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Eliana Elisabeth Diehl and Esther Jean Langdon

English abstract:

In 1990, the Brazilian Unified Health System institutionalized new relationships between the government and society. In recognition of the inequalities and inequities inflicted upon Indigenous Peoples, the Indigenous Health Subsystem was established in 1999. Roles were created for the democratic exercise of Indigenous participation and prominence in three border spaces: Indigenous health agents as members of health teams; Indigenous representatives on health councils; and Indigenous organizations as primary care providers. This article explores these spaces based on ethnographic research from southern Brazil. It concludes that the roles created for Indigenous participation and governance are ambiguous and contradictory. When participating in new opportunities created by the government, Indigenous actors are subjected to a centralized and bureaucratized system that offers little possibility of autonomous decision- making or action.

Spanish abstract:

En 1990, el Sistema Único de Salud institucionalizó nuevas relaciones entre el gobierno y la sociedad, estableciendo en 1999 el Subsistema de Salud Indígena. Se crearon nuevos roles para el ejercicio democrático de la participación indígena con prominencia en tres espacios de frontera: agentes indígenas de salud como miembros de los equipos de salud; representantes indígenas en los consejos de salud; y organizaciones indígenas como proveedores de atención primaria. Este artículo explora estos espacios basado en investigación etnográfi ca del sur de Brasil. Se concluye que los roles creados para la participación y gobernanza indígena son ambiguos y contradictorios. Cuando se participa en nuevas oportunidades creadas por el gobierno, los actores indígenas son sometidos a un sistema que ofrece poca posibilidad de tomar decisiones autónomas o actuar.

French abstract:

1990 le système unique de santé brésilien, le SUS (Sistema Único de Saúde) institutionnalisait de nouvelles relations entre le gouvernement et la société en donnant aux usagers un rôle central et en leur att ribuant une large participation dans tous les secteurs des soins. En reconnaissance des inégalités et iniquités historiques infl igées aux peuples indigènes, le sous-système de soin indigène fut établi en 1999. De nouveaux rôles furent créés pour l’exercice démocratique de la participation indigène et sa reconnaissance dans trois zones d’action et de communication délimitées. Cet article explore ces espaces sur la base de recherches ethnographiques réalisées au Sud du Brésil et conclut que les rôles créés pour la participation indigène et la notion associée de gouvernance sont souvent ambigus et contradictoires.

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Birgitte Bruun

Today medical research funded by resourceful commercial companies and philanthropic organizations increasingly takes place in much less resourceful settings across the globe. Recent academic studies of this trend have observed how global inequalities have shaped the movements of this research, and how human subjects who make their blood and bodies available are at risk of exploitation. In Lusaka, people expressed their fears of being used by transnational medical research projects in various idioms of concern. While such concerns were always latent, people were generally eager to join the projects. Concerns were often backgrounded in favor of pragmatic attention to—and active creation of—possibilities that might stretch well beyond the purpose and time limit of individual research projects. The article illuminates how intimately the ambiguities and possible scenarios of exploitation inherent in transnational medical research projects are intertwined with scenarios of possibility.

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Katja's canteen

Complex intersections of the public and the private in the South Bohemian countryside

Haldis Haukanes

This article discusses notions of "public" and "private" in the postsocialist Czech Republic through a comparative examination of food practices in families and in the canteen of an agricultural cooperative in South Bohemia. Different meanings of public and private will be outlined, making up a complex set of referential contexts for the interaction between canteen personnel and customers. Analysis of daily life in the canteen revealed that the personnel tended to personalize customer relations. It is argued that this inclination cannot be explained first and foremost as the influence of market-oriented postsocialist public debates on public-private relations. The canteen is a key provider of services to the community but is not run according to market principles or driven by the logic of profit. Its friendly atmosphere is predicated on the moral practice and personal skills of its employees and is embedded in local cultures of food sharing. By exploring daily practice and interaction in the canteen, the article critically examines implications for the feminist concept of emotional labor that have emerged in studies on capitalist, profit-driven enterprises.

