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Social security and care after socialism

Reconfigurations of public and private

Rosie Read and Tatjana Thelen

State frameworks for welfare and social security have been subject to processes of privatization, decentralization, and neoliberal reform in many parts of the world. This article explores how these developments might be theorized using anthropological understandings of social security in combination with feminist perspectives on care. In its application to post-1989 socioeconomic transformation in the former socialist region, this perspective overcomes the conceptual inadequacies of the "state withdrawal" model. It also illuminates the nuanced ways in which public and private (as spaces, subjectivities, institutions, moralities, and practices) re-emerge and change in the socialist era as well as today, continually shaping the trajectories and outcomes of reforms to care and social security.

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Dafna Halperin

This study aims to identify future care preferences and examine the associations between personal resources, filial expectations, and family relations and the preferences of independent elderly Jews and Arabs aged 65 and over, using mixed methods. Data were collected using structured interviews of 168 Jews and 175 Arabs; additionally, 20 Jews and Arabs were interviewed in depth to enable more detailed analysis. The main findings show the effects of the modernization and individualization processes on elder preferences. Significant differences were found between Jews and Arabs for most variables. Whereas Jews' first preference was formal care, with mixed care following as second, Arabs preferred mixed care to other types. Differences in several factors associated with preference for mixed care were also noted, including in categories that were identified in the qualitative phase, such as 'dignity' versus 'honor' and the meaning of 'home'.

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‘Coming to Look Alike’

Materializing Affinity in Japanese Foster and Adoptive Care

Kathryn E. Goldfarb

In contemporary Japan, non-biological family ties are not easily legible as kinship. This article examines how parents of adopted and fostered children in Japan mobilize material similarity to represent their kinship relationships as existing objectively in the world, untainted by socially suspect desires. Material resemblance is taken up as a semiotic framework through which people self-reflexively interpret the signs that are understood as relatedness, what I call ‘kinship technologies’. Focusing on two local categories used to conceptualize non-biological kinship (kizuna and en), this article explores how long-lasting relational ties are embodied through caring proximity and physical similarity. However, difference always lingers within similarity: the borderlines between family and non-family; made connections or inherent, ineffable ties; and observable markers of otherness, such as race and ethnicity.

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Anthropological Insights about a Tool for Improving Quality of Obstetric Care

The Experience of Case Review Audits in Burkina Faso

Marc-Eric Gruénais, Fatoumata Ouattara, Fabienne Richard and Vincent De Brouwere

The ratio of maternal morbidity and mortality in developing countries is high. The World Health Organization (WHO) and public health specialists promote case review audits as a means of improving quality of obstetric care. This reflects the need for high reactivity in health personnel's management of obstetric complications. Within an action-research programme in Burkina Faso, a trial of case review audits was implemented in a maternity ward. This was designed to help health personnel better align their practice with clinical standards and to enable more consideration of pregnant women's needs. Social anthropologists were involved in these case review audits in order to collect data about pregnant women's lifestyles and circumstances. They also worked to train health personnel to conduct interviews. Although it is important to take account of women's circumstances within audit sessions, conducting interviews in 'anthropological ways' (at women's homes, with observations) is time consuming and may sometimes be better replaced with interviews in hospital contexts. Anthropologically informed interviews may pinpoint socio-economic situations as key reasons for problems in healthcare, but health personnel are usually powerless to address these. However, anthropology contributes an awareness of the relevance of these issues for broader healthcare planning.

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The Role of Small-Scale Farming in Familial Care

Reducing Work Risks Stemming from the Market Economy in Northeast Thailand

Shinsuke Tomita, Mario Ivan Lopez and Yasuyuki Kono

At present, Thailand’s market economy is placing pressure on familial care within rural households. An increasing amount of people are making their living in the current market economy and moving to urban areas in search of employment. The provisioning of care has come under greater risk, especially for women and couples of working age who are exposed to the possibilities of losing employment opportunities. While caregiving has been a responsibility of the household, shifts in working patterns have weakened its ability to care for children and the elderly. However, the capacity to care in northeast Thailand is still higher than in other regions of the country. This article discusses the balancing act that takes place between a progressive market economy and familial care as provided within households in northeast Thailand to demonstrate the importance that rice farming plays in familial care even if income from farming is limited.

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Saudi Patients and Health Care Providers

Divergent Perceptions of Illnesses and Their Symptoms

Mohamed Harakati, Faissal Shaheen, Hani Tamim, Saadi Taher, Adel Al. Qublan and Abdulla Al Sayyari

This cross-sectional survey study analyses the degree of concordance between Saudi patients and their nurses and physicians in four areas: (1) perceived causation of diseases and drivers of cure, (2) symptom ranking and perception, (3) views on social habits and traditional medicine, and (4) assessment of health care providers' empathy. The doctors and nurses were asked to predict their patients' responses to the survey. Significant divergence was found between the patients' responses and the health care providers' predictions. Cultural and background differences between the two groups, as well as a large educational gap, might account for this disparity. Such discordance could conceivably lead to wrong diagnoses being made, due to the different levels of importance that patients and doctors accord to symptoms.

