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Medical Anthropology Quarterly / Medical Anthropological Quarterly

Impact factor: 1.938 5-Year impact factor: 1.818 Print ISSN: 0745-5194 Online ISSN: 1548-1387 Publisher: Wiley Blackwell (Blackwell Publishing)

Subjects: Anthropology, Public, Environmental & Occupational Health, Biomedical Social Sciences

Most recent papers:

  • Pregnant Metaphors and Surrogate Meanings: Bringing the Ethnography of Pregnancy and Surrogacy into Conversation in Israel and Beyond.
    Tsipy Ivry, Elly Teman.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. October 11, 2017
    This article explores the way that surrogacy and normal pregnancy share cultural assumptions about pregnancy. Through a juxtaposition of our ethnographic studies of two groups of Jewish–Israeli women—women who have undergone “normal,” low‐risk pregnancies and women who have given birth as gestational surrogates—we argue that surrogacy and pregnancy emerge as potent metaphors for one another. Both pregnant women and surrogates divided their bodies into two separate realms: fetus and maternal pregnant body. Both trivialized the effect of gestational influence on fetal health, making the fetus seem detached from gestational capacities of the mother. We argue for closer scrutiny of the way local cultural priorities and experiences of pregnancy shape surrogacy and for bringing the scholarship on pregnancy and on surrogacy into deeper conversation. This article is protected by copyright. All rights reserved
    October 11, 2017   doi: 10.1111/maq.12419   open full text
  • The Attachment Imperative: Parental Experiences of Relation‐making in a Danish Neonatal Intensive Care Unit.
    Laura E. Navne, Mette N. Svendsen, Tine M. Gammeltoft.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. October 08, 2017
    In this article, we explore how parents establish relations with extremely premature infants whose lives and futures are uncertain. Drawing on ethnographic fieldwork in a Danish Neonatal Intensive Care Unit (NICU), we engage recent discussions of the limits of conventional anthropological thinking on social relations and point to the productive aspects of practices of distance and detachment. We show that while the NICU upholds an imperative of attachment independently of the infant's chances of survival, for parents, attachment is contingent on certain hesitations in relation to their infant. We argue that there are nuances in practices of relationmaking in need of more attention (i.e., the nexus of attachment and detachment). Refraining from touching, holding, and feeding their infants during critical periods, the parents enact detachment as integral to their practices of attachment. Such “cuts” in parent–infant relations become steps on the way to securing the infant's survival and making kin(ship). We conclude that although infants may be articulated as “maybe‐lives” by staff, in the NICU as well as in Danish society, the ideal of attachment appears to leave little room for “maybe‐parents.”
    October 08, 2017   doi: 10.1111/maq.12412   open full text
  • “Corporate Mortality Files and Late Industrial Necropolitics”.
    Peter C. Little.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. October 05, 2017
    This article critically examines the corporate production, archival politics, and socio‐legal dimensions of Corporate Mortality Files (CMFs), the largest corporate archive developed by International Business Machine's Corporation (IBM) to systematically document industrial exposures and occupational health outcomes for electronics workers. I first provide a history of IBM's CMF project, which amounts to a comprehensive mortality record for IBM employees over the past 40 years. Next, I explore a recent case in Endicott, New York, birthplace of IBM, where the U.S. National Institute for Occupational Safety and Health (NIOSH) studied IBM's CMFs for workers at IBM's former Endicott plant. Tracking the production of the IBM CMF, the strategic avoidance of this source of Big Data as evidence for determining a recent legal settlement, alongside local critiques of the IBM CMF project, the article develops what I call “late industrial necropolitics.” This article is protected by copyright. All rights reserved
    October 05, 2017   doi: 10.1111/maq.12417   open full text
  • Living the Social Determinants of Health: Assemblages in a Remote Aboriginal Community.
    Richard D. Chenhall, Kate Senior.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. October 05, 2017
    This article provides a critical discussion of the social determinants of health framework and compares it with theoretical perspectives, such as that offered by assemblage theory, offering an alternative view of the complex interplay between human relationships and the structures around us. We offer an ethnographic perspective, discussing the lived experiences of the social determinants in an Indigenous community in a remote part of northern Australia. [Indigenous health, social determinants of health, assemblages, ethnography, medical anthropology] This article is protected by copyright. All rights reserved
    October 05, 2017   doi: 10.1111/maq.12418   open full text
  • Handle with Care: Rethinking the Rights versus Culture Dichotomy in Cancer Disclosure in India.
    Cecilia Coale Hollen.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. September 18, 2017
    Medical practitioners, bioethicists, psychologists, and anthropologists have debated whether it is ethical to disclose or withhold information from patients about cancer diagnoses. This debate is framed as pitting universal individual human rights against cultural pluralism. The rights‐based argument asserts that people have a right to information about their own health to make the best decisions about their treatment. The cultural variation argument suggests that in some cultural contexts there is a perception that information about one's cancer diagnosis may cause more harm than good due to the psychological trauma this may cause. Based on ethnographic research with cancer patients in India, I argue that both sides of this debate overemphasize the importance of the content of the information that may be disclosed or withheld and underestimate the central ways in which the act of disclosing or withholding information is evaluated as a symbol of care of paramount concern to patients.
    September 18, 2017   doi: 10.1111/maq.12406   open full text
  • Care in the Context of a Chronic Epidemic: Caring for Diabetes in Chicago's Native Community.
    Margaret Pollak.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. August 11, 2017
    American Indians have some of the highest rates of diabetes worldwide, and they are disproportionately affected by the secondary complications of the disease. While most research on Native populations focuses on reservations, this study investigates diabetes care in Chicago's Native community. People living with diabetes manage blood sugar levels to prevent the development of secondary complications. As with many diabetics, the majority of their health care work is completed outside of the biomedical setting. In this article, I explore how, in a community facing epidemic rates of disease, care is enmeshed in the everyday lives of not just those living with the disease but also significant others. As care in this context is accomplished across multiple spheres, from inside individual households to community‐wide considerations, Chicago's intertribal community ties are strengthened. Care, in this sense, becomes a (perhaps tragic) means of Native American community building tied to cultural identity. This article is protected by copyright. All rights reserved
    August 11, 2017   doi: 10.1111/maq.12405   open full text
  • Only Near Is Dear? Doing Elderly Care with Everyday ICTs in Indian Transnational Families.
    Tanja Ahlin.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. August 09, 2017
    In Kerala, South India, young people, especially women, are encouraged to become nurses in order to migrate abroad for work and thereby improve the financial status of their family. Meanwhile, many of their parents remain in India by themselves. This is occurring in the context of a strong popular discourse of elder abandonment, related to the local norms of intergenerational co‐habitation. Based on fieldwork in Kerala and one of the nurses’ destination countries, Oman, I present evidence that complicates this discourse by showing how: (1) migration is a form of elder care practice in itself; and (2) care for the elderly continues across countries and continents with the help of information and communication technologies (ICTs). Using the theoretical approaches of science and technology studies, I analyze ICTs as key members of care collectives and argue that ICTs have a significant role in reshaping care relations at a distance. This article is protected by copyright. All rights reserved
    August 09, 2017   doi: 10.1111/maq.12404   open full text
  • Efficacious Holidays: The Therapeutic Dimensions of Pleasure and Discipline in Czech Respiratory Spas.
