injury, I consider the limits of narrative as a genre of repair. Instead, I unpack a non-textual, relational archive of injury, charting the processes that sustain care and recognition in conditions of extreme rupture.

Long abstract:

Taking the case of a young woman ("Nellie") afflicted by brain injury after a car accident, I reflect on the limitations of narrative genres, as demarcated by the boundaries of language and discursive memory, instead highlighting relational practices and forms of recognition that attend to “the pain, disruption, and alienation of illness” (Woolf 1925). At the time I met her, Nellie remembered very little of the accident and her life prior. As she slowly re-learned basic skills, such as how to brush her teeth and get dressed in the morning, she also asked few questions about the events that had transpired, demonstrating a seemingly paradoxical indifference in light of expectations that subjects of illness must know and understand their affliction. Building on critiques of illness narratives (Mattingly and Garo 2000, Buchbinder 2010), I attempt to re-open overdetermined modes of individual testimony by attending to the relational methods through which Nellie and her caregivers interact, share, love, explore, and sometimes remain silent. I attempt to document these activities as an alternative archive of illness that nevertheless indexes suffering and its responses while charting paths toward repair. Taking narrativizing as an ability rather than a precondition of understanding, ethical contract, and care, I attempt to learn from Nellie and her family to understand what kinds of recognition can begin to repair extreme rupture in the context of traumatic injury.

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Short abstract:

Periprosthetic femoral fractures are traumatic injuries that complicate concepts of injury and repair. In this presentation, we explore the complexities around standardising care for a heterogeneous condition in complex patients, and the trade-offs involved in centralising or decentralising care.

Long abstract:

Surgery for periprosthetic femoral fractures (PPFF) is a developing sub-specialism within orthopaedic trauma care. PPFFs are major injuries which occur in people who have previously had a hip replacement or hip fracture surgery, and the bone around the prosthesis breaks. Their incidence has increased as joint replacements have become more common, and numbers will escalate further due to an ageing and increasingly frail population. Our study aims to understand the best care for patients with PPFF by exploring variations across services in England. In this enquiry, standardisation is implicitly taken as one of the key goals.

We suggest that ongoing efforts to transform PPFF services might be understood as an example of multiple frictions, which makes us question the normalisation of standardisation in healthcare service design and delivery. Firstly, PPFFs are complex injuries in complex patients; variabilities in care pathways, from injury to surgery to recovery, mean that PPFFs are heterogeneous. Consequently, variations between patients and complex care needs mean that PPFF care is highly personalised. Finally, patient outcomes are thought to be better at ‘high volume’ centres, thus driving the centralisation of surgical skills and multidisciplinary expertise. However, the concentration of patients with complex injuries and multimorbidity at expert centres may not serve PPFF patients well as it puts distance between them and their support networks, delays surgery and threatens to overwhelm the centres. In this presentation, we explore the implications of these frictions for the making – or unmaking – of PPFF care as a necessary sub-specialism.

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Short abstract:

Amidst the "Israel-Hamas" war outbreak, smartphone documentation raised questions about the adaptive nature of this behavior. Through Media Witnessing and phenomenology, Smartphone documentation is suggested as a survival mechanism, protecting the body-mind from adversity during a traumatic event.

Long abstract:

Amidst the "Israel-Hamas" war outbreak on November 7, 2023, thousands of individuals utilized mobile phones to document and share their experiences of fleeing, hiding, and facing life-threatening situations on social media, prompting speculation about their motivations, as well as safety concerns.

Traditionally, trauma literature examines physical responses like "fight-flight-freeze" as survival mechanisms, emphasizing the organism's focus and attention on overcoming threats. While mobile phone use is often perceived as hazardous in attention-requiring situations such as driving, smartphone documentation in traumatic events of the "Israel-Hamas" war outbreak, introduces a novel survival response not thoroughly explored in psychological and media literature, raising questions about its adaptive value in the digital age.

Through the lens of Media Witnessing, smartphone technology is proposed to have become an intrinsic part of the traumatic experience and terminology. Integrated with phenomenological methodology, it is suggested that human survival during crises involves utilizing physical, emotional, and technological resources. Thus, mobile phone documentation, while seemingly ineffective to outsiders, may offer a survival advantage in the face of adversity, as a means to protect both body and mind from trauma, in the smartphone era.

This presentation will feature examples illustrating how smartphones act as extensions of injured or fleeing bodies, compensating for physical limitations, and as tools for sense-making and empowerment. However, conventional smartphone use for direct calls for help will not be explored in this context.

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Short abstract:

This study investigates the emergence of traumatic brain injury (TBI) as a scientific, clinical, and social problem through comparative sociological analysis of three populations: athletes, veterans, and domestic violence survivors.

Long abstract:

This study investigates the emergence of traumatic brain injury (TBI) as a scientific, clinical, and social problem through comparative sociological analysis of three populations: athletes, veterans, and domestic violence survivors. While TBI has a rich clinical and scientific history, its visibility as a public health problem is more recent. Our research tracks TBI’s emergence across the three populations. We are interested in the convergence of ideas about TBI as a work object for scientists, clinicians, practitioners, and affected populations. Specifically, when and how did TBI come to be understood as a scientific problem within each of these communities, and with what impacts? How has TBI been made visible through publications, collaborations, media coverage, and social movements? How do each of these communities understand the problem of TBI?

A robust STS tradition investigates the conditions under which research questions, methods, and broader lines of inquiry are created, maintained, contested, and sunset. Certain key concepts, such as paradigms, epistemes, boundary objects, and sociotechnical imaginaries, have guided researchers for generations. Our project intervenes in these debates through multi-sited ethnography and network analysis of a novel convergence between research communities. We ask: what social and intellectual processes spurred scientists in the fields of military medicine, sports medicine, and domestic violence/intimate partner violence to coalesce around shared interests in TBI? For more than two decades, doctors, military officials, sports medicine professionals, and researchers in the DV/IPV community developed lines of inquiry linking their subject to brains and brain health. How have these come together?