Paper short abstract:

In the context of abortion, Latour’s (2010) ‘Factish’ is engaged to appreciate the relationship between facts and belief. Beyond the mundanity of paper and text, a pro-life pamphlet is shown to acquire agency beyond the collective work through which it emerged. The human-pamphlet is born.

Paper long abstract:

“We must, with our words, also give the baby a face and make her a part of our human family” (Gans Turner and Spaulding Balch, n.d., p. 9).

The quote by Gans Turner and Spaulding Balch (n.d.) is from a ‘package’ of text for ‘pro-life’ actors on the language to use when engaged in debate about abortion. Implicit in this quote is the active fabrication of a reality beyond the mundanity of paper and text.

Drawing on ethnographic research conducted at an abortion provider in Aotearoa New Zealand, we step outside to the gate that borders the setting. Sometimes there are protesters at the gate, chanting, praying, and holding out pamphlets, but not today. The pamphlets are on the ground, woven into the wire lattice of the gate, and crammed in the spaces between the fence posts. In the absence of the protestors who seek to disrupt the work of abortion provision, it is the pamphlet itself does the ‘talking’.

Latour’s (2010) concept of ‘factish’ is taken up as a strategy to attend to pro-life textual devices. The term ‘factish’ is a way of thinking about the relationship between facts and beliefs and how nothing is distinct from its fabrication. Nonetheless, knowing a fact is constructed, does not make it less real or displace its power and transformative effects. This account attends to the process of fabrication and the way mundane objects like a pamphlet can acquire certain qualities or agency beyond the collective work through which they emerged.

Paper short abstract:

Science and Technology Studies have problematised scholarly engagement for long. This paper explores what scholarly practice could learn from preventive care professionals in the NL fostering 'everyday courage as a collective practice' by re-telling struggles experienced in their everyday practice.

Paper long abstract:

Science and Technology Studies have problematised scholarly engagement for long. Feminist inspired STS scholarship insisted thereby on not forgetting about ‘matters of care’ (Puig de la Bellacasa 2015). Drawing on such scholarship, this paper argues that attention to the mundane as it happens in a ‘here-and-now’, deserves utmost attention. This allows us to explore, what Ferreira da Silva (2015) refers to as, an ‘excess of possibilities’ always already there, of how to live in difference together. Drawing on ethnographic research on a public preventive care approach in the Netherlands 'Not Pregnant Now' shows that professionals seems to establish and keep in ‘personal contact/touch’ and resist the ‘distancing’ and ‘abstracting from everyday life’ that biomedicalization/scientification and professionalisation of public health care and social work seem to require. How do they hold on to the complexities, struggles of everyday life and thereby transform ‘being vulnerable’ into an actual strength? How do they keep on doing so, even while scaling up as a programme and being included in broader preventive public health strategies on a national level by the Ministry of Health through the very success(rate) the approach has and can scientifically validate? This paper argues that it requires ‘everyday courage as a collective practice’ to do so. Listening, telling and re-telling the struggles encountered in the everyday seems to be a method to foster, share and cultivate such everyday courage collectively. This paper aims to explore what scholarly practice could learn from those preventive care professionals that ‘stay true’ to such struggles.

Paper short abstract:

Drawing on ethnographic materials from several projects studying public health in Switzerland, I imagine what a mundane story of “health inequalities” might look like and explore how renouncing to big stories of “inequalities” to tell them in a minor mode may help to conceptualize them differently.

Paper long abstract:

« Big stories » about ‘health inequalities’ abound in public health. At the beginning of the Covid-19 pandemic concerns about rising inequalities and health equity burgeoned with calls to prevent them and pay specific attention to groups of the population considered to be vulnerable socially and/or medically. In the aftermath of this health crisis, various accounts of the pandemic, stemming from epidemiology, but also from social sciences, reassert that it affected more those who are already made more vulnerable structurally (Manderson, Burke, and Wahlberg 2021; Fassin and Fourcade 2022). However, the iterative multiplication of big stories of inequalities tend to distract the attention from the multiple “mundane” ways through which “inequalities” are made and remade in daily life. Drawing on ethnographic materials from several projects exploring the world of public health in Switzerland, I aim to imagine what a mundane story of “health inequalities” might look like. By doing so, this paper explores how looking at “health inequalities” through the ethnographic lens of the mundane helps us to conceptualize them differently. It will shed light on what shifts when one renounces to big stories and categories of health inequalities and question what is lost and gained through this move to a minor mode.