    Susanna Trnka.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. August 04, 2017
    As evidence‐based medicine has increasingly become the standard for assessing the efficacy of health care, the Czech Republic finds itself in a dilemma, with centuries of sanatorium‐style spa treatments resisting easy categorization. Despite some critics’ contentions that spas are “pointless holidays” and reductions in government funding of health spas, in 2014 Czech courts affirmed every Czech citizen's right to spa treatments if their health status merits it. Drawing on research in two children's respiratory spas, this article considers the experiences of patients aged two–15 and their accompanying parents or guardians (mainly mothers) to suggest that in addition to the range of therapeutic procedures highlighted within spa cures, more amorphous aspects—such as pleasure and discipline—may be just as central to spas’ successes. Indeed, as some spa physicians contend, spas may be considered a “package deal,” to which EBM criteria is not easily applied. This article is protected by copyright. All rights reserved
    August 04, 2017   doi: 10.1111/maq.12403   open full text
  • To Keep this Disease from Killing You: Cultural Competence, Consonance, and Health among HIV‐positive Women in Kenya.
    Toni Copeland.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. August 02, 2017
    The HIV/AIDS crisis continues in sub‐Saharan Africa, where nearly 70% of infections are found. Despite recent efforts to supply antiretroviral therapy to those infected, most are not receiving medication and are forced to rely on self‐management to remain healthy. In Kenya, many of those infected are women living in extreme poverty. This article presents the findings of research among poor women in Nairobi that examined the relationship between knowledge of a cultural model of self‐managing HIV/AIDS, cultural consonance, and health. This biocultural study expands on earlier findings showing that knowledge of the model (competence) is a significant predictor of health by examining here how behavior consistent with that knowledge (consonance) affects health outcomes, as measured by CD4 counts, perceived stress, depressive symptoms, and recent illnesses. It concludes that knowledge of the model is a significant predictor of health, even after controlling for demographic data and behaviors. This article is protected by copyright. All rights reserved
    August 02, 2017   doi: 10.1111/maq.12402   open full text
  • From the “Technician Thing” to the “Mental Game”: Masculinity and U.S. Homebirth.
    April Driesslein.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. July 20, 2017
    Previous research on pregnancy and birth from the perspective of men has found that men approach them from the perspective of hegemonic masculinity, though many find that hospital birth is a time of potential failure at masculinity. In this qualitative study of 11 men who had children born at home, I find that, like their hospital‐birth counterparts, they find roles in their partners’ pregnancies and early labors that are congruent with hegemonic masculinity. In ways that converge and diverge with the experience of hospital‐birth fathers, they find their masculinity disrupted as the birth approaches, becoming nurturers and servers rather than technicians and protectors. These acts shift them from the masculinity of a young man to that of a father. This is consonant with Connell's (1995) theory that masculinity is not singular, but shifts situationally and across the life course, and Butler's (2003) theory that gender is constructed through acts.
    July 20, 2017   doi: 10.1111/maq.12338   open full text
  • (In)visibility online: the benefits of online patient forums for people with a hidden illness: the case of multiple chemical sensitivities (MCS).
    Tarryn Phillips, Tyson Rees.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. July 20, 2017
    Sufferers of medically unexplained conditions that are not observable in the clinic can experience multiple layers of invisibility: a lack of biomedical diagnosis; legal skepticism; political disinterest; and a loss of their prior social identity. For those with environmental sensitivities, this is compounded by literal hiddenness due to often being housebound. Drawing on an online survey of people with multiple chemical sensitivity, this article examines how the everyday experience of invisibility is mitigated by engaging with other patients online. Respondents used online forums to undertake various forms of “visibility work,” including attempts to crystallize their suffering into something recognizable medically, legally, and politically, and to reconstruct an identity considered valid and deserving—although the therapeutic potential of online support was contingent on intra‐group politics. This study demonstrates that online forums allow biomedicine's “invisible others” to struggle for alternative forms of recognition beyond the clinical gaze. This article is protected by copyright. All rights reserved
    July 20, 2017   doi: 10.1111/maq.12397   open full text
  • Security and the Traumatized Street Child: How Gender Shapes International Psychiatric Aid in Cairo.
    Rania Kassab Sweis.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. July 11, 2017
    There is no abstract available for this paper.
    July 11, 2017   doi: 10.1111/maq.12392   open full text
  • Body Image Models among Low‐income African American Mothers and Daughters in the Southeast United States.
    Martina Thomas, Jason A. DeCaro.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. July 09, 2017
    Obesity among low‐income African American women has been studied using the concepts of both satisfaction and acceptance. The satisfaction frame suggests greater satisfaction with their bodies than their white counterparts, irrespective of size. The acceptance frame suggests that alternative aesthetics serve as resistance against intersectional marginalization. Yet, while these women accept their body size in defiance of thinness ideals, they may not be satisfied. We describe cultural models of body image among mothers and daughters in Alabama. We found that respectability, material consumption, and parental support were important factors determining positive body image, exceeding descriptions of physical features. We further found that those expressing greater body dissatisfaction emphasized respectability, whereas those with less dissatisfaction assigned importance to consumerism and physical form. These findings suggest divergences between biomedical messaging and lived experience. They also challenge uncritical or universalist applications of these frames when interpreting African American women's perceptions of their own bodies.
    July 09, 2017   doi: 10.1111/maq.12390   open full text
  • Buffering the Uneven Impact of the Affordable Care Act: Immigrant‐serving Safety‐net Providers in New Mexico.
    Christina M. Getrich, Jacqueline M. García, Angélica Solares, Miria Kano.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. July 09, 2017
    We conducted a study in early 2014 to document how the initial implementation of the Affordable Care Act (ACA) affected health care provision to different categories of immigrants from the perspective of health care providers in New Mexico. Though ACA navigators led enrollment, a range of providers nevertheless became involved by necessity, expressing concern about how immigrants were faring in the newly configured health care environment and taking on advocacy roles. Providers described interpreting shifting eligibility and coverage, attending to vulnerable under/uninsured patients, and negotiating new bureaucratic barriers for insured patients. Findings suggest that, like past efforts, this recent reform to the fragmented health care system has perpetuated a condition in which safety‐net clinics and providers are left to buffer a widening gap for immigrant patients. With possible changes to the ACA ahead, safety‐net providers’ critical buffering roles will likely become more crucial, underscoring the necessity of examining their experiences with past reforms.
    July 09, 2017   doi: 10.1111/maq.12391   open full text
  • “The First Intervention Is Leaving Home”: Reasons for Electing an Out‐of‐hospital Birth among Minnesotan Mothers.
