, patriarchal societal systems and, more importantly, that Islamic ethics and Shari’a primarily govern those ethics ( Rahim 2013 ). Through our experience in teaching bioethics to medical residents and medical students, we have noticed that virtually all of
Abdulla Al Sayyari, Fayez Hejaili, and Faissal Shaheen
Exploitation is a prominent theme in recent critical academic observations of the workings of transnational medical research that recruit study subjects from less privileged se ttings. Kaushik Sunder Rajan, for example, illuminates the inherent
The articles in this special issue tackle a problem at the heart of medical anthropology today—a problem that bedevils our methods, theoretical ambitions and public stance in the world. How should we rank the relative importance of local cultural meanings, on the one hand, and large-scale political and economic forces, on the other? That is, how should we train our sights on both culture and politics as we study the social contexts of suffering and apply our expertise to the worlds of policymaking and service delivery? How do we keep ‘culture’ and ‘politics’ in motion (and both are very broad analytical terms) without lapsing into one-sided analyses that champion the one term at the expense of the other? The following articles significantly advance the debate about such issues. They offer powerful theoretical models of the dialectic between culture-specific illness idioms and the operations of power that constrain people’s lives. They also re-think the very notion of culture in light of the complex networks—connecting individuals to nationstates, empires, NGOs, pharmaceutical firms and global capital—in which medical anthropologists increasingly work.
This article explores a specific kind of student–patient interaction in Egypt. It demonstrates how the increasing need for patients in medical schools and the shift to a neoliberal economy have generated a population of 'bioavailable' professional patients who find meaning in their diseases and sell knowledge about them in medical schools. The encounter with these patients causes tensions and has its high financial costs for the students; yet, some perceive it as a solution to the shortcomings of the medical system. Furthermore, students view professional patients as a cooperative group who possess extensive medical knowledge and relate to their bodies differently compared to 'ordinary' patients. The encounter highlights the inadequacies pertinent to medical education in this system and shows that the rhetoric of patient-centred training, a common model around the world, can lead to inverted power relations and imbalances in the student–patient encounter.
The Case of Emergency Medicine
This article first describes the unique place of emergency medicine (EM) within the American healthcare system. Second, it examines the uncertainty that underlies the practice of emergency medicine. It then describes how risk is perceived, negotiated and minimised by emergency physicians in their day-to-day practice. Finally, it explores how the management of medical risk is related to the establishment of trust within the physician–patient interaction and to the construction of the 'competent physician'. In caring for patients, the emergency physician must minimise risk and instil trust within a pressured, time-sensitive environment. Consequently, the management of risk and display of competence to patients are simultaneously accomplished by symbolic representations, the use of medical diagnostic tools in decision-making, and narrative construction within the clinical interaction.
Explanatory Models, Philosophies and Behaviour
Analysis of my ethnographic data on medical popular culture in tribal south-west Iran, mostly from 1965 to 1983, suggests several traditional explanatory models and philosophical tenets that guide approaches to health issues. Empirical knowledge of natural processes motivates people to observe their bodily requirements. The belief in God's autocratic power is tempered with God's purported wish that people use their abilities to take responsibility for their health, complicating the notion of 'fate'. The various models provide health management choices. Traditionally, patients and healers shared these models, acting on the same cosmological assumptions.
What, if not Durkheim’s ‘collective representations’ acquired during exalted states of effervescence, gives rise to society, culture and science? Marcel Mauss provides another answer by pointing to the different rhythms of social relationships and the human effort to synchronise them. The seasonal cycle of the Eskimo [Inuit], Mauss argues, is in accord with their game; hence people disperse in summer to pursue economic activities in small bands, while they congregate in dense house-complexes in winter and engage in ritual. It would appear that Mauss draws heavily on Boas’s contrast between the Kwakiutl winter celebrations and their ‘uninitiated’ livelihood in summer. These insights have traction for medical anthropologists who are interested in finding an anthropological explanation for the efficaciousness of ‘traditional’ medicines or ‘indigenous’ healing techniques.
In an earlier paper (Dressler, 2001), I suggested that medical anthropology as a research enterprise could not ignore either meaning or structure in human social life in the production of health. Rather, drawing on the early work of Bourdieu, I argued that we need to take into account both how the world is configured by the collective meanings we impose upon it, as well as the social structural (and physical) constraints on our behaviour that exist outside those meanings. Human health can be understood, in part, as the intersection of meaning and structure. Here, my aim is to extend this perspective in three ways. Firstly, I present an expanded theoretical framework within which collectivei meaning and social structure can be conceptualised. A useful theoretical framework must take into account paradoxical features of culture, including the seeming contradiction that it is a property both of social aggregates and of individuals, and that, ultimately, social structural constraints external to individuals depend on shared meaning. Secondly, I review recent research employing this perspective conducted in Brazil, the southern United States and Puerto Rico. These studies have all employed a 'structural-constructivist' theoretical orientation, using especially the concept of 'cultural consonance', or the degree to which individuals incorporate shared meaning into their own beliefs and behaviour. Where individual efforts to attain a higher cultural consonance are frustrated by structural constraints, poor health results. Thirdly, I consider some of the policy implications of this perspective. While much work in traditional public health focuses on a highly individualised notion of meaning (as in 'health beliefs'), it seems unlikely that the health of populations can be altered substantially without taking into account the structures that constrain individual action.
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.
Penetrating “the fog of health” in a Nigerian community, 1970–2017
Too often, research into the health of a particular community is brief and superficial, focusing only on what is public and leaving the private health of women and children ‘foggy’. By contrast, long-term anthropology can offer access to processes taking place within a local culture of illness. Here, an account of a community’s experience of health over the past 50 years not only outlines the key changes as seen anthropologically but also shows how even close ethnography can initially miss important data. Furthermore, the impact of a researcher – both as a guest and as a source of interference – underlines how complex fieldwork can be in reality, especially if seen through the eyes of the researcher’s hosts.