Search

In this era of personalisation a patient's molecular profile plays an increasingly central role in development and delivery of personalised medicine. This paper sets out to explore the sociocultural implications of mainstreaming BRCA genetic testing in the treatment of advanced ovarian cancer patients, who carry a BRCA1 or BRCA2 gene mutation. It draws on ethnographic research conducted by between April-June 2016 in a large tertiary London hospital. Participant observation was conducted across two sites. For the first two weeks participant observation was conducted in the traditional genetic testing setting in two separate clinics. From thereon, participant observation was conducted in the clinical encounters of treating patients in the ovarian cancer clinic. In addition, face-to-face interviews were conducted with medical oncologists who worked in the clinic. Contributing to the fields of cancer genetics, personalised medicine and medical material culture studies in medical anthropology the paper seeks to further discussions about the interactions and relationships unfolding between medical objects and subjects across the landscape of cancer care. It highlights the importance of clinic-based ethnography to examine the complexities of identities and technologies as they intersect with the themes of suffering and hope in new and contradictory ways for BRCA-positive patients with late-stage disease. The paper argues that a BRCA mutation is not only central to the political economy of hope but takes on a more materialist nature as it becomes an embodied practice that moves in and beyond the clinic. [ABSTRACT FROM AUTHOR]

This paper explores how independently organised peer support workers conceptualise drug users to determine how they deliver their service. The work is undergirded by Spiro's critique of the social view that conceptions of the human are fixed, and his contention that sometimes the concept of the self is set aside for utilitarian purposes. A literature review indicates that different conceptions of the drug user as the 'psychological self' and the 'social self' are variously held by public health, peer support workers employed by public health and independent peer support workers. An ethnographic account thereafter investigates how independently organised peer support workers prioritise three conceptions of the 'social self': drug users are hurt by social exclusion; they can benefit from shared experience; they can achieve social inclusion with peer support. The paper concludes with a discussion on the implications of using social conceptions of drug users in the provision of service and signals considerable scope for investigating how independent organisations of peer support workers attend drug users seeking recovery. [ABSTRACT FROM AUTHOR]

Drawing on participant observation and interviews in two yoga studios in the highly socially stratified city of Marseille, France, this paper explores the understandings of yoga as a health practice that emerge at the intersections between yoga styles and their social contexts of consumption. Its insights emerge from the comparison of three modern yoga styles that were developed for Western English-speaking cultural contexts – Iyengar, Bikram and Forrest – and which differ in form but also in the chronology of their emergence on the global yoga market and that of their reception in France. These three yoga styles are also branded through contrasting mythologies of transformational healing, and the aim of this paper is to explore how a brand conceptualization of yoga as a health practice relates to or resonates with the embodied experiences of practitioners, and to the socio-cultural contexts in which practitioners and their practices are embedded. The paper contributes a new case study to the global yoga scholarship and to a poorly studied French yoga scene, but more importantly, it cross-examines the discourses through which a yoga style is branded, the way it is transmitted, and the social context and social positioning of the individuals who practice it. Combining perspectives on the body, narrative and rituals, it identifies how yoga healing is construed in relation to gender, ethnicity and class and the points of consensus and dissent that emerge from the encounters between French social bodies and exogenous yoga styles. [ABSTRACT FROM AUTHOR]

Growing numbers of women are showing interest in clitoral reconstructive surgery after 'Female Genital Mutilation'. The safety and success of reconstructive surgery, however, has not clearly been established and due to lack of evidence the World Health Organization does not recommend it. Based on anthropological research among patients who requested surgery at the Brussels specialist clinic between 2017 and 2020, this paper looks at two cases of women who actually enjoy sex and experience pleasure but request the procedure to become 'whole again' after stigmatising experiences with health-care professionals, sexual partners or gossip among African migrant communities. An ethnographic approach was used including indepth interviews and participant observation during reception appointments, gynecological consultations, sexology and psychotherapy sessions. Despite limited evidence on the safety of the surgical intervention, surgery is often perceived as the ultimate remedy for the 'missing' clitoris. Such beliefs are nourished by predominant discourses of cut women as 'sexually mutilated'. Following Butler, this article elicits how discursive practices on the physiological sex of a woman can shape her gender identity as a complete or incomplete person. We also examine what it was that changed the patients' mind about the surgery in the process of re-building their confidence through sexology therapy and psychotherapy. [ABSTRACT FROM AUTHOR]