    Helen Hazen.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 01, 2017
    The Twin Cities (Minneapolis–St. Paul), Minnesota, has seen a recent increase in the number of mothers seeking an out‐of‐hospital birth. This research uses in‐depth interviews with 24 mothers who intended an out‐of‐hospital birth in the previous two years, exploring their reasons for pursuing an alternative approach to birth. For many women, an out‐of‐hospital birth fits within a philosophy that rejects the pathologizing of birth. Escaping rigid hospital protocols is seen as critical to avoiding what many mothers described as unnecessary interventions. In addition, homebirth midwives are perceived as offering more holistic care for the expectant and new mother. Home itself is seen as providing a more pleasant and calm, family‐friendly atmosphere than a hospital, helping the mother relax, with the expectation that this will expedite labor. Many of the recommendations developed here have applicability to improving hospital birth experiences as well as furthering our understanding of out‐of‐hospital birth.
    June 01, 2017   doi: 10.1111/maq.12358   open full text
  • Normal, Regular, and Standard: Scaling the Body through Fecal Microbial Transplants.
    Matthew J. Wolf‐Meyer.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 25, 2017
    In 2013, the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) held a workshop to determine the risks and benefits associated with the experimental use of fecal microbial transplants to treat Clostridium difficile and other gastroenterological disorders. By focusing on the proceedings of the NIH–FDA workshop on the treatment of the human microbiome, the question of how medicine colonizes human bodies through microbial transplants raises questions about what an individual body is, how determinative of human health the microbiome is, and what the limits of molecular biomedicine are when the microbiome is taken into consideration. In the workshop presentations and discussion of this emerging treatment, experts used ideas about the normal, regular, and standard to move between scales of bodily analysis, from the microbial to the body politic, demonstrating how the individual and society are deeply influenced by the unruly community of microbial symbiotes that humans host.
    May 25, 2017   doi: 10.1111/maq.12328   open full text
  • Neocolonialism and Health Care Access among Marshall Islanders in the United States.
    Michael R. Duke.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 24, 2017
    In the Marshall Islands, a history of extensive nuclear weapons testing and covert biomedical research, coupled with the U.S.’s ongoing military presence in the country, has severely compromised the health of the local population. Despite the U.S.’s culpability in producing ill health along with high rates of emigration from the islands to the mainland United States, the large portion of Marshallese who reside in the United States face substantial barriers to accessing health care. Drawing from ongoing field research with a Marshallese community in Arkansas, this article explores the multifaceted impediments that U.S.‐based Marshall Islanders face in receiving medical treatment. Calling on an expansive and inclusive notion of neocolonialism, I argue that Marshallese structural vulnerability with regard to health and health care treatment derives from their status as neocolonial subjects and from their limited claims to health‐related deservingness associated with this status. [Marshall Islanders, health care access, neocolonialism, radiation exposure, immigrant health] L̗ōmn̗ak ko rōttin̗o: Ilo M̗ajel̗, juon bwebwenato kōn kōmmālmel im nuclear baam̗ ko im ekkatak ko rōttin̗o̗ kōn wāwein an baijin ko jelōt armej, barāinwōt an to an ri tarinae ro an Amedka pād ilo aelōn̄ kein, em̗ōj an jelōt ājmour an armej ro ilo aelōn̄ kein. Men̄e alikkar bwe Amedka in ear jino nan̄inmej kein im ej un eo armej rein rej em̗m̗akūt jān āne kein āne er n̄an ioon Amedka, elōn̄ iaan ri M̗ajel̗ rein rej jelm̗ae elōn̄ apan̄ ko n̄an aer del̗o̗n̄e jikin ājmour ko. Jān ekkatak eo ej bōk jikin kiō, jerbal in ej etali kabōjrak rak kein rōlōn̄ im armej in M̗ajel̗ ro ioon Amedka in rej jelm̗ae ilo aer jibadōk lo̗k jikin taktō. Ilo an kar Amedka jibadōk juon jea eo eutiej imejān lal̗ in, ij kwal̗ok juon aō akweelel bwe apan̄ ko an armej in M̗ajel̗ ikijjeen ājmour im jikin taktō ej itok jān aer kar ri kōm̗akoko ilo an kar Amedka lelōn̄ l̗o̗k etan ilo mejān lal̗ im jān aer jab pukot jipan kein ej aer bwe kōn jōkjōk in.
    May 24, 2017   doi: 10.1111/maq.12376   open full text
  • Recognizing Dementia: Constructing Deconstruction in a Danish Memory Clinic.
    Iben M. Gjødsbøl, Mette N. Svendsen.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 21, 2017
    This article investigates how a person with dementia is made up through intersubjective acts of recognition. Based on ethnographic fieldwork in a Danish memory clinic, we show that identification of disease requires patients to be substituted by their relatives in constructing believable medical narratives; yet during memory testing, patients are not allowed any substitution to clearly expose cognitive shortcomings. In combining works of theorists Ian Hacking and Paul Ricoeur, we argue that the clinical identification of dementia unmakes the knowing subject, a deconstruction that threatens to misrecognize and humiliate the person under examination. The article ends by proposing that dementia be the condition that forces us to rethink our ways of recognizing persons more generally. Thus, dementia diagnostics provide insights into different enactments of the person that invite us to explore practices of substitution and modes of interaction emerging when our fundamental dependency becomes unquestionable.
    May 21, 2017   doi: 10.1111/maq.12365   open full text
  • Embedded Narratives: Metabolic Disorders and Pentecostal Conversion in Samoa.
    Jessica Hardin.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 21, 2017
    Drawing from interviews and participant observation, this article explores the intersection of diagnosis of metabolic disorders and religious conversion among Pentecostal Christians in Samoa by analyzing what I call embedded narratives––conversion narratives embedded in illness narratives. Drawing from ethnographic data, I examine how using conversion narrative conventions enabled those living with metabolic disorders to narrate behavior change in a culturally and socially valorized way. By embedding their narratives, I suggest those living with metabolic disorders shifted the object of care from a disease process toward the creation of a religious life and in turn transformed the risks associated with metabolic disorders, including diet, exercise, and pharmaceutical use into moral risks associated with everyday religious life. In these cases, Pentecostal conversion created possible scripts for changing health practices, managing stress, and shifting resource use in the name of religious commitment, providing insights into how self‐care can be an expression of religious practice. [metabolic disorders, Christianity, narrative, conversion, self‐care]
    May 21, 2017   doi: 10.1111/maq.12368   open full text
  • “You Can Learn Merely by Listening to the Way a Patient Walks through the Door”: The Transmission of Sensory Medical Knowledge.
    Gili Hammer.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 21, 2017
    Examining the mechanisms of medical knowledge transfer, this article addresses the ways nonvisual senses are employed within medical training, asking about the role of sound, touch, and movement in transmitting knowledge of the body. Based on a 10‐month ethnography in a medical massage training course for blind students, the article examines the ways sensory medical knowledge is transferred in this setting. I discuss the multisensory characteristics of medical knowledge transfer, and the dual process inherent in this sensory pedagogy, in which senses such as touch and hearing undergo medicalization and scientification, while medicine enters the realm of the sensorial. Contributing to emerging research of nonvisual senses in medical training, this case study allows rethinking larger processes of medical knowing, challenging the dominancy of vision as the means of scientific knowledge transmission, and exposing the multisensorial elements of medical perception, and learning in general.