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Paul Bissell

Although community pharmacists have a well-established and culturally acknowledged role supplying medicines, the reconfiguration of occupational boundaries within healthcare in England and other countries (Charles-Jones et al. 2003) has resulted in increasing policy and professional interest in developing the role of the pharmacist in a number of areas. Whilst many of the new roles for pharmacists involve the sale or supply of medicines by different means (for example, via patient group directions or pharmacist prescribing) and are mainly aimed at improving access to medicines, other suggested developments shift community pharmacy practice into rather more unfamiliar territory. In particular, there is now increasing interest in the role that pharmacists might play in public health, and the term ‘pharmaceutical public health’ is increasingly heard within practice research circles and pharmacy policy more generally, both in the UK and abroad (Boorman et al. 2001; Anderson et al. 2003; Jones et al. 2004). For example, the Department of Health in England has devoted considerable attention to the idea of pharmaceutical public health.

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Crisis, Power, and Policymaking in the New Europe

Why Should Anthropologists Care?

Bilge Firat

At a time when European integration faces many crises, the efficacy of public policies decided in Brussels, and in member state capitals, for managing the everyday lives of average Europeans demands scrutiny. Most attuned to how global uncertainties interact with local realities, anthropologists and ethnographers have paid scant attention to public policies that are created by the EU, by member state governments and by local authorities, and to the collective, organised, and individual responses they elicit in this part of the world. Our critical faculties and means to test out established relations between global–local, centre–periphery, macro–micro are crucial to see how far the EU's normative power and European integration as a governance model permeates peoples' and states' lives in Europe, broadly defined. Identifying the strengths and shortcomings in the literature, this review essay scrutinises anthropological scholarship on culture, power and policy in a post-Foucaultian Europe.

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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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Andreea Deciu Ritivoi

Before identifying the roles of women writers and intellectuals in the current political climate in Eastern Europe, and particularly in Romania, let me first qualify the climate itself, as I see it.1 Over a decade a er the collapse of communism, the political situation in Romania is still very much a transitional one, defined by competing cultural and moral codes, widespread societal mistrust (intensified by the recent scandals surrounding collaboration with the political police, the Securitate) and anxiety about the future. In this context, women intellectuals in Romania have o en found themselves in difficult positions, accused by their more established male colleagues of trying to introduce new intellectual concepts and values on the cultural market for the sole purpose of drawing attention to themselves, opportunistically and in a facile manner.

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Roberta Raffaetà and Mark Nichter

On 18 December 2014, the results of the U.K.’s Research Excellence Framework (REF) evaluation exercise were released. This extensive and very costly exercise is intended to take the pulse of U.K. university-based research and now happens once every six years or so. It is also the principal tool used to determine the allocation of approximately £1.6 billion of quality-related (QR) research funding which maintains the fabric of research activity in U.K. HE institutions. Given the fiscal consequences of REF performance it is not surprising that that universities expended considerable time and effort preparing their submissions in the run-up to the exercise and that the results were pored over by academics and their managers across the country. This was a very complex set of runes to read.

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The Politics of Vodou

AIDS, Access to Health Care and the Use of Culture in Haiti

Catherine Benoît

During the past few years, the AIDS campaign in Haiti has been targeting Vodou officiants and organizations. These awareness and training programmes inform officiants about the transmission and prevention of AIDS, tests for HIV and antiretroviral drugs, or even try to encourage them to become involved in a medical referral system. These culturalist interventions are grounded in an essentialist concept of culture that can have harmful effects on the targeted groups. The concept of culture underlying such interventions is deconstructed along with the categories of traditional medicine and the 'tradipractitioner'. An approach to public health is advocated that would contextualize medical pluralism in Haiti.

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Re/Making Immigration Policy through Practice

How Social Workers Influence What It Means to Be a Refused Asylum Seeker

Kathryn Tomko Dennler

Refused asylum seekers living in the UK face hostility and legal restrictions on the basis of immigration status that limit access to statutory support, employment, and social goods. Working at a non-profit organization that offered an advice service for refused asylum seekers, I observed how the experiences of refused asylum seekers are constituted not simply by restrictions within immigration law, but rather by the ways in which laws are perceived and implemented by a wide range of actors. I argue that the legal consciousness of social workers hostile to refused asylum seekers plays an important role in making policy through practice. I show that social workers prioritized immigration enforcement over other legal obligations, thereby amplifying the meaning of immigration status and deepening the marginalization of refused asylum seekers.