This paper explores miscarriage in a variety of Qatari contexts to reveal the multiple realities of the unborn. During 18 months of ethnographic research, a range of settings in which fetuses emerged were explored. The unborn are represented and imagined differently, particularly in relation to the ways they are located, with multiple beings emerging according to the context and position of the stakeholder. This paper considers fetuses produced within these contexts and considers how they can be different beings simultaneously. The paper reveals how categories meant to define these beings are in flux and are constantly negotiated; it reflects moments of ambiguity. The paper serves as an illustration of the way in which value-afforded pregnancy materials affects the contexts in which they emerge; this then loops back as context dictates the significance of the material, hence multiple realities of these beings. [ABSTRACT FROM PUBLISHER]

Drawing on ethnographic fieldwork in Trinidad, this paper examines how the framing of a particular apocalyptic future provided a moral commentary and model for wellbeing in contemporary everyday life. Changing social, political, and economic circumstances and relations had brought a range of new risks and anxieties into daily life. These more recent problems originating from beyond the village (such as climate change, criminality, inequality, pollution, neglect by the State) could not be resolved through working with obeah spirits as might have been used previously for more local issues, or through the long-established Catholic and Anglican churches. Instead evangelical Christian cosmology and practices gave a means of making sense of such issues and for protecting oneself. The development of a strong individual relationship with God connected individuals to a greater power and a global community, framing such problems not only as the work of the Devil but as evidence of the coming of the End of Days. Political protest or attempts at wider change were futile therefore; individuals should focus on their own practices to develop a strong relationship with God. Health and wellbeing relied on an individualised and deep relationship with the Holy Spirit. This was developed through practices that both drew on, and helped create, a type of neoliberal logic and global subjectivity to understand and live within current times, evangelical Christianity promoting ways of living without anxiety in the present through understandings of an apocalyptic future. [ABSTRACT FROM AUTHOR]

The ‘ontological turn’ involves some anthropological points of long standing but the approaches recently coordinated into this turn have been presented as a ‘call to arms’, as shaking up ‘mono-realist singularities’ and as inherently political. This fighting talk has no doubt made important contributions to anthropology and insights from the ontological turn can help in anthropological understandings of medical practices. However, this paper contends that this helpfulness is also limited and that a call to arms may be inappropriate. This point is made through an ethnographic understanding of medical concern about the diagnosis of death. [ABSTRACT FROM PUBLISHER]

Engaging recent social science work examining the truth making claims of science and biomedicine, this paper explores how biology is being localised in Brazilian cancer genetics. It draws from ethnographic fieldwork in urban regions of southern Brazil working with and alongside patients, families and practitioners in cancer genetic clinics. It examines how different sorts of ‘local biologies’ are articulated in the context of research, clinical practice and among implicated patient communities and the way these can ‘recursively’ move across different spheres and scales of social action to extend and transform the meaning of the biological. It shows how the mattering of the biological in Brazilian cancer genetics is fundamentally informed by questions of inequity and care, even while multiple local biologies may obscure rather than reveal the biopolitics of cancer. In an era of epigenetics this raises new opportunities and challenges for anthropological analysis as intervention. [ABSTRACT FROM PUBLISHER]