    May 21, 2017   doi: 10.1111/maq.12366   open full text
  • From Reproductive Rights to Responsibilization: Fashioning Liberal Subjects in Mexico City's New Public Sector Abortion Program.
    Elyse Ona Singer.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 21, 2017
    Building on medical anthropology literature that analyzes doctor–patient interactions as a charged site for the production of political subjectivities, I demonstrate how a central feature of Mexico City's new public sector abortion program involves “responsibilization.” In accordance with entrenched Ministry of Health objectives, providers transmit a suite of values about personal responsibility and self‐regulation through the use of birth control, hinging abortion rights to responsible reproductive subjectivity. Based on 18 months of ethnographic research across program clinics, including 75 interviews with patients and providers, I show how interrupción legal del embarazo protocols fashion “responsibilized” liberal subjects. I argue that the recent granting of abortion rights in Mexico City—ostensibly a new moment for the construction of women's citizenship—instead reflects and extends long‐standing state agendas of “reproductive governance.” My analysis of reproductive rights as the newest framing of ongoing population policies in Mexico adds to a critical anthropology of human rights and of liberal projects of governance.
    May 21, 2017   doi: 10.1111/maq.12321   open full text
  • Ethical Gifts?: An Analysis of Soap‐for‐data Transactions in Malawian Survey Research Worlds.
    Crystal Biruk.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 21, 2017
    In 2008, thousands of Malawians received soap from an American research project as a gift for survey participation. Soap was deemed an ethical, non‐coercive gift by researchers and ethics boards, but took on meanings that expressed recipients’ grievances and aspirations. Research participants reframed soap and research benefits as “rights” they are entitled to, wages for “work,” and a symbol of exploitation. Enlisting the perspectives of Malawi's ethics board, demographers, Malawian fieldworkers, and research participants, I describe how soap is spoken about and operates in research worlds. I suggest that neither a prescriptive nor a situated frame for ethics—with their investments in standardization and attention to context, respectively—provides answers about how to compensate Malawian research participants. The conclusion gestures toward a reparative framework for thinking ethics that is responsive not just to project‐based parameters but also to the histories and political economy in which projects (and ethics) are situated.
    May 21, 2017   doi: 10.1111/maq.12374   open full text
  • Guadalupan Devotion as a Moderator of Psychosocial Stress among Mexican Immigrants in the Rural Southern United States.
    Mary Rebecca Read‐Wahidi, Jason A. DeCaro.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 17, 2017
    This study considers how shared devotion to the Virgin of Guadalupe among Mexican immigrants in rural Mississippi buffers the effects of immigration stress. Rural destinations lacking social services can quickly compound the already stressful experience of immigration. Guadalupe devotion provides a way of coping with the daily life stressors of immigration. We test the hypothesis that high consonance in the cultural model of Guadalupan devotion will moderate the adverse health effects of immigration stress. Results indicate that as exposure to immigration stressors increased, well‐being decreased among those with low consonance, while the effect was eliminated in those with high consonance. Findings demonstrate the advantage of expanding research on coping to incorporate complex models that consider religious and secular elements and also illustrate how a master symbol, characterized as a cultural model of coping with limited local distribution, yields health effects dissimilar to the mediation normally associated with consonance.
    May 17, 2017   doi: 10.1111/maq.12372   open full text
  • Shifting Gears: Triage and Traffic in Urban India.
    Harris Solomon.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 17, 2017
    While studies of triage in clinical medical literature tend to focus on the knowledge required to carry out sorting, this article details the spatial features of triage. It is based on participation observation of traffic‐related injuries in a Mumbai hospital casualty ward. It pays close attention to movement, specifically to adjustments, which include moving bodies, changes in treatment priority, and interruptions in care. The article draws on several ethnographic cases of injury and its aftermath that gather and separate patients, kin, and bystanders, all while a triage medical authority is charged with sorting them out. I argue that attention must be paid to differences in movement, which can be overlooked if medical decision‐making is taken to be a static verdict. The explanatory significance of this distinction between adjustment and adjudication is a more nuanced understanding of triage as an iterative, spatial process.
    May 17, 2017   doi: 10.1111/maq.12367   open full text
  • Electronic Health Records and the Disappearing Patient.
    Linda M. Hunt, Hannah S. Bell, Allison M. Baker, Heather A. Howard.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 16, 2017
    With rapid consolidation of American medicine into large‐scale corporations, corporate strategies are coming to the forefront in health care delivery, requiring a dramatic increase in the amount and detail of documentation, implemented through use of electronic health records (EHRs). EHRs are structured to prioritize the interests of a myriad of political and corporate stakeholders, resulting in a complex, multi‐layered, and cumbersome health records system, largely not directly relevant to clinical care. Drawing on observations conducted in outpatient specialty clinics, we consider how EHRs prioritize institutional needs manifested as a long list of requisites that must be documented with each consultation. We argue that the EHR enforces the centrality of market principles in clinical medicine, redefining the clinician's role to be less of a medical expert and more of an administrative bureaucrat, and transforming the patient into a digital entity with standardized conditions, treatments, and goals, without a personal narrative.
    May 16, 2017   doi: 10.1111/maq.12375   open full text
  • The Work of Inscription: Antenatal Care, Birth Documents, and Shan Migrant Women in Chiang Mai.
    Bo Kyeong Seo.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 16, 2017
    For transnational migrant populations, securing birth documents of newly born children has crucial importance in avoiding statelessness for new generations. Drawing on discussions of sovereignty and political subjectivization, I ask how the fact of birth is constituted in the context of transnational migration. Based on ethnographic data collected from an antenatal clinic in Thailand, this article describes how Shan migrant women from Myanmar (also known as Burma) utilize reproductive health services as a way of assuring a safe birth while acquiring identification documents. Paying close attention to technologies of inscription adopted for maternal care and birth registration, I argue that enacting bureaucratic documents offers a chance for migrant women to bridge the interstice between human and citizen. Birth certificates for migrant children, while embodying legal ambiguity and uncertainty, epitomize non‐citizen subjects’ assertion of their political relationship with the state.
    May 16, 2017   doi: 10.1111/maq.12342   open full text
  • The New Rich and Their Unplanned Births: Stratified Reproduction under China's Birth‐planning Policy.
    Lihong Shi.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 23, 2017
    This article explores the creation and ramifications of a stratified reproductive system under China's state control of reproduction. Within this system, an emerging group of “new rich” are able to circumvent birth regulations and have unplanned births because of their financial capabilities and social networks. While China's birth‐planning policy is meant to be enforced equally for all couples, the unequal access to wealth and bureaucratic power as a result of China's widening social polarization has created disparate reproductive rights and experiences. This article identifies three ways in which reproductive privileges are created. It further explores how a stratified reproductive system under state population control reinforces social polarization. While many socially marginalized couples are unable to register their unplanned children for citizenship status and social benefits, the new rich are able to legitimate their births and transfer their privilege and status to their children, thus reproducing a new generation of elites.