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High-tech Romania?

Commoditisation and Informal Relations in the Managerialist Informatisation of the Romanian Health-Care System

Sabina Stan and Valentin-Veron Toma

While informatisation has officially been hailed as a major component of the modernisation of the Romanian health-care system, this paper, based on ethnographic research in Romanian hospitals, shows that it has been mostly geared towards managerialist goals of administrative control and cost containment. Paradoxically, informal relations, which were supposed to be suppressed as a result of both informatisation and managerialist marketisation, continue to thrive in the Romanian health-care system.

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Heide Castañeda

This article examines the unintended effects of policy on the cross-border health care experiences of persons from the new Central and Eastern European (CEE) states of the European Union (EU) during a time of major transition. While permitted to travel freely, most individuals from the new member states are not yet authorised to work in Germany. As a result, they face many everyday forms of exclusion, including lack of access to medical services. Drawing upon ethnographic fieldwork, this article examines experiences of patients from newly acceded CEE countries. Cross-border health care highlights instrumentality because implementation has consisted only of patchwork policies and is characterised by insufficient attention to marginalised populations, such as those who are driven to seek work abroad due to economic asymmetries across borders. In the current transitional period, evidence suggests a disconnect as social rights struggle to catch up to economic ones.

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Tatjana Thelen, Andre Thiemann and Duška Roth

In this article, we analyze processes of kinning within state-initiated programs of elder care in Serbia in order to explore how images of the state as an entity are cast as distinct from the domain of the family. We present data from the fieldwork we conducted in two settlements, in northern and central Serbia respectively. Contrary to the findings of many anthropological studies of the state, state actors in these cases surpass the expectations of citizens. Nevertheless, within complex processes of kinning between state-paid care workers and their clients, dominant images of an absent state as well as state-kinship boundaries are (re)produced. Placing this boundary work within the evolving relations at the center of the analysis underlines the merits of rethinking the interconnections between kinship and the state with a relational focus.

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Pascale Molinier

*Full article is in French

English abstract:

Through the metaphor of a bridge of interdependence, this article brings together two traditions—Western ecofeminism and Amerindian feminist thought—focusing on two intellectuals and activists: the Australian philosopher Val Plumwood and yanacona leader, Maria Ovidia Palechor. Drawing on their convergence around territory and attachments between humans and non-humans, the article’s purpose is to show the plurality of feminist voices that characterizes new citizenship and not to stifl e it under the chape of a single Western trend of feminism. Contrary to rationalist conceptions of citizenship based on identical preference (democracy of the brothers), it is a matt er of valuing att achments and relational responsibility as conditions for a dysharmonic democracy based on the plurality of voices.

Spanish abstract:

A través de la metáfora de un puente de interdependencia, este artículo reúne dos tradiciones—el ecofeminismo occidental y el pensamiento feminista amerindio—centrándose en dos intelectuales y activistas: el filósofo australiano Val Plumwood y la líder yanacona María Ovidia Palechor. Basándose en su convergencia en torno al territorio y los vínculos entre los seres humanos y los no humanos, el propósito del artículo es mostrar la pluralidad de voces feministas que caracteriza a la nueva ciudadanía y no sofocarla bajo la cápsula de una sola tendencia occidental del feminismo. Contrariamente a las concepciones racionalistas de la ciudadanía basada en la preferencia de lo idéntico (democracia de los hermanos), se trata de valorar los apegos y la responsabilidad relacional como condiciones para una democracia disarmónica basada en la pluralidad de voces.

French abstract:

À travers la métaphore d’un pont de l’interdépendance, cet article met en dialogue deux traditions – l’écoféminisme occidental et la pensée féministe amérindienne –, en se centrant sur deux intellectuelles et activistes : la philosophe australienne Val Plumwood et la leader yanacona Maria Ovidia Palechor. S’appuyant sur leurs convergences autour du territoire et des att achements entre les humains et envers les non humains, le propos de l’article est d’exposer la pluralité des voix féministes qui caractérise les nouvelles citoyennetés, et de ne pas l’étouff er sous la chappe d’une seule tendance occidentale du féminisme. À rebours des conceptions rationalistes de la citoyenneté fondées sur la préférence à l’identique (démocratie des frères), il s’agit de valoriser les attachements et la responsabilité relationnelle comme conditions d’une démocratie dysharmonique fondée sur la pluralité des voix.