This paper examines family planning in Brazil as biopolitics and explores how the democratization of the State and of reproductive health services after two decades of military dictatorship (1964–1984) has influenced health professionals’ and family planning users’ discourses and practices. Do health professionals envisage family planning as a ‘right’ or do they conceive it, following the old neo-Malthusian rationale, as a ‘moral duty’ of poor people, whose ‘irrational’ reproduction jeopardizes the family's and the nation's well being? And how do their patients conceptualize and embody family planning? To answer these questions, this paper draws on 13 months of multi-sited ethnographic research undertaken between 2003 and 2005 in two public family planning services in Salvador da Bahia, where participant observation was undertaken and unstructured interviews were conducted with 11 health professionals and 70 family planning users, mostly low income black women. The paper examines how different bio-political rationalities operate in these services and argues that the old neo-Malthusian rationale and the current, dominant discourse on reproductive rights, gender equality and citizenship coexist. The coalescence of different biopolitical rationalities leads to the double stigmatization of family planning users as ‘victims’ of social and gender inequalities and as ‘irrational’ patients, ‘irresponsible’ mothers and ‘bad’ citizens if they do not embody the neo-Malthusian and biomedical rationales shaping medical practice. However, these women do not behave as ‘docile bodies’: they tactically use medical and non-medical contraceptives not only to be good mothers and citizens, but also to enhance themselves and to attain their own goals. [ABSTRACT FROM PUBLISHER]

This paper deals with the role of earth shrines in generating and maintaining social order and cohesion in a Dogon village on the Bandiagara escarpment (Mali, West Africa), in a context of scarcity. Earth shrines are erected at significant points in the landscape and in remote times symbolised the foundation of the territory. They form part of the ritual control of space by reinforcing, through sacrificial practice, a symbolic boundary that encloses and protects the village space. Through their yearly reactivation, this practice firstly enables the Dogon to strengthen their relationship with their god, their ancestors and the spirits that own the place and, secondly, it aims to renew social relationships and maintain the cohesion and continuity of the society whilst simultaneously conveying a sense of well-being. This paper examines the materiality, efficacy and activation principles of Dogon earth shrines that operate through the intervention of complementary living substances: millet and blood. These earth shrines function on an ontological principle of containment by which people protect themselves, act and dwell in the world. That is to say, they endow active principles and play a part in forming a local cosmology in a harsh and changing world. [ABSTRACT FROM AUTHOR]

This paper draws from two years of fieldwork investigating the social course of illness among Pakistani Muslims in East London, exploring how chronic illness is communicated and negotiated in local worlds disrupted by migrancy. It examines episodic short stories about dreams, premonitions and uncanny coincidences that were prominent within the illness narratives of migrant Pakistani Muslims, recalling and throwing light on complex questions concerning subjective constructions of misfortune, the personal and social meanings of illness and the relationships between narrative and selfhood. The ethnography identifies a strong normative context of communication about ill health and bad news, within which revelation through the mode of the supernatural takes on added significance. Recurrent motifs in the dreams emphasize the connectedness between family members scattered across migratory contexts, and the reawakening of moral obligations in families. Whilst medical anthropology has understood descriptions of dreams and other uncanny experiences as 'subjunctivising tactics' serving to maintain alternative plots about the source and outcome of illness, in the Islamic context the narrating of supernatural encounters can have transformative effects, re-organising praxis and conferring legitimacy to certain forms of moral selfhood. The paper therefore argues that the notion of the 'subjunctive mode' imposes the analysts' own system of logic and that there is a need to understand the interpretive frameworks present in the illness narratives in their own terms. [ABSTRACT FROM AUTHOR]