    March 23, 2017   doi: 10.1111/maq.12352   open full text
  • Mohit's Pharmakon: Symptom, Rotational Bodies, and Pharmaceuticals in Rural Rajasthan.
    Andrew McDowell.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 21, 2017
    This article reexamines medical anthropology theories of symptom, illness, and disease to consider unregulated medical care in India. It builds on clinical observations, an inventory of the pharmaceuticals used by men who call themselves “Bengali doctors,” and their patients to understand medical care in a context that privileges symptom not disease. It draws on Derrida's use of pharmakon to outline the complexities of care and embodiment and helps locate local and medical anthropology theories of symptom and pharmaceuticals within theories of the experiential body. It asks two key questions: What is medical care without disease and what are its implications on a local biology in which disease‐based biomedicine is modified? Searching for a tentative answer, it works to bring medical anthropology's interest in symptom back to the body without losing symptoms’ connection to political economies, individual experience, and localized biomedicine.
    March 21, 2017   doi: 10.1111/maq.12345   open full text
  • The Irrelevance Narrative: Queer (In)Visibility in Medical Education and Practice.
    William J. Robertson.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 19, 2017
    How might heteronormativity be reproduced and become internalized through biomedical practices? Based on in‐depth, person‐centered interviews, this article explores the ways heteronormativity works into medical education through the hidden curriculum. As experienced by my informants, case studies often reinforce unconscious heteronormative orientations and heterosexist/homophobic stereotypes about queer patients among straight and queer medical students alike. I introduce the concept of the irrelevance narrative to make sense of how queer medical students take up a heteronormative medical gaze. Despite recognizing that being queer affects how they interact with patients, my informants describe being queer as irrelevant to their delivery of care. I conclude with a discussion of how these preliminary findings can inform research on knowledge production in biomedical education and practice with an eye toward the tensions between personal and professional identity among biomedical practitioners.
    March 19, 2017   doi: 10.1111/maq.12289   open full text
  • Ethics in Numbers: Auditing Cleft Treatment in Mexico and Beyond.
    Samuel Taylor‐Alexander.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 12, 2017
    Plastic surgeons around the globe are implementing projects that mix audit with medical research to ensure and improve the level of care offered to patients with cleft lip and palate. Drawing on recent literature on “audit culture” and the global growth of “performance indicators” as a form of governance, I demonstrate the conjugation of ethics and the production of numerical indicators in cleft treatment. By standardizing documentation, cleft treatment audit programs facilitate evidence‐based medicine and a form of reflexive self‐governance. However, the abstraction that accompanies standardization is amplified as corollary data practices travel. In emerging as the answer to improving treatment, these projects lock out the politico–economic factors that mediate medical care in resource poor settings. This danger is compounded by the tendency of numerical governance to replace political conversation with technocratic expertise.
    March 12, 2017   doi: 10.1111/maq.12337   open full text
  • Negotiations of Blame and Care among HIV‐positive Mothers and Daughters in South Africa's Eastern Cape.
    Beth Vale, Rebecca Hodes, Lucie Cluver.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 12, 2017
    Research delineates two epidemiological categories among HIV‐positive adolescents: those who contract the virus sexually and those who inherit it as infants. In this article, we are interested in how tacit inferences about adolescents’ mode of infection contribute to their experiences of HIV‐related blame, and their ability to achieve care, in their intimate, everyday settings. The analysis arises from ethnographic research with 23 HIV‐positive adolescents living in South Africa's Eastern Cape. From these, we draw particularly on the narratives of four HIV‐positive teenage girls and their HIV‐positive mothers. The article explores the social stakes entailed in ascriptions of adolescents’ mode of infection, particularly in terms of how blame was allocated between mothers and daughters. It further considers how these families have sought to negotiate repudiation and thereby sustain intergenerational care. The article furthers limited research on the life projects and dilemmas of this HIV‐positive adolescent cohort.
    March 12, 2017   doi: 10.1111/maq.12351   open full text
  • Bioseguridad in Mexico: Pursuing Security between Local and Global Biologies.
    Emily Mannix Wanderer.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 12, 2017
    In the aftermath of the 2009 outbreak of H1N1 influenza, scientists in Mexico sought to develop bioseguridad, that is, to protect biological life in Mexico by safely conducting research on infectious disease. Drawing on ethnographic research in laboratories and with scientists in Mexico, I look at how scientists make claims about local differences in regulations, infrastructure, bodies, and culture. The scientists working with infectious microbes sought to establish how different microbial ecologies, human immune systems, and political and regulatory systems made the risks of research different in Mexico from other countries. In developing bioseguridad, the idea of globalized biology that animates many public health projects was undermined as scientists attended to the elements of place that affected human health and safety. Scientists argued for the importance of local biologies, generating tension with global public health projects and regulations premised on the universality of biology.
    March 12, 2017   doi: 10.1111/maq.12339   open full text
  • Commodifying Indigeneity: How the Humanization of Birth Reinforces Racialized Inequality in Mexico.
    Rosalynn Adeline Vega.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. December 30, 2016
    This article examines the humanized birth movement in Mexico and analyzes how the remaking of tradition—the return to traditional birthing arts (home birth, midwife‐assisted birth, natural birth)—inadvertently reinscribes racial hierarchies. The great irony of the humanized birth movement lies in parents’ perspective of themselves as critics of late capitalism. All the while, their very rejection of consumerism bolsters ongoing commodification of indigenous culture and collapses indigeneity, nature, and tradition onto one another. While the movement is quickly spreading across Mexico, indigenous women and their traditional midwives are largely excluded from the emerging humanized birth community. Through ethnographic examples, the article suggests that indigenous individuals are agentive actors who appropriate cards in decks stacked against them. Examples of resistance emerge within a context of power and political economy that often capitalizes on images of indigeneity while obscuring the lives, experiences, and opinions of indigenous people.
    December 30, 2016   doi: 10.1111/maq.12343   open full text
  • Special Section on Comorbidity: Introduction.
    Lesley Jo Weaver, Ron Barrett, Mark Nichter.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. December 21, 2016
    There is no abstract available for this paper.
    December 21, 2016   doi: 10.1111/maq.12335   open full text
  • Culture and Comorbidity: Intimate Partner Violence as a Common Risk Factor for Maternal Mental Illness and Reproductive Health Problems among Former Child Soldiers in Nepal.
    Brandon A. Kohrt, Christine Bourey.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. October 13, 2016
    Our objective was to elucidate how culture influences internal (psychological), external (social), institutional (structural), and health care (medical) processes, which, taken together, create differential risk of comorbidity across contexts. To develop a conceptual model, we conducted qualitative research with 13 female child soldiers in Nepal. Participants gave open‐ended responses to intimate partner violence (IPV) vignettes (marital rape, emotional abuse, violence during pregnancy). Twelve participants (92%) endorsed personal responses (remaining silent, enduring violence, forgiving the husband). Twelve participants endorsed communication with one's husband. Only four participants (31%) sought family support, and three contacted police. Ultimately, 12 participants left the relationship, but the majority (nine) only left after the final IPV experience, which was preceded by prolonged psychological suffering and pregnancy endangerment. In conclusion, comorbidity risks are increased in cultural context that rely on individual or couples‐only behavior, lack external social engagement, have weak law and justice institutions, and have limited health services.