Paper short abstract:

Through the ethnographic case of a 5-months old critically ill girl, the presentation analyses how ‘transitions’ to paediatric palliative care are achieved in the mundane goings-on of providing healthcare, conceptualising this as a process of ‘becoming weak’ of dominant practices.

Paper long abstract:

Paediatric palliative care (PPC), as defined in guidelines and policy documents, is as an active, total approach of care that aims at improving the quality of life of children with life-limiting or -threatening conditions and providing support for their families. It begins with the diagnosis, goes on through a child’s life and, in the form of bereavement support for families, continues afterwards.

But how is a transition to paediatric palliative care achieved in the mundane goings-on (Mann 2015; Mesman 2017) of providing healthcare to patients on a day-to-day basis? And how to make sense of such moments in STS?

To address these questions, we will present ethnographic materials collected in 2023 in Switzerland in a children’s hospital. Through the case of Amira, a 5-months old, critically ill girl, we will analyse how paediatric specialists achieved that it was “clear” that the PPC team needed to be involved, called them subsequently, and administered disease directed treatments next to end-of-life care provided by their colleagues from palliative care. We will conceptualize this as a process of ‘becoming weak’ of dominant practices and contrast it to the ways in which relations between dominant and alternative practices have been theorized in STS so far: ‘othering’ (Leigh Star 1991), ‘mobilisation’ (Callon & Rabeharisoa 2003), and ‘alternatives within’ (Mol 2008).

Through the example of transitions to paediatric palliative care, the presentation will, thus, contribute to storying transformations in healthcare and STS.

Paper short abstract:

This academic paper explores how a focus on the everyday practices of ‘doing safety’ offers a potential interpretive aid for understanding moments of translation and adaption in how local safety cultures are accomplished.

Paper long abstract:

After two decades of systems thinking in healthcare, it is difficult to demonstrate increased safety. The systems approach has been criticized for its functionalist ontology (Caldwell 2012) which privileges a technical, de-coupled and systemic understanding of reality, rather than situation-based, everyday accomplishments (Bertels et al. 2016; Waring 2015). ‘Safety culture’ is difficult to operationalise as it is ‘slippery’ (defies classification) and ‘sticky’ (socially embedded) (Waring, 2015). In response to calls for ‘endeavours that prioritise practical change and local involvement over knowledge production’ (Jorm et al. 2021), this paper describes how we developed an interpretive aid, designed to be used collaboratively, in context, by care teams to explore and enrich their own safety culture.

We present empirical data from an interview study of maternity/neonatal leaders /safety managers in England which informed the development of the interpretive aid. Our initial focus of enquiry centred on the local accomplishment of cultural values through collaborative routines or situated practices (Mesman 2007) and the ways in which actors/teams actively tailored practices according to their local environments.

We explore how ordinary, taken-for-granted practices as a category of analysis (i.e., safety huddles, staff allocation) can provide a potential ‘window’ to explicate ambivalences, contradictions, accommodations and transformative possibilities (Neal and Murji 2015; Feldman 2022). We share insights (and tensions) from our ongoing collaborative work (with clinical staff and policy makers) to fold abstract grand notions of safety culture into the ‘small’ everyday moments and to situate these reflective processes within a wider programme of leadership and culture change

Paper short abstract:

Located as part of a ‘maternity care crisis’, the care for ‘second-degree’ vaginal tears is a matter of concern. We explore how attending to ‘second-degree’ vaginal tears as mundane ‘classification work’ in care practice allows us to intervene in the improvement of maternity and postpartum care.

