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Taking Responsibility

Ovarian Cancer Patients’ Perspectives on Delayed Healthcare Seeking

Susanne Brandner, Wiebke Stritter, Jacqueline Müller-Nordhorn, Christina Fotopoulou, Jalid Sehouli and Christine Holmberg

Patient-related diagnostic delay has been established as an analytical category in cancer research. This category has come under critique because it postulates linear cause-and- effect explanations of delayed care-seeking. These explanations are based on a one-dimen- sional idea of causality that neglects the processual character and the contextual situatedness of bodily experiences and care-seeking decisions. Using a notion of causality that is both process-oriented and context-sensitive, this article aims to understand ovarian cancer patients’ stories on delayed healthcare seeking. It uses data from a qualitative interview study that investigated ovarian cancer patients’ illness and healthcare-seeking experiences. We suggest that the interviewees’ retrospective perspective generated a multi-layered notion of diagnostic delay that differs from the definition of patient-related delay commonly used in the litera- ture. Our analysis shows how interviewees negotiate current social discourses on health and (social) responsibility, and thereby situate themselves and their healthcare seeking within a broader socio-economic and political context.

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‘The Good Citizen’

Balancing Moral Possibilities in Everyday Life between Sensation, Symptom and Healthcare Seeking

Sara Marie Hebsgaard Offersen, Peter Vedsted and Rikke Sand Andersen

This article explores how healthcare-seeking practices and the transformation of bodily sensations into symptoms are embedded in what we term a ‘moral sensescape’ of ev- eryday life. Based on fieldwork in a suburban middle-class neighbourhood in Denmark, we discuss how a moral relation between the Danish welfare state and the middle-class popula- tion is embodied in a responsibility for individual health. Overall, we identify a striving to be a ‘good citizen’; this entails conflicting moral possibilities in relation to experiencing, inter- preting and acting on bodily sensations. We examine how people meet the conflicting moral possibilities of complying with current public health rhetoric on proper healthcare seeking, including timely presentation of symptoms, and simultaneously try to avoid misusing the healthcare system and be characterised as overly worried or even as a hypochondriac; this challenge constitutes complex navigational routes through the moral sensescape of the Danish middle class.

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Too Little, Too Late?

The Challenges of Providing Sexual and Reproductive Healthcare to Men on College Campuses

Lilian Milanés and Joanna Mishtal

Scholarship and advocacy work regarding reproductive health have often focused on women’s experiences. Concerns about men’s sexual and reproductive healthcare (SRH) have historically been on the margins in this context. In the United States, young men are at the greatest risk for sexually transmitted infections (STIs), yet are the least likely to seek SRH. Based on research with 18 healthcare providers in a large public Florida university clinic, we examined providers’ perspectives about expanding men’s SRH provision and utilisation. Research findings demonstrate inconsistent provider strategies in treating men’s SRH needs and a clinical environment that has low expectations of men receiving preventive care, further perpetuating the placement of SRH responsibility upon women. This article contributes to applied and medical anthropology scholarship on health inequalities through its discussion of the challenges and barriers that contribute to poor SRH for young men and the critical role of providers in this context.

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Rikke Sand Andersen, Mark Nichter and Mette Bech Risør

Inspired by the sensory turn in the humanities, anthropologists have coined the term ‘an anthropology of the senses’ to describe the study of the perceptual construction and output of bodily sensations and sense-modalities (cf. Howes 2006; Nichter 2008). Starting from the premise that different cultures and social settings configure, elaborate and extend the senses in different directions, key proponents have argued for a greater empirical and analytical attention to the cultural embeddedness and socio-biological basis of bodily perception and experience. This follows a rethinking of a series of theoretical (cf. Hinton et al. 2008; Ingold 2011) and methodological commitments in anthropology (cf. Pink 2009; Stoller 2004) that also holds relevance for anthropological studies of health and illness, which is the focus of this special issue on sensations, symptoms and healthcare seeking.

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Lisen Dellenborg and Margret Lepp

This article describes the development of ethnographic drama in an action research project involving healthcare professionals in a Swedish medical ward. Ethnographic drama is the result of collaboration between anthropology and drama. As a method, it is suited to illuminating, addressing and studying professional relationships and organisational cultures. It can help healthcare professionals cope with inter-professional conflicts, which have been shown to have serious implications for individual well-being, organisational culture, quality of care and patient safety. Ethnographic drama emerges out of participants’ own experiences and offers them a chance to learn about the unspoken and embodied aspects of their working situation. In the project, ethnographic drama gave participants insight into the impact that structures might have on their actions in everyday encounters on the ward.