    October 13, 2016   doi: 10.1111/maq.12336   open full text
  • Medical Research Participation as “Ethical Intercorporeality”: Caring for Bio–Social Bodies in a Mexican Human Papillomavirus (HPV) Study.
    Emily Wentzell.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. October 13, 2016
    While medical research ethics guidelines frame participants as individual and autonomous, anthropologists emphasize the relational nature of health research participation. I analyze interviews with Mexican male HPV study participants and their wives to examine how research participants themselves focus on relationships when imagining research‐related benefits. I argue that couples incorporated the local trope of the Mexican citizenry as a biologically homogeneous national body, which individual members help or harm through their gendered health behavior to understand these benefits. I use the concept of “ethical intercorporeality” to discuss spouses’ understandings of themselves as parts of bio–social wholes—the couple, family, and society—that they believed men's research participation could aid both physically and socially. This finding extends the insight that focusing on relationships rather than individuals is necessary for understanding the consequences of medical research by showing how participants themselves might apply this perspective in context‐specific ways.
    October 13, 2016   doi: 10.1111/maq.12326   open full text
  • Enveloped Lives: Practicing Health and Care in Lithuania.
    Rima Praspaliauskiene.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. October 12, 2016
    This article analyzes informal medical payments that the majority of Lithuanians give or feel compelled to give to doctors before or after treatment. It focuses on how patients and their caretakers encounter, practice, and enact informal payments in health care and how these payments create a reality of health care that is not limited to an economic rationality. Within such a frame, rather than being considered a gift or bribe, it conceptualizes these little white envelopes as a practice of health and care. The article shows how an envelope of money given to a doctor transcends the material patient–doctor transaction and emerges as a productive force for coping with illness, medical encounters, and misfortunes.
    October 12, 2016   doi: 10.1111/maq.12291   open full text
  • The Erosion of Rights to Abortion Care in the United States: A Call for a Renewed Anthropological Engagement with the Politics of Abortion.
    Elise Andaya, Joanna Mishtal.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. October 12, 2016
    Women's rights to legal abortion in the United States are now facing their greatest social and legislative challenges since its 1973 legalization. Legislation restricting rights and access to abortion care has been passed at state and federal levels at an unprecedented rate. Given the renewed vigor of anti‐abortion movements, we call on anthropologists to engage with this shifting landscape of reproductive politics. This article examines recent legislation that has severely limited abortion access and maps possible directions for future anthropological analysis. We argue that anthropology can provide unique contributions to broader abortion research. The study of abortion politics in the United States today is not only a rich opportunity for applied and policy‐oriented ethnographic research. It also provides a sharply focused lens onto broader theoretical concerns in anthropology and new social formations across moral, medical, political, and scientific fields in 21st‐century America.
    October 12, 2016   doi: 10.1111/maq.12298   open full text
  • Stress, Pregnancy, and Motherhood: Implications for Birth Weights in the Borderlands of Texas.
    K. Jill Fleuriet, T. S. Sunil.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. September 30, 2016
    We argue that changes over time in how ideas of stress are incorporated into understandings of pregnancy and motherhood among Mexican immigrant women living in the United States may affect the documented increase of low birth weight infants born to those women. Stress has consistently been linked to low birth weight, and pregnant Mexican American and Mexican immigrant women differ in levels of perceived social stress. What is lacking is an explanation for these differences. We utilize a subset of 36 ethnographic interviews with pregnant immigrant women from northern Mexico and Mexican Americans living in south Texas to demonstrate how meanings of pregnancy and motherhood increasingly integrate notions of stress the longer immigrant Mexican women live in the United States. We situate our results within anthropological and sociological research on motherhood in the United States and Mexico, anthropological research in the U.S.–Mexico borderlands, and interdisciplinary research on Hispanic rates of low birth weight.
    September 30, 2016   doi: 10.1111/maq.12324   open full text
  • “No One Ever Even Asked Me that Before”: Autobiographical Power, Social Defeat, and Recovery among African Americans with Lived Experiences of Psychosis.
    Neely Anne Laurenzo Myers, Tali Ziv.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. September 13, 2016
    Our article draws on ethnographic research with African American males diagnosed with a psychotic disorder in a high‐poverty urban area of the northeastern United States. Our participants frequently described the ways public mental health services led them to experience a paralyzing erosion of autobiographical power, which we define as the ability to tell one's own story and be the editor of one's own life. We identified three important points when the loss of autobiographical power seemed to perpetuate social defeat or a sense of social powerlessness (Luhrmann 2007) for our participants during their interactions with public mental health care. We invite further inquiry into the loss of autobiographical power in settings of public mental health care, the sense of social defeat it seems to perpetuate, and the impact of these on mental health recovery, especially for people living in contexts of persistent social adversity.
    September 13, 2016   doi: 10.1111/maq.12288   open full text
  • Publically Misfitting: Extreme Weight and the Everyday Production and Reinforcement of Felt Stigma.
    Alexandra Brewis, Sarah Trainer, SeungYong Han, Amber Wutich.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. August 25, 2016
    Living with extreme weight in the United States is associated with discrimination and self‐stigma, creating structural exclusions, embodied stress, and undermining health and wellbeing. Here we combine ethnographic interviews and surveys from those with experiences of living with extreme weight to better explain how this vulnerability is created and reinforced by public cues, both physical (e.g., seatbelts) and social (the reactions of strangers). “Misfitting” is a major theme in interviews, as is the need to plan and scan constantly while navigating too‐small public spaces. The most distressing events combine physical misfitting with unsympathetic reactions from strangers. Sensitivity to stigmatizing public cues reduces with weight loss, but does not disappear. This study explains one basic mechanism that underlies the creation of felt stigma related to weight even after weight loss: the lack of accommodation for size and the lack of empathy from others that characterize modern urban spaces.
    August 25, 2016   doi: 10.1111/maq.12309   open full text
  • Routines, Hope, and Antiretroviral Treatment among Men and Women in Uganda.
    Margaret S. Winchester, Janet W. McGrath, David Kaawa‐Mafigiri, Florence Namutiibwa, George Ssendegye, Amina Nalwoga, Emily Kyarikunda, Judith Birungi, Sheila Kisakye, Nicholas Ayebazibwe, Eddy J. Walakira, Charles Rwabukwali.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. August 21, 2016
    Antiretroviral treatment programs, despite biomedical emphases, require social understanding and transformations to be successful. In this article, we draw from a qualitative study of HIV treatment seeking to examine the drug‐taking routines and health‐related subjectivities of men and women on antiretroviral treatment (ART) at two sites in Uganda. We show that while not all participants in ART programs understand clinical protocols in biomedical terms, they adopt treatment‐taking strategies to integrate medication into daily practices and social spaces. In turn, these embedded practices and understandings shape long‐term hopes and fears for living with HIV, including the possibility of a cure. More significant than new forms of citizenship or sociality, we suggest that quotidian dimensions of treatment normalization shape the long‐term experience of medication and outlook for the future.