In Norway, as in many other wealthy countries, the number of health-related services that are being offered outside of the health sector is increasing. The present paper is based on qualitative interviews that were conducted with providers of health-related services at a commercial health hotel in Norway. The hotel is marketed as a health hotel – that is, a place for people with health problems and for those who need relaxation and an escape from their stressful everyday lives. The paper discusses whether the providers of this kind of service consider it a health service or if they distinguish and distance themselves from the health system. The interviews showed that they consider themselves health workers and refer to themselves as therapists. Even though they use therapy in the health sector as a model, they distinguish themselves from therapists in the health sector. They do not want to treat what they call sick people. Most of their therapy is directed toward cultivating or improving people's bodies and souls. These service providers think that they contribute to improving their guests' health by teaching them how to take care of themselves; enjoying oneself (for instance, by receiving skin treatment or a massage) is an important aspect of good health. According to the therapists, modern-day women, in particular, are often worn-out, and they deserve, and are entitled, to enjoy themselves. In these ways, the therapists use health to legitimize their services, and they challenge the current understanding of health. [ABSTRACT FROM AUTHOR]

This paper considers how the globalized discourse of genetic risk in cousin marriage is shaped, informed and taken up in local moral worlds within the context of Qatar. This paper investigates the way Qataris are negotiating the discourse on genetics and risk. It is based on data from ongoing ethnographic research in Qatar and contributes to anthropological knowledge about this understudied country. Participants were ambivalent about genetic risks and often pointed to other theories of causation in relation to illness and disability. The discourse on genetic risk associated with marrying in the family was familiar, but for some participants the benefits of close marriage outweighed potential risks. Furthermore, the introduction of mandatory pre-marital screening gave participants confidence that risks were monitored and minimized. [ABSTRACT FROM AUTHOR]

Experiences of autism-spectrum disorder are now increasingly studied by social scientists. Human-animal relations have also become a major focus of social inquiry in recent years. Examining horse-assisted therapy for autistic spectrum disorders, this is the first paper that brings these fields together. Drawing on participant observation and interviews at a UK horse therapy Centre, this article examines how staff and the parents of riders account for the successes and limitations of equine therapy. To the respondents, horses ‘open up’ autistic children and make possible interactions that seemed impossible before. Horses were regarded as facilitating the emergence of apparently social behaviours, which included eye contact, pointing, and speech. Three key explanations emerged for therapeutic success: the sensorial, embodied experience of riding the horse; the specific movements and rhythms of the horse; and, the ‘personality’ of the horse. Equine therapy can be regarded as enabling a form of multispecies intersubjectivity, with the resonance between rider and horse seeming to make possible a new attunement between humans. Practices of equine therapy, and perceptions of its efficacy, serve in turn to attune social scientists to a version of empathy constituted through lively and sensorial interactions, as opposed to one that is restricted to particular kinds of humans. [ABSTRACT FROM AUTHOR]

This paper deals with the simultaneous mainstreaming and diversification of ni-Vanuatu social categories associated with the ways in which population growth is understood as a possible crisis in both demographic knowledge and everyday ni-Vanuatu knowledge. The author is interested in understanding the downplaying but primarily the amplification of difference with respect to place, generation and gender identities. The relationship between reproduction, social reproduction and the multiple meanings of modernity is at issue. In the expert knowledge of demography that proffers advice for the ni-Vanuatu state, it is the lack of modern development – in the form of adequate biomedical birth control, western education, and the equality of women – that is the implicit cause of population growth. Yet, many ni-Vanuatu see population growth as tied to the troubles that arise from the dilution of traditional social forms: there is too much modernity. In both demographic and ni-Vanuatu everyday narrations of the potential population crisis, diversification and mainstreaming take place and vulnerabilities are produced. [ABSTRACT FROM PUBLISHER]

The paper discusses different positions by psychiatrists and anthropologists taken towards ‘folk’ mental health care and summarizes what has been said in favour of the folk sector. Further, examples indicating a changing relationship between the Indian state and the folk sector are outlined, including the impacts of the fire tragedy at the dargah of Erwadi in 2001. On this basis it is argued that a prevailing ignorance of the folk sector has provided it with some autonomy, while at the same time, recent attempts at collaboration tend to utilize folk practitioners rather than valuing their positive elements in their own right. [ABSTRACT FROM PUBLISHER]