Paper long abstract:

Located as part of a larger ‘maternity care crisis’, the care for vaginal tears has, in Sweden and beyond, become a public and political matter of concern. In particular, improving the handling of ‘second-degree’ vaginal tears – i.e. a tear in the vagina and/or perineal muscle that needs suturing – has been enacted as key for improving maternity and postpartum care. As a daily, yet mundane and taken-for-granted, practice, the classification of vaginal tears plays an important role here. What care routines are followed – and which are not – is intimately connected to ‘classification work’ (Bowker & Star 1999). In this presentation, we draw upon interviews, and a workshop, with gynaecologists, midwives, physiotherapists, sexologists, and policy-actors managing and/or treating ‘second-degree’ vaginal tears to explore what the classifying of vaginal tears as ‘second-degree’ does.

The mundane act of classifying a tear is far from easy but has significant consequences. Notably, while the distinction between a ‘second-degree’ and a ‘third-degree’ tear may not be given in practice, the consequences are pivotal. Whereas ‘third-degree’ patients are closely followed up, follow-up care for ‘second-degree’ tears is largely absent. Consequently, we analyse the complexities and consequences of classification work concerning ‘second-degree’ tears, such as in relation to suturing and follow-up postpartum care. Ultimately, we ask how attending to the grading and classifying of vaginal tears as ‘second-degree’ as a mundane ‘daily life matter’ (Mol et al. 2010) allows us to intervene in debates about how to improve the care for vaginal tears.

Paper short abstract:

Our paper draws from empirical research on the living with a chronic and/or rare disease or beyond a serious illness experience. We will present our reflections on the role and values of the mundane in healthcare, politics and research for such illness trajectories.

Paper long abstract:

While we can observe an increasingly sophisticated biomedicine, given the changing types of diseases in our society and the increasingly widespread and rapid circulation of personal health-related data collected in the flow of everyday life, an increasingly pivotal space is also being created in healthcare and research on how patients experience their illnesses, take and follow the therapies and behaviours prescribed to them, create data about themselves or use data produced about themselves.

Drawing from many qualitative studies conducted both individually and collaboratively over the past years, our reflections focus on diverse relevant aspects to think on the mundanization of healthcare: the pervasive sense of uncertainty experienced in the daily lives of individuals diagnosed with a rare disease that might push these patients in engaging with research; the role of technology in the everyday life of people living with a chronic disease and the value of these mundane interactions in healthcare; the professional challenges and vulnerabilities impacting the return to work for individuals living with or beyond chronic illness that become an urgent political issue to address; the pivotal role of peer support within healthcare trajectories and research.

Emphasizing the significance of mundane experiences in healthcare research enriches the ongoing debate on the coexistence of multitude logics in healthcare. We also aim to maintain focus on the enduring contributions of the Social Studies of Health and STS in fostering critical inquiry into the subjective experiences of living with illness and the diverse forms of expertise that hold significance in healthcare.

Paper short abstract:

In this session, I invite colleagues to jointly reflect on how that which is bracketed everyday and trivial is omnipresent in a forensic mental health care clinic and whether or not it could ever be evidence-based.

Paper long abstract:

In the early days of an ethnographic collaborative study aiming to build local infrastructure able to capture different forms of knowledges, as well as store them in the clinic's long-term memory (Bowker 1997), I find myself spending even more time than usual thinking about crisps. As I move around the clinic, not without difficulty, there are conversations about food, everywhere. How it is served, who touches it, how much of it one can have, and who should decide? What sort of food should the hospital make available to patients? How much should patients be allowed to buy and how often? Why are there conflicting rules regarding what can be brought in from the local shop? Meanwhile, in the research section of the clinic the "somatic body" is relegated to the lowest rung of the knowledge ladder. When it does feature it is in terms of blood samples, stress hormone levels and BMI to establish and set apart a forensic psychiattric "patient population" and to create a baseline to assess how treatment is progressing. This and potentially problematic plans to exnovate (Mesman 2008) and evidence-base chatting will be the core ingredients in this talk.

