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The Intimate Uncertainties of Kidney Care

Moral Economy and Treatment Regimes in Comparative Perspective

Ciara Kierans

Today the social and material situations of sick bodies are increasingly and intimately bound up with the variable moral economies of national healthcare systems in uncertain and contrastive ways. I approach these ‘intimate uncertainties’ comparatively and methodologically by drawing on ethnographic fieldwork on transplant medicine in Mexico in order to interrogate European healthcare, specifically the UK. The UK National Health Service is an exemplary site of moral economy, one that the Mexican case appears to stand in stark contrast to. However, as I show, the uncertainties we see at work in Mexico enable us to seek them out in the UK too, particularly those generated at the nexus of the state, failing organs and new strategies for healthcare rationing. The article traces the gendered and socioeconomic inequalities, which follow from these shifts, while offering a critique of analyses that take the European and North American experience as methodologically foundational.

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Introduction

Risks, Ruptures and Uncertainties

Kirsten W. Endres and Maria Six-Hohenbalken

Asia's ongoing economic transformation has created a variety of unexpected ruptures, discontinuities and opportunities in the lives of local citizens across the region. The introduction to this special section of the journal frames the contributions that follow with a brief review of current scholarly discussions regarding the interrelated concepts of crisis, risk and uncertainty. It then provides an overview of the articles in this collection and highlights the ways in which they contribute to an understanding of local responses to, and strategies for coping with, risk and uncertainty as multidimensional, interwoven aspects of their daily lives, guided by social, economic and moral considerations.

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Living an Uncertain Future

Temporality, Uncertainty, and Well-Being among Iraqi Refugees in Egypt

Nadia El-Shaarawi

While displacement has always involved the refiguring of space, scholars of forced migration have recently begun to consider how temporality might be crucial to an understanding of displacement. In this article, I consider the interplay of temporal and spatial uncertainty in the experience of exile for Iraqi refugees in metropolitan Cairo. By examining how Iraqis understand displacement as uncertain and how this uncertainty is a cause of significant distress, I show that an attunement to temporality can help us to understand refugees' experiences of displacement. Iraqi refugees spoke of exile in Cairo as 'living in transit'—a condition in which disjuncture between their expectations about exile and its realities contributed to an altered experience of time in which the future became particularly uncertain and life was experienced as unstable. One solution sought by refugees is resettlement, a process that often renders the future even more uncertain, at least in the short term.

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Introduction

Flight and Exile—Uncertainty in the Context of Conflict-Induced Displacement

Cindy Horst and Katarzyna Grabska

This introduction addresses the ways in which flight and exile create particular types of uncertainty, including both radical and protracted, in people's lives. We argue that the concept of uncertainty, in its meaning of imperfect knowledge and the unpredictability of the future, is central to studies that theorize conflict-induced displacement, transit, and refugeeness. We start with an exploration of the spatial and temporal aspects of uncertainty in situations of displacement, and within that we discuss how uncertainty functions as a governing mechanism. We then analyze the ways that refugees and those internally displaced navigate situations of radical and protracted uncertainty. This article and those that follow in this special issue suggest that in our analysis of conflict-induced displacement, we must understand uncertainty rather than certainty as the norm.

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'It's Got to Be the Patient's Decision'

Practicing Shared Decision-making in the U.K. Renal Units

Ikumi Okamoto

In modern medicine, patient choice and involvement in treatment decision-making are increasingly recognised as an important issue in improving the quality of healthcare, and in recent years the concept of shared decision-making has attracted attention as a new approach in the medical encounter. This model is particularly appropriate in life-threatening situations in which no best treatment exists and there are trade-offs between benefits and risk of available treatments. In this article, I demonstrate how clinical uncertainty makes shared decision-making difficult in practice, using the case of elderly patients with end-stage renal failure based on data collected by interviewing renal healthcare professionals in the U.K. I then propose the possibility of 'patient choice' becoming a burden for some elderly patients and the institutionalisation of shared decision-making, and discuss the importance of building a good relationship between healthcare professionals and patients to facilitate shared decision-making.

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Barbara Bodenhorn

This article takes one form of extreme event - namely forest fires - and asks how the ways in which they come to be understood might contribute to core questions about evidence. In particular, I shall suggest that, by considering the moment-ousness of extreme events, we are offered tools for considering the tension between 'rupture' and 'continuity' which emerges throughout the articles of this Special Section, not only at the methodological level but also in terms of understanding these processes themselves. The controversial and often political relationship between evidence, modelling and prediction - that is, taking fragmentary evidence of past events to speculate on future process - is an issue to which we return in the conclusion when the question 'what are scientists for anyway?' comes to the fore. 'Uncertainty' - as a variable, or as a sign of failure - emerges as key in what the article calls a 'clash of modernities'.

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“And When I Become a Man”

Translocal Coping with Precariousness and Uncertainty among Returnee Men in South Sudan

Katarzyna Grabska and Martha Fanjoy

In this article, we argue that return in the aftermath of conflict-induced displacement is often undertaken in contexts of uncertainty. After years spent in war and displacement, people return to an unknown and uncertain present and future, shaped by ideal images of home and brutal memories of conflict. Based on ethnographic fieldwork among South Sudanese refugees in Kenya and Canada and returnees in South Sudan, we analyze the 'return home' strategies, motivations, and experiences of returnee men. We suggest that uncertainty often transforms the present and the future of returning populations and the societies to which they return. Our research shows that in their attempts to minimize their wartime and displacement uncertainties, returnee men transform, negotiate, and reconstruct national, ethnic, and gender identities in a variety of ways, depending on their age and experiences in exile.

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Facing bureaucratic uncertainty in the Bolsa Família Program

Clientelism beyond reciprocity and economic rationality

Flávio Eiró and Martijn Koster

Clientelism is often analyzed along lines of moral values and reciprocity or an economic rationality. This article, instead, moves beyond this dichotomy and shows how both frameworks coexist and become entwined. Based on ethnographic research in a city in the Brazilian Northeast, it analyzes how the anti-poverty Bolsa Família Program and its bureaucracy are entangled with electoral politics and clientelism. We show how the program’s beneficiaries engage in clientelist relationships and exchanges to deal with structural precariousness and bureaucratic uncertainty. Contributing to understanding the complexity of clientelism, our analysis demonstrates how they, in their assessment of and dealing with political candidates, employ the frames of reference of both reciprocity and economic rationality in such a way that they act as a “counterpoint” to each other.

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Temperature and Capital

Measuring the Future with Quantified Heat

Scott W. Schwartz

My iPhone tells me the temperature this Saturday will be 99°F. Is this appliance of mine making a benign assertion about sensible heat, or reifying the hypothetical future of capital by suppressing uncertainty? Both, perhaps, but the latter is far

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Raw Data

Making Relations Matter

Antonia Walford

long stretches of time. The implication for the researchers and technicians is that the raw data from the towers could potentially be full of errors and gaps and therefore highly uncertain. As I shall now show, this uncertainty is also the result of a