The paper addresses forms of medical pluralism, studied from the microsocial perspective, among the Polish community in Misiones, Argentina. It shows different attitudes to health treatment within the field of home medicine, local non-biomedical specialists and biomedicine. It points out the relationship between the diversity of offers of medical assistance and community members' negotiations between various medical approaches. It also identifies the factors influencing these choices. While prior research examines Indigenous and Mestizo medical ethnobotany in this region, there has not been research on medical pluralism and very little study of complementary and alternative medicine among the inhabitants of Misiones. The study group comprises Polish peasants who settled in northern Misiones between 1936 and 1938 and their descendants born in Argentina. Field research was based on semi-structured, indepth and free-listing interviews. The analysis was carried out using both qualitative and quantitative approaches. The results show that Polish settlers tried to reconstruct bits and pieces of their familiar and traditional healing practices in the new environment. Phytotherapy plays the most important role among home therapies. It is at home that most treatments start. Members of the Polish community also treat folk illnesses at home and report them to local healers. The growing influence of biomedicine does not contribute to the elimination of home medicine or non-biomedical specialists in the study area. There has been a medicalization of childbirth and fractures, but folk experts such as curanderos, hueseros and naturistas are still very popular in the region. [ABSTRACT FROM AUTHOR]

Little anthropological research has been conducted on the health care perspectives of homeless people in rural areas. The aim of the present study is to elicit health-care beliefs, and examine overall health experience among a sample of current or recently homeless people in rural New Hampshire. Thirteen qualitative interviews were conducted, 11 with single men. Interviews were audio-recorded and transcribed, and analyzed using thematic analysis. Despite a massive burden of disease and illness, almost all participants reported an abiding aversion to doctors, hospitals and professional health care. Participants reported numerous negative encounters with doctors and health care professionals, often of a demeaning and disparaging nature. Participants noted that these encounters resulted in frequent cases of misdiagnosis and iatrogenesis. In contrast, participants spoke more fondly of other social and voluntary services, for example homeless organizations. Like other rural New Englanders, participants made their own individual efforts to maintain and promote health, for example by pursuing hobbies or prayer. The findings are contextualized within literature suggesting that these perspectives are generally shared by other poor rural people. Consistent with this literature, the findings suggest that homelessness in rural areas is often temporary and episodic. As such, this paper brings into question the distinctiveness and overall utility of the concept: ‘the rural homeless’. The key determinant of negative attitudes to health care may not be recent homelessness. It may be entrenched socio-economic marginalization, and the resultant social stigma, that are shared amongst the rural poor, regardless of their current housing status. [ABSTRACT FROM PUBLISHER]

The co-existence of different types of medical systems (medical pluralism) is a typical feature of India's healthcare system. For conditions such as influenza-like illness (ILI), where non-specific disease signs/symptoms exist, clinical reasoning in the context of medical pluralism becomes crucial. Recognising this need, we undertook a qualitative study, which explored factors underpinning clinical decisions on diagnosis and management of ILI. The study involved semi-structured interviews including clinical vignettes with 20 healthcare practitioners (working within allopathy, homeopathy and Ayurveda) working in the private healthcare sector in Solapur city, India. An inquiry was conducted into criteria influencing the diagnosis, treatment, referral to specialist care and role of treatment guidelines for ILI. Thematic analysis was used to identify aspects relating to ILI diagnosis, treatment and referral. The diagnosis of influenza was based largely on clinical symptoms suggestive of influenza in the absence of other diagnoses. Referral for laboratory tests was only initiated if illness did not resolve, generally after 2–3 consultations. Antibiotics were often prescribed for persistent illness, with antivirals rarely considered. Some differences between practitioners from different medical systems were observed in relation to treatment and referral in case of persistent illness. A combination of analytical and intuitive clinical reasoning was used by the participants and clinical decisions were based on both social and clinical factors. Clinical decision-making was rarely a linear process and respondents felt that broad guidelines on influenza that allowed doctors to account for the sociocultural context within which they practised medicine would be helpful. [ABSTRACT FROM AUTHOR]