Paper short abstract:

This paper examines how gamete preservation prior to gender affirmation treatment is enacted as a 'mundane' care practice. It argues that it enables concerned experts and trans* individuals to advance reproductive rights by circumventing moralistic and general opposition.

Paper long abstract:

This paper examines how "the mundane" can become a fruitful framework for healthcare professionals, legal experts, or LGBTQ+ associations involved in advancing trans* reproductive rights. I will explore this question based on collective research conducted with Delphine Gardey and Raphaël Albospeyre on gamete preservation prior to gender affirmation treatment which can affect fertility. Drawing from 49 interviews with caregivers, legal experts, LGBTQ+ organizations, and 12 trans* individuals, I will revisit how they practically envision gamete preservation and assisted reproductive technologies. I will focus particularly on how some actors seek to conceptualize care for trans* individuals as "nonspecific," ordinary, and thus self-evident. By linking assisted reproductive practices for trans people to the mundane, they aim to move away from general moralistic positions toward an everyday ethics, situationally attached to the diversity of individual circumstances and aimed at promoting reproductive rights "from below." I will reflect on how the mundane, rather than “big stories” about minority rights, aligns with the concerns of these actors. As feminist STS scholars, how can we make room in research narratives for the craft of actors who find ways to navigate through oppositions on trans* reproductive rights by making them practical realities within healthcare institutions? What debates does this raise for both researchers and concerned actors?

Paper short abstract:

The notion of ‘optimization’ is increasingly finding room in biomedicine, in spaces such as public health, healthcare, or e-health. Here I explore ‘optimization’ in the context of AMS programmes in Spain, not as a grand transformation, but as a pragmatic ethics of work and clinical care.

Paper long abstract:

In this paper, I draw on results from an ethnographic study of antimicrobial stewardship (AMS) programmes in the context of Spain, particularly in the public hospital. These programmes are known as Programas para la Optimización de Antimicrobianos (PROAs). In a scenario in which antimicrobial drugs are imagined and framed as scarce medicines and as depleting resources, the implementation of AMS/PROAs interventions is identified as a crucial solution to the impact of antimicrobial resistance (AMR) in human health and healthcare. The notion of ‘optimization’ is increasingly finding discursive space in how AMS programmes are imagined and enacted, including in policy documents published by the WHO or the European Union. In this research project, I critically interrogate the ‘O’ in the acronym PROA: what does such an aspiration to ‘optimization’ offer these healthcare professionals involved in designing, enacting and implementing PROA teams in healthcare settings? As some of my research participants would put it, optimization in antimicrobial stewardship is ‘knowing how to adapt decisions’, and ‘an exercise of collaboration and teamwork’, it is an aspiration to ‘use the best antibiotic for the best outcome for each patient’. I will argue that this yearning for optimization in the Spanish public hospital functions as a pragmatic ethics in the day-to-day of PROA teams. Instead of acting as a grand ambition to streamlining, efficiency and maximising available resources, here ‘optimization’ becomes a mundane, pragmatic exercise of navigating collective decision-making, where choices, judgement and regard for others find a space to be expressed and practiced.

Paper short abstract:

This paper reflects on temporality in relation to life-limiting illness and death. Doing so might help us pursue an ’everyday ethics’ that moves in other directions or against biomedical logics and concerns.

Paper long abstract:

Time—how we spend it, how it unfurls—is often discounted as mundane in the busyness of life. In the face of life-limiting illness, however, time comes to the fore, pressing on the everyday and on possibilities for and of futurity. How might focusing on the ostensibly mundane notion of ‘time’ help us attend to modes of living and dying well? This paper reflects on temporality in relation to life-limiting illness and death, relations between tenuous biological health-status and sociality, and the socio-political challenges presented by living and dying in what might be called ‘shadow times’: those disavowed times that exist on the underside of normative time. The shadow times examined here are ‘diagnostic time,’ ‘prognostic time,’ ‘terminal time,’ and ‘mourning time.’ Paying attention to the everyday experience of time in life-limiting illness, death, and beyond might allow us to recognize the regulatory imperatives of normative time and the slippages between normative and lived shadow time. Importantly, doing so might help us pursue an ’everyday ethics’ (Pols 2023) that moves in other directions or against biomedical logics and concerns—to do justice to those living in the complicated ontological ambiguities of lived shadow time, where we see the imbricated folding of life and death.

