Paper short abstract:

With many British healthcare professionals working in the field of Global Health, it becomes increasingly important to explore their motivations. By combining narratives and reflection from healthcare professionals and the author, this paper aims to further our understanding of this complex concept.

Paper long abstract:

From missionary work to humanitarianism and 'voluntourism', there is a long, evolving history of British healthcare professionals working in the field of what is presently called Global Health. A wealth of literature has described this work as romanticising the exotic, perpetuating stereotypes and neo-colonial but an increasing number of opportunities to work abroad are presented to British workers.

Alongside these broader ethical and philosophical arguments, there is a need for a pragmatic understanding of this work. Exploring the motivations of healthcare professionals who elect to work in a resource-poor setting may enable us to greater understand how to optimise the impact of these complex interactions. What are these motivations? How does one's perceptions of global health and the developing context impact these? What can we learn from beliefs concerning the concept of altruism? Can a greater understanding of motivation inform employees in the decision to recruit international workers? And how can anthropology inform this process?

Drawing on personal experience working as a medical student and junior doctor in Uganda and Papua New Guinea, this paper will combine narratives from British healthcare professionals with personal reflections, aiming to stimulate considerable thought and discussion on this complex concept.

Paper short abstract:

Tobacco use has become an issue of global health as the risk factor of Noncommunicable diseases. Medical anthropologists have been fulfilling ethnographic researches to tackle smoking issues. In these processes, a physician-anthropologist faces theoretical and practical conflicts.

Paper long abstract:

WHO recently announced the global plan to control Noncommunicable diseases(NCDs). Tobacco use, one of the common risk factors of NCDs seems to converge disadvantaged groups as well as low and middle income countries. These unequal distributions are likely to be strengthened via international tobacco companies and disproportionate tobacco control policies amongst countries.

Medical anthropologists fulfilled ethnographic researches to investigate tobacco industries and relating national health policies in Southeast Asia and South America. Simultaneously 'tailored smoking cessation programs' to solve the inequity of smoking rates between classes have been pursued. During these projects, however, a 'physician-anthropologist' inevitably faces the theoretical and practical conflicts

First of all, a physician-anthropologist has to confront the theoretical friction between biomedical 'etic' views and anthropological 'emic' understandings. Following biomedicine, a physician seems to have two assumptions about smoking. One is 'smoking is mainly based on nicotine addiction' and another is 'smoking is unhealthy'. In contrast, an anthropologist understands smoking having diverse utilities including physical, emotional, social and symbolic aspects.

A physician-anthropologist will also have a practical conflict while doing one's fieldwork especially amongst marginalised smoking groups. The researcher have to reveal one's career as a doctor following ethical guidelines of 'overt' research. This identity itself often evokes a sense of social inferiority of participants being attached with stigma about tobacco use. Although it depends on how much the researcher reveals one's subjectivity as a doctor and convinces biomedical findings, participants may do performances to hide their stigmatic behaviours or resist biomedical views.

Paper short abstract:

This paper seeks to explain and explore the ethical implications of the medicalisation of our subjectivities, with a particular focus on the right to health.

Paper long abstract:

This paper interrogates Paul Farmer's statement that "the right to health

is perhaps the least contested social right" (2005:19), starting from a hypothesis that the right to health has been strengthened by medicalised subjectivities. I start by fleshing out the questions implied by my hypothesis, before discussing my own position as a physician and trainee in psychiatry, with a pre-existing belief that health is and should be a human right.

I establish my theoretical rationale by explicating the Foucaultian

concept of subjectivity as the medium through which power relations are

enacted in the liberal state. Following this, I briefly trace the history and

philosophy of human rights, finding autonomy to be a central organising

principle.

I then interpret the sociological and ethnographic evidence, delineating

how biological explanations of suffering served to reconfigure them as ethical

problems amenable to biomedical solutions, thus creating a privileged role for doctors. I argue that medicalised subjectivities have been crafted and that they strengthen the right to health, but can have consequences that are both beneficial and oppressive, as universal ethics are enacted in complex social space. Therefore, we must be mindful of how they are being used and experienced, taking care not to silence those whom human rights seek to protect. In particular, I find that there is a danger of the authoritative voice of the medical professional being used in unintended ways as the universal right to health becomes imbricated in local moral worlds.

Paper short abstract:

Exploring how anthropology can be wholly companionable in research situations where it is impossible to attain a control group, I discuss a scenario where such an approach was abandoned because it could not meet strict medical methodological standards.

Paper long abstract:

Although often welcome on Public Health grant proposals to illustrate the depth of the research that can be achieved, the Anthropological perspective is often treated as the less-skilled sister when medical formalities must rule in approach and write-up. Using an example from when I was a full-time Lecturer in Anthropology and a Public Health and Policy consultant, I explore the difficulty in backing a medically proposed one-size-fits-all approach, particularly with populations that are hard-to reach or research. I tell the tale that inevitably led to a research project being abandoned because, although willing, the doctors on the project could not make 'it' 'fit' with the strict medical write-up criteria.

This paper, far from damning the doctors involved, hopes to examine the increasingly stringent criteria for research assessment, and how this progressing focus is narrowing our options, limiting our creativity and squelching new ways to solve problems. Locked into specific criteria for both research proposal and publication, I hope to bring to the table this example, as well as some recent and thought-provoking experiences that illustrate continuing division. If one of the tenants of medical anthropology is the integration of alternative systems in culturally diverse environments, how can we begin to achieve this when the parameters to attain the funding or publish the research remain so strikingly divided.

Paper short abstract:

This study focuses on a figure: the Registered Medical Practitioner, a type of community health human resource, who occupies a niche in the medical market-place as an informal exponent of quasi-biomedical treatment in India. We challenge the overdrawn dichotomy of formal and informal health sector.

Paper long abstract:

Papreen Nahar, 1 Sitamma Mikkilineni,2 NandakishoreKannuri,2

GVS Murthy,2 Peter Phillimore1

This analysis challenges the tendency to associate India's medical pluralism with a distinction between biomedicine, as a homogeneous entity, and its non-biomedical 'others'. We argue that this overdrawn dichotomy obscures the important part played by 'informal' biomedical practice. Based on a qualitative study in rural Andhra Pradesh, South India, and drawing on Sarah Pinto and Ananya Roy on 'informality', we focus on a figure little discussed in the academic literature: the Registered Medical Practitioner (RMP), a type of community health human resource, who occupies a niche in the medical market-place as an informal exponent of quasi-biomedical treatment. The RMP, who despite the title is rarely registered, sheds revealing light on the formal-informal sector divide in India's healthcare system.