In treating illness and suffering, the Akan anti-witchcraft shrine is often presented as a model of unchanging, tightly bounded and antiquated ideals. This fails to acknowledge the extensive repertoire of Ghanaian witchcraft discourses and contemporary divinatory practices uncovered at Akan anti-witchcraft shrines. This paper analyses how one of the most popular Akan anti-witchcraft shrine in Europe, in an eastern banlieue of Paris, diagnoses the seemingly common and innocuous coughs and colds suffered by recently arrived, unskilled female Ghanaian migrants as something more socially and economically malignant, witchcraft. Successful treatment combines divinatory techniques, paracetamol medicines and positive thinking in order to empower clients and present them with the possibility of new social and gainful employment prospects. [ABSTRACT FROM AUTHOR]

Research has documented that, around the world, women who are childless against their will suffer from an array of social, economic and emotional difficulties. The causes of this suffering are primarily related to their gender position in society and their gender identity. This paper addresses the impact of class differences on the gender-related suffering of childless women in the socially very hierarchically structured society of Bangladesh. The main method was gathering life histories of illiterate rural poor childless women and educated urban middle-class childless women. The rural childless women experience strong stigma in society, as their identity is devalued due to their inability to produce children. As a result, they suffer from feelings of guilt, role failure, loss of self-esteem, abandonment by the family, social isolation, and impoverishment. In contrast, because of their relatively high socio-economic status and good educational background, urban childless women have more opportunities to avail themselves of alternative social identities and thus avoid social isolation. Despite these differences, both groups of women lead frustrated lives, burdened with a deep sense of guilt for not being able to produce children. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) has stated that referral practices along with midwifery care are a means of heightening the quality of perinatal care and lessening perinatal mortality and morbidity. In 2002, in response to high perinatal mortality and morbidity, a referral system was instituted nationally in Greenland, transferring all at-risk pregnancies to its national referral hospital. Little or no current research has focused on evaluation of the perinatal referral system or on the thoughts, beliefs, opinions and challenges faced by women and Greenlandic families themselves. The aim of this paper is to document how women referred to Nuuk because of at-risk pregnancies narratively constructed self-understanding and defined meaning during their period of separation from family and community; and how they dealt with the challenges they were presented with. Interviews were conducted with women upon their arrival at the national referral hospital and during fieldwork over a one-year period. Narrative framework was used for analysis. Coping theory and narrative theories were the theoretical base for structuring the narratives. Through their narratives, women presented their identities as mothers, community members and caretakers. Acceptance of referral was described as a means of protecting their unborn child and was where women found an inner source of strength to deal with their own anger, joy, anxiety and loneliness. The ability to accept referral was directly connected to their family and community and the support they found therein. [ABSTRACT FROM AUTHOR]

In this paper the author explores notions of illness and health among a particular group of spirit mediums in Havana: the Sociedad de Estudios Psicologicos Amor y Caridad Universal. For its members and leaders, the development of mediumship is not just therapeutic but prophylactic. And traumas (of spirits and persons) must not simply be acknowledged but metabolised through the execution of good mediumship. More importantly, people's existences are chemically and psychologically entangled with those of their protective spirits, making of their 'selves' systems, rather than bounded essences. The author argues that such concepts of personhood offer alternative modes of understanding the self in relation to forms of otherness, including dysfunction and pathology. [ABSTRACT FROM AUTHOR]