Paper short abstract:

In this proposal, we refer to temporality in healthcare scenarios as a “matter of care”, and as an empirical issue. We address this from the notion of “sensitive trajectory” of time, arguing that temporality obeys a mundane question, linked to the attention of the entities that constitute it.

Paper long abstract:

Conventionally, time in health is usually assumed either as a backdrop or as a social construction from which life unfolds; only in the last two decades has it begun to be problematised as a socio-technical issue, i.e., as a “matter of concern” composed in a multiple and varied way by the articulation of heterogeneous agents. In this proposal, we refer to temporality in health care scenarios as a “matter of care” and sensitivity, considering temporality itself as an empirical issue. In concrete terms, we argue that temporality obeys a mundane question, elaborated by vulnerable practices and relations, linked to the attention and care of the entities that constitute it. We base this on a case study on the latest health reform in Chile (the Explicit Health Guarantees regime), considering 78 interviews to experts, professionals and patients, along focused ethnographic sessions on ministerial spaces and hospitals. In order to account for the conditions in which temporal configurations are composed, we consider the notion of "sensitive trajectory". With this, we intend to account for the subtle character of the composition of time and the temporality of transformations in healthcare scenarios. We will note three sensitive trajectories of time: one of primacy, one of synchrony and one of continuity. We discuss in particular the sensitive production of the durability of these trajectories and the consideration of the effort of the articulated entities to configure such formations of time.

Paper short abstract:

Exploring the mundane food work undertaken by individuals to regulate their eating behavior, we address certain oversights within the public health strategy aimed at reducing salt and sodium consumption, arguing for situated ethics in food practices.

Paper long abstract:

Our presentation delves into certain overlooked aspects of the public health strategy aimed at reducing salt and sodium consumption. We explore the everyday food work undertaken by individuals to align with the expectations set forth by public health messages. We conceptualize this effort as a form of care work, often underestimated and marginalized within nutritional campaigns that moralize food behaviors in the name of public health.

Drawing on empirical insights from French eaters regarding their daily food practices, hyper-responsibilization, and the unattainable standards of "eating healthily", we present findings from 13 ethnographic observations of meal preparation and consumption, alongside interviews with 25 participants, and in vivo observations at the experimental restaurant platform (OVALIE).

By focusing on the nuances of everyday food work, through the lens of salting practices, we propose three considerations for public health policies regarding salt: 1. The emancipatory escape and rupture from practicing "healthy salting" within the context of food vulnerability and inequalities; 2. The knowledge gained from bodily salting techniques; 3. The balance between health and pleasure values that influence the ethical and dignified aspects of eating behaviors.

We conclude by emphasizing that attention to mundane food work may contribute to the development of situated food ethics, offering an alternative to the moralization of eating behaviors that exacerbate social and gender inequalities.

Paper short abstract:

Liver disease is typically understood as a problem of an organ but attending to mundane practices highlights the importance of fluids. Fore-fronting fluids and fluidity reconfigures liver disease and its care, moving away from biomedical values and allowing what is neglected to become evident.