    August 21, 2016   doi: 10.1111/maq.12301   open full text
  • Comorbidity: Reconsidering the Unit of Analysis.
    Mark Nichter.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. August 21, 2016
    In this short essay, I wish to briefly discuss smoking, polypharmacy, the human biome and multispecies relations, and biomedicalization as a means of stretching the common ways we think about comorbidity. My intent is to expand our thinking about comorbidity and multimorbidity beyond the individual as a unit of analysis, to reframe comorbidity in relation to trajectories of risk, and to address comorbid states of our own making when the treatment of one health problem results in the experience of additional health problems. I do so as a corrective to what I see as an overly narrow focus on comorbidity as co‐occurring illnesses within a single individual, and as a complement to critical medical anthropological assessments of synergistic comorbid conditions (syndemics) occurring in structurally vulnerable populations living in environments of risk exposed to macro and micro pathogenic agents.
    August 21, 2016   doi: 10.1111/maq.12319   open full text
  • Embodying Transition in Later Life: “Having a Fall” as an Uncertain Status Passage for Elderly Women in Southeast London.
    Miriam Boyles.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. August 15, 2016
    In their (2014 report, the charity AgeUK states that one‐third of older people (over 3 million) fall each year. This article takes a focused look at falling by describing four women's accounts of “having a fall” in Walworth, southeast London, which sheds light on the experience of personal and corporeal change in later life. While some experiential studies of falling have made reference to a loss of embodied control and changes in identity, these aspects have not been explored in sufficient depth. Attending closely to the embodied experience of falling for older women in the context of everyday activity reveals the uncertainty surrounding what it actually signifies and the powerful effect this uncertainty has on their everyday lives and sense of self. This in‐depth phenomenological account speaks to important gaps in the literature on falls, given the current research emphasis on the management of falls risk.
    August 15, 2016   doi: 10.1111/maq.12320   open full text
  • Fertility Control: Reproductive Desires, Kin Work, and Women's Status in Contemporary India.
    Holly Donahue Singh.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. August 15, 2016
    This article reappraises the link between fertility and women's status by examining changing means and meanings of reproduction in India. It is based on data gathered during and after 16 months of ethnographic fieldwork conducted between 2005 and 2007 in Lucknow, Uttar Pradesh, India, on social and cultural contexts of infertility. Lucknow is the capital city of Uttar Pradesh, India's most populous state. Historical views of population and fertility control in India and perspectives on the contemporary use of assisted reproductive technologies (ARTs) for practices such as surrogacy situate the ethnographic perspectives. Analysis of ARTs in practice complicates ideas of autonomy and choice in reproduction. Results show that these technologies allow women to challenge power relations within their marital families and pursue stigmatized forms of reproduction. However, they also offer new ways for families to continue and extend an old pattern of exerting control over women's reproductive potential.
    August 15, 2016   doi: 10.1111/maq.12312   open full text
  • Locating Purity within Corruption Rumors: Narratives of HPV Vaccination Refusal in a Peri‐urban Community of Southern Romania.
    Cristina A. Pop.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. July 06, 2016
    This article locates the symbolic construction of “corrupted purity”—as a key assertion in Romanian parents’ HPV vaccination refusal narratives—within a multiplicity of entangled rumors concerning reproduction and the state. Romania's unsuccessful HPV vaccination campaign is not unique. However, the shifting discourses around purity and corruption—through which some parents conveyed anxieties about their daughters being targeted for the vaccine—place a particular twist on the Romanian case of resisting the HPV vaccination. Parental discourses took the form of clusters of rumors about state medicine's failure to provide adequate reproductive health care, additive‐laden foods, and exposure to radioactive contamination. In these rumors, corruption becomes literally embodied, through ingestion, consumption, contact, or inoculation. Parental discourses about what is being injected into their daughters’ pristine bodies express their uncertainty around navigating the unsettled post‐socialist medical landscape.
    July 06, 2016   doi: 10.1111/maq.12290   open full text
  • Dying for Money: The Effects of Global Health Initiatives on NGOs Working with Gay Men and HIV/AIDS in Northwest China.
    Casey James Miller.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. July 06, 2016
    Drawing on 17 months of ethnographic fieldwork (2007–2011), this article critically examines the consequences of two global health initiatives (GHIs), the Global Fund and the Gates Foundation, on NGOs engaged in HIV/AIDS prevention and treatment among gay men in northwest China. I argue that a short‐term surge in funding provided by GHIs between 2008 and 2010 exacerbated preexisting conflicts between NGOs by promoting a neoliberal process in which the state outsourced public health services to civil society organizations, deliberately encouraging a climate of competition among NGOs. I also show how GHIs encouraged the bureaucratization and medicalization of one grassroots gay NGO, channeling its activities away from broader political and social objectives and compelling the group to develop a narrower and more entrepreneurial emphasis on HIV testing and treatment. This article contributes to a deeper ethnographic understanding of the complex and perhaps unintended consequences of GHIs.
    July 06, 2016   doi: 10.1111/maq.12300   open full text
  • “Just One Thing after Another”: Recursive Cascades and Chronic Conditions.
    Lenore Manderson, Narelle Warren.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 30, 2016
    Chronic conditions and their resultant difficulties in daily living frequently occur with other health problems, sometimes due to interactions or complications at a biological level, or as a result of common pathogens or risk factors. On other occasions, they develop independently. Drawing on research conducted with Australian women that began in the mid‐2000s and is still ongoing, we highlight how chronic structural factors shape the risk factors of “chronic” conditions, influencing health seeking, continuity of care, and health outcomes. Institutional, economic, and other circumstantial factors pertain and impact health trajectories as much in highly industrialized as in resource poor settings. In illustrating how poverty and social exclusion create the preconditions of multiple chronic health problems, and how chronic health problems increase such disadvantages for individuals and their households, we introduce the idea of “recursive cascades” to capture the often inevitable trajectory of increasing ill health and growing empoverishment.
    June 30, 2016   doi: 10.1111/maq.12277   open full text
  • Caring for Strangers: Aging, Traditional Medicine, and Collective Self‐care in Post‐socialist Russia.
    Tatiana Chudakova.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 30, 2016
    This article explores how aging patients in Russia assemble strategies of care in the face of commercialization of medical services and public health discourses and initiatives aimed at improving the population's lifestyle habits. By focusing on how the formation of pensioner publics intersects with the health‐seeking trajectories of elderly patients, it tracks an emerging ethic of collective self‐care—a form of therapeutic collectivity that challenges articulations of good health as primarily an extension of personal responsibility or solely as a corollary of access to medical resources. By drawing on traditional medicine, these pensioners rely on and advocate for stranger intimacies that offer tactics for survival in the present through the care of (and for) a shared and embodied post‐socialist condition of social, economic, and bodily precarity.