Following the recognition that 'culture matters' in designing effective public health programs, this paper focuses on one refraction of culture within the so-called 'homosexual' community in India, to highlight how attention to local knowledge and its socio-economic underpinnings can impact the politics of health care. Drawing primarily on ethnographic fieldwork conducted from 1995-1997 and 2003 in the South Indian city of Hyderabad among hijras (the so-called third sex of India) as well as the wider community of MSM or 'men who have sex with men', the paper argues that public health framings of homosexuality often fail to pay attention to differential understandings of stigma and their socio-economic underpinnings, a failure that accounts in some measure for the ineffectiveness of prevention programs targeted at 'high risk' communities such as hijras and MSM. Focusing on the local moral economy of respect and shame as one pathway of stigma and contagion, and in particular on the differences in constructions of respect and shame between hijras and the wider community of MSM, this paper points at one small way in which understanding how culture matters can ultimately address the ineffectiveness of prevention programs and redress the inequalities in health outcomes between the various margins and centers of power. [ABSTRACT FROM AUTHOR]

Though rates of depression are comparable across cultures, similar rates may obscure the diversity of the experience and meaning of depression and related behaviour. Appreciation of the social and cultural contexts is crucial in developing culturally sensitive intervention strategies to reduce the burden and disability of depression. Data are required not just to elucidate biological or cognitive understandings of the disorder, but also its social and cultural contexts, especially in non-Western settings. This paper reports cultural epidemiological research studying depression-related experience, meaning, and behaviour with the EMIC in the psychiatric outpatient clinic at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India. Patients spontaneously emphasized somatic symptoms when asked about the problems that brought them to seek help, but on further probing, they acknowledged feelings of depression and sadness, which they related to various social problems and interpersonal issues. The personal significance and meaning of the symptoms were shaped by cultural notions concerning the human body in health and in sickness. Culturally salient symbols (like heat and cold) and ethnophysiological concepts like nara (nerves) figured prominently as causative factors in their accounts. Patients were dissatisfied and disappointed with allopathic physicians whom they had previously consulted for their problems, who seemed to them not to appreciate their needs and expectations in treatment. Findings show that it is important that clinicians attend not only to questions of diagnosis and clinical formulation according to professional concepts, but also to the experience and meaning of their patients' problems. A cultural epidemiological framework facilitates this process by integrating emic and etic perspectives. [ABSTRACT FROM AUTHOR]

Little is known about the perspectives of young people suffering from medically unexplained symptoms. This study aims to explore the experiences and strategies of young Norwegians related to incipient and persistent health complaints affecting everyday life functioning. The study draws on field notes, video material and interview transcripts from a multi-sited ethnographic study of healthcare services and select schools in a small Norwegian town between 2015 and 2016. A central theme is the emphasis upon social and existential constraints seemingly framed by a social imaginary of youth rather than a medical imaginary, and their active engagements to 'fix' their lives through what we identify as two main modalities of self-care. Navigating temporal and relational aspects of sociocultural configurations of youth in their social environments, they imagine and enact alternative qualifying positions better adapted to constraints, personal preferences and needs. Our findings may add to understandings of the needs and strategies of young sufferers of medically unexplained symptoms, relevant for health and social care encounters. [ABSTRACT FROM AUTHOR]

The case of Nicaraguan migrants in Costa Rica is emblematic of the issues that immigration generates in host countries. Undocumented Nicaraguan women seeking maternal care constitute a key challenge to the universal coverage of Costa Rica's health system. Can the long-standing commitment to universality, solidarity and equality expressed in the legislation be translated into practice? Discourses of health professionals in Costa Rica reveal a contradiction between merit and prejudice in prenatal and delivery care. Here, I present qualitative research based on semi-structured interviews with physicians and nurses at a Costa Rican National Hospital. The data show that migrant women, rejected from primary care, do find help in emergency services, but not without difficulties, as they must engage in individual negotiations centred on their bodies. The discourses of health providers reflect an ambivalence between the perceived undeservingness of undocumented migrant women and the medical realisation that two lives are at risk. While the foetus often evokes compassion, the mother commonly provokes repression, as specific and shifting rationalities reflect new moral regimes that are applied to this population. Women are perceived as being ‘illegal’, ‘immoral’ and ‘irrational’, and the baby, although legally Costa Rican due tojus solispolicy, embodies ‘the other’. Ultimately, otherness frames perceptions of deservingness of maternal care for undocumented migrant women in Costa Rica. [ABSTRACT FROM AUTHOR]