Paper long abstract:

Liver disease is typically understood as a problem of an organ, but a focus on everyday practices and concerns points us towards considering liver disease through a problem of fluids. Liver disease can disrupt usual blood flow and cause bleeds, and blood content is a key aspect of the gut:liver axis. For patients with severe disease, particularly those towards the end of life, fluid build-up in the abdomen can severely impact daily life and has the potential to become infected. Regular draining is necessary but not always easily available. Instead of exploring liver disease through a focus on a discrete organ and the highly charismatic process of liver transplantation, fore-fronting fluids allows another way into the disease, its relationality, and situatedness. Fluids are often neglected in the body, seen as ‘of the body’ rather than an intrinsic element. Attending to fluids shifts the usual hierarchy of biomedical framings, allowing what may be neglected to become more evident and raising consideration as to how (else) we might care (Puig de la Bellcasa, 2011). We are also moved away from understanding the body as static and bounded into working with movement, flow, and fluidity. These are, I suggest, more generative ways of situating liver disease in relation to its development, progression, and care, and to more recent developments in biomedical understandings and interventions around liver disease. Following what is for biomedicine a mundane focus on fluids, I explore these ideas drawing on my ethnographic fieldwork in specialist liver units.

Paper short abstract:

In this presentation, I specifically turn my attention to the health-political aspects of the mundane, daily-grind practices of un/invited participation in Type 1 Diabetes care. With this I illustrate how the everyday engagement with medical devices led to an influential global health movement.

Paper long abstract:

The #WeAreNotWaiting movement in Type 1 Diabetes (T1D) care is often employed as a showcase for tech-optimist patient innovators who took matters into their own hands. In T1D affected individuals are “invited” to participate in their care, the members of the #WeAreNotWaiting movement use this "invitation" not only to uninvitedly rethink and redo algorithmic care, by automating parts of their (self)care in an open-source manner, but also critique and challenge the ones that invited them in the first place––device manufactures and healthcare professionals. Most of the discussions of the #WeAreNotWaiting movement challenging clinicians, regulatory bodies, and the pharmaceutical industry, is characterized by a focus on the bigger health political aspirations and the global aspects of this health movement. In this presentation, I center my inquiry around the mundane everyday-life practices of tinkering, repair work, maintenance, and other daily practices of un/invited material participation in care, and with this illustrate how the everyday engagement with medical devices in, on, and with bodies builds the basis for the activism of the global #WeAreNotWaiting movement in the first place. Drawing on ethnographic fieldwork within the German #WeAreNotWaiting community and twenty-eight in-depth interviews I introduce three different situations of mundane un/invited participation in form of ethnographic vignettes: collective maintenance, repetitive data work and elaborative tinkering. I argue that specifically turning the attention to the health-political aspects of the mundane, daily-grind practices of participation in care, can unravel how these practices led to an influential global health movement and with this transform T1D care.

Paper short abstract:

The big story is AMR. Where policy responses so far have reflected a conservationist, depressed approach, cause for greater optimism is found in the mundane practices of chronically ill people who cultivate non-antibiotic care practices. I offer a method to elicit these mundane practices.

Paper long abstract:

Globally, the emergence of antimicrobial resistance (AMR) in clinically important microbes threatens routine medical work, from treating common infections to prophylaxis for surgery.

In the UK, responses to AMR have primarily understood it as a problem of excess, and often reflect a depression about what else might be done to care aside from antibiotics. If the ‘slow emergency’ of AMR has elicited as a transformation in healthcare, transformed antibiotic practices would be the same, but smaller.

I take the important case of urinary tract infection and, drawing on Pols’ theorisation of patient knowledge (2013), bell hooks’ theorisation of the ‘radical openness of the margins’ (1989), and Mallers and Strengers’ social practice theory (2018), I offer an object interview methodology used to elicit mundane but often innovative and creative practices of living with poor bladder health.

STS theorizing through the mundane can therefore intervene in responses to AMR by locating transformations in post-antibiotic healthcare in the mundane things that people are already doing. Instead of using large scale policy instruments to conserve resources by restricting access to antibiotics, we can recognise a multitudinous bounty of different ways to care in the small-scale mundane practices of people with chronic urinary problems. This is a route to greater optimism about a transformation in healthcare which may transform our dependence and reliance on antibiotics.

I hope to offer an interactive session led by visual sources within 20 minutes.