    June 30, 2016   doi: 10.1111/maq.12276   open full text
  • Afghan Refugee Explanatory Models of Depression: Exploring Core Cultural Beliefs and Gender Variations.
    Qais Alemi, Susan C. Weller, Susanne Montgomery, Sigrid James.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 30, 2016
    Relatively little empirical attention has been paid to understanding how refugees conceptualize depression and how this concept varies between genders. The purpose of this study was to explore beliefs about depression among Afghans residing in San Diego County, California, using cultural consensus analysis. Using the prescribed mixed‐method approach, we employed results from in‐depth interviews to develop a culturally meaningful questionnaire about depression. Consensus analysis of responses to questionnaire items from 93 Afghans (50 men, 43 women) indicates shared beliefs that associates depression causality with mild traumatic experiences and post‐resettlement stressors, symptomatology to include culturally salient idioms of distress, and treatment selections ranging from lay techniques to professional care. Divergence between genders occurred most in the symptoms subdomain, with women associating depression with more somatic items. This study contributes to understanding the etiology of and cultural responses to depression among this population, which is critical to improving culturally sensitive intervention for Afghan refugees.
    June 30, 2016   doi: 10.1111/maq.12296   open full text
  • Neurasthenia, Generalized Anxiety Disorder, and the Medicalization of Worry in a Vietnamese Psychiatric Hospital.
    Allen L. Tran.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 30, 2016
    This article examines two forms of the medicalization of worry in an outpatient psychiatric clinic in Ho Chi Minh City, Vietnam. Biomedical psychiatrists understand patients’ symptoms as manifestations of the excessive worry associated with generalized anxiety disorder (GAD). Drawing on an ethnopsychology of emotion that reflects increasingly popular models of neoliberal selfhood, these psychiatrists encourage patients to frame psychic distress in terms of private feelings to address the conditions in their lives that lead to chronic anxiety. However, most patients attribute their symptoms to neurasthenia instead of GAD. Differences between doctors’ and patients’ explanatory models are not just rooted in their understandings of illness but also in their respective conceptualizations of worry in terms of emotion and sentiment. Patients with neurasthenia reject doctors’ attempts to psychologize distress and maintain a model of worry that supports a sense of moral selfhood based on notions of obligation and sacrifice.
    June 30, 2016   doi: 10.1111/maq.12297   open full text
  • Resisting “Reason”: A Comparative Anthropological Study of Social Differences and Resistance toward Health Promotion and Illness Prevention in Denmark.
    Camilla Hoffmann Merrild, Rikke Sand Andersen, Mette Bech Risør, Peter Vedsted.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 30, 2016
    Social differences in health and illness are well documented in Denmark. However, little is known about how health practices are manifested in the everyday lives of different social classes. We propose acts of resistance and formation of health subjectivities as helpful concepts to develop our understanding of how dominant health discourses are appropriated by different social classes and transformed into different practices promoting health and preventing illness. Based on fieldwork in two different social classes, we discuss how these practices both overtly and subtly challenge the normative power of the health promotion discourse. These diverse and ambiguous forms of everyday resistance illustrate how and when situated concerns move social actors to subjectively appropriate health promotion messages. Overall, the different forms of resistance elucidate how the standardized awareness and education campaigns may perpetuate the very inequalities they try to diminish.
    June 30, 2016   doi: 10.1111/maq.12295   open full text
  • “With This You Can Meet Your Baby”: Fetal Personhood and Audible Heartbeats in Oaxacan Public Health.
    Rebecca Howes‐Mischel.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 01, 2016
    This article examines how amplified fetal heartbeats may be used to make claims about fetuses’ social presence. These claims are supported by the Mexican Public Health system's selection of the maternal–child relationship as a key site of clinical intervention, intertwining medical and moral discourses. Drawing on the robust literature on cross‐cultural propositions of “fetal personhood,” this analysis uses ethnographic material from public health institutions in Oaxaca, Mexico, to explore how doctors use diagnostic technology to materialize fetuses for their patients. I argue that Spanish's epistemological distinction between saber (to have knowledge about) and conocer (to be acquainted with) is key to how diagnostic technologies may be deployed to make social claims. I use one doctor's attempts to use technology to shift her patient from saber to conocer as illustrative of underlying cultural logics about fetal embodiment and its proof. Focused on the under‐theorized socio–medical deployment of audio fetal heartbeat technology, this article suggests that sound—in addition to sight—is a potent tool for constructing fetal personhood.
    June 01, 2016   doi: 10.1111/maq.12181   open full text
  • “Time with Babe”: Seeing Fetal Remains after Pregnancy Termination for Impairment.
    Lisa M. Mitchell.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. April 03, 2016
    Some North American hospitals now offer parents the opportunity to see, hold, and photograph fetal remains after pregnancy loss. I explore the social, material, and interpretive strategies mobilized to create this fetal visibility after second trimester–induced abortion for fetal anomaly. My analysis examines both the discursive framing of fetal remains in practice guidelines on pregnancy loss and the responses of a group of Canadian women to being offered “time with babe.” I show that while guidelines tend to frame contact with fetal remains as a response to women's desires to see their baby and to feel like mothers, women's experiences of this contact were shaped by more diverse wishes and concerns as well as by specific abortion practices and practitioner comments and actions.
    April 03, 2016   doi: 10.1111/maq.12173   open full text
  • Human Rights, Humanitarianism, and State Violence: Medical Documentation of Torture in Turkey.
    Başak Can.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. April 03, 2016
    State authorities invested in developing official expert discourses and practices to deny torture in post‐1980 coup d’état Turkey. Documentation of torture was therefore crucial for the incipient human rights movement there in the 1980s. Human rights physicians used their expertise not only to treat torture victims but also to document torture and eventually found the Human Rights Foundation of Turkey (HRFT) in 1990. Drawing on an ethnographic and archival research at the HRFT, this article examines the genealogy of anti‐torture struggles in Turkey and argues that locally mediated intimacies and/or hostilities between victims of state violence, human rights physicians, and official forensics reveal the limitations of certain universal humanitarian and human rights principles. It also shows that locally mediated long‐term humanitarian encounters around the question of political violence challenge forensic denial of violence and remake the legitimate levels of state violence.
    April 03, 2016   doi: 10.1111/maq.12259   open full text
  • Incertitude, Hepatitis B, and Infant Vaccination in West and Central Africa.
    Tamara Giles‐Vernick, Abdoulaye Traoré, Louis Bainilago.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 31, 2016
    This comparative study explores incertitude about hepatitis B (HBV) and its implications for childhood vaccination in Bangui, Central African Republic, and the Cascades region, Burkina Faso. Anthropological approaches to vaccination, which counter stereotypes of “ignorant” publics needing education to accept vaccination, excavate alternative ways of knowing about illness and vaccination. We build on these approaches, evaluating different kinds of incertitude (ambiguity, uncertainty, ignorance) about infancy, HBV, health protection, and vaccination. Using interviews and participant observation, we find that Bangui and Cascades publics framed their incertitude differently through stories of infancy, illness, and protection. We locate