Coexisting medical traditions operate at different levels of scale. In rural eastern Africa there are diviners and herbalists whose clients are drawn from the immediate neighbourhood. Some develop healing reputations more widely over a region or nation, sometimes with prophetic and witch-finding powers. Biomedical clinics and hospitals are also interlinked regionally, nationally and internationally. Patients or carers may seek healthcare by moving through these different levels, sometimes beginning with a neighbourhood healer and sometimes trying out different therapies simultaneously. Sicknesses and misfortunes are often first discussed within a family or homestead, with concern for the victim extending to all its members. The talk is based on assumed trust among its members. However, if unresolved, the affliction may trigger a crisis that breaks the trust, so that healers beyond the neighbourhood are sought, whether prophetic/witch-finding or biomedical. Taken out of the context of family and homestead intimacy, the talk blames the ailment on the malevolence or negligence of individuals in the community. Talk about sickness among sufferers and between them and healers, is thus transformed from that which seeks resolution in amity to that which seeks culpability and, sometimes, retribution. A similar process of sickness talk changing through its appropriation by wider scale and more powerful medical authority also occurs in western biomedical hospitals and clinics. [ABSTRACT FROM AUTHOR]

Having concurrent sexual partners is a risk factor for STIs and HIV/AIDS, yet few studies have investigated the cultural meanings and functions of concurrency. A multi-method qualitative/quantitative study of sexual ideas, attitudes, and behaviors among inner-city Puerto Rican and African American emergent adults (age 18–25) in Hartford, Connecticut, USA, suggests that having concurrent partners is common in this population. Using data from 12 focus groups and 40 participants in systematic data collection techniques (e.g., pile sorts), the underlying cognitive structure of concurrency and cheating/infidelity are explored. Results suggest that participants are less tolerant of multiple partners in more committed relationships, but that very few relationships can be considered committed. Furthermore, participants see cheating as inevitable even in committed relationships. Sexual transgressions are considered the most severe form of cheating. Having an outside partner for emotional reasons or to have access to one's child were seen as more acceptable/forgivable than doing so for sexual satisfaction, social status or material goods. Multiple partnerships must be seen in the context of the inner city where resources and opportunities are scarce and young adults attempt to protect themselves from emotional injury. Documenting new and changing social constructions of infidelity is important for understanding the social context of sexual behavior in our global world and for designing culturally appropriate health interventions. [ABSTRACT FROM PUBLISHER]

Clinically significant symptoms and disorders of medically unexplained chronic fatigue and weakness constitute a serious problems for primary care with considerable cost, patient dissatisfaction, and clinician frustration. Such problems are likely to be more troublesome when cultural differences make if difficult for patients and clinicians to communicate adequately to establish an effective alliance for treatment. This research studied 50 Chinese immigrant patients in Toronto with problems characterized by prominent, medically unexplained fatigue and weakness. The EMIC, a semi-structured interview for research in cultural epidemiology, was adapted for study of the experience and meaning of patients' problems, self-perceived stigma, and prior help-seeking. The impact of migration was the predominant theme in narrative accounts of illness, which typically included multiple somatic symptoms. Patients were troubled by anticipated stigmatization and social effects of their condition on themselves and their families. Interpersonal conflicts and underemployment were prominent among perceived causes. Although patients had typically sought prior help from other health care providers, they had relied mainly on self-help. Prior experience with clinicians had been unsatisfactory, because it seemed to patients that the doctors who appreciated so little about the social context of their lives did not really understand the nature of their problems. Practitioners of traditional Chinese medicine (TCM) would understand better, but financial constraints and the higher cost of TCM deterred patients from using them more. Findings indicate the value of studying the cultural epidemiology of these conditions in a culturally distinctive immigrant population, and its contribution to cultural sensitivity in clinical care. [ABSTRACT FROM AUTHOR]