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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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Intimate Uncertainties

Ethnographic Explorations of Moral Economies across Europe

Sabine Strasser and Luisa Piart

For this special issue we are bringing together six ethnographic cases of intimate uncertainties that are situated within different regimes of reproduction, healthcare and borders in and beyond Europe. These ethnographic inquiries exemplify unprecedented settings of moral ir/responsibility shaping the intimate on different scales and in various sites of power (agencies, clinics, borderlands). These uncertainties in times of major transitions from old to new moral orders, from industrial to postindustrial, from welfare to austerity spark off a renewed debate on moral economy. The authors of these contributions all focus the theoretical lens of moral economy squarely onto the intimate.

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Abigail Baim-Lance and Cecilia Vindrola-Padros

Academic funding bodies are increasingly measuring research impact using accountability and reward assessments. Scholars have argued that frameworks attempting to measure the use-value of knowledge production could end up influencing the selection of research topics, limiting research agendas, and privileging linear over complex research designs. Our article responds to these concerns by calling upon insights from anthropology to reconceptualise impact. We argue that, to conduct socially beneficial studies, impact needs to be turned from a product to an inclusive process of engagement. Anthropology's epistemologically and methodologically rich tradition of ethnography offers a particularly apposite set of tools to achieve this goal. We present three concrete examples of how we have used ethnography to impact on the work we carry out, particularly in shaping multidisciplinary team-based research approaches.

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Securitization, alterity, and the state

Human (in)security on an Amazonian frontier

Marc Brightman and Vanessa Grotti

English abstract: Focusing on the region surrounding the Maroni River, which forms the border between Suriname and French Guiana, we examine how relations between different state and non-state social groups are articulated in terms of security. The region is characterised by multiple “borders” and frontiers of various kinds, the state boundary having the features of an interface or contact zone. Several key collectivities meet in this border zone: native Amazonians, tribal Maroon peoples, migrant Brazilian gold prospectors, and metropolitan French state functionaries. We explore the relationships between these different sets of actors and describe how their mutual encounters center on discourses of human and state security, thus challenging the commonly held view of the region as a stateless zone and showing that the “human security” of citizens from the perspective of the state may compete with locally salient ideas or ex- periences of well-being.

Spanish abstract: El artículo examina cómo se articulan las relaciones en términos de seguridad entre grupos estatales y no estatales en la región que rodea el Río Maroni (frontera entre la Guyana francesa y Surinam). La región se caracteriza por múltiples “límites” y tipos de fronteras, teniendo así la frontera Estatal características de una zona de contacto o de una interfaz. Importantes comunidades se encuentran en esta zona de frontera: Nativos del Amazonas, comunidades tribales del Maroni, buscadores de oro brasileños y funcionarios estatales franceses. Los autores exploran las relaciones entre estas diferentes redes de actores, y describen la manera en que sus mutuos encuentros se centran en discursos de seguridad humana y del Estado, desafiando así, el tradicional enfoque que sostiene la región como una zona sin Estado y mostrando que la “seguridad humana” desde la perspectiva del Estado puede competir con importantes ideas locales o con experiencias de bienestar.

French abstract: En se concentrant sur la région entourant le fleuve Maroni, qui forme la frontière entre le Suriname et la Guyane française, nous examinons comment les relations entre les différents groupes sociaux étatiques et non-étatiques sont articulées en termes de sécurité. La région est caractérisée par de multiples «frontières» et les frontières de toutes sortes, la frontière de l'État ayant les caractéristiques d'une interface ou zone de contact. De nombreuses et importantes collectivités se rencontrent dans cette zone frontalière: Indigènes d'Amazonie, la communauté tribale Maroon, les migrants brésiliens à la recherche de l'or et les fonctionnaires d'Etat de la France métropolitaine. Nous explorons les relations entre ces différents groupes d'acteurs, et décrivons la manière dont leurs rencontres mutuelles sont centrées sur les discours relatifs à la sécurité humaine et l'État, remettant ainsi en cause l'idée communément admise de la région en tant zone apatride et montrant par la même que la «sécurité humaine» des citoyens perçue du point de vue de l'État peut rivaliser avec des idées saillantes au niveau local ou des expériences relatives au bien-être.

Open access

Julie Spray

Working at the nexus of medical anthropology and the anthropology of childhood, this article challenges three assumptions often embedded in child health policy: (1) children are the passive recipients of healthcare; (2) children’s knowledge of illness and their body can be assumed based on adult understandings; and (3) children’s healthcare can be isolated from their social relations. I explore these themes through the case study of a 2011 New Zealand government initiative to reduce the rates of rheumatic fever affecting low-income Māori and Pasifika children. Drawing on fieldwork with around 80 children at an Auckland primary school, I show how the ‘sore throat’ programme does not merely treat streptococcus A infections, but plays an active role in constituting children’s experiences and understandings of their bodies and illness, and in shaping healthcare practices in ways unintended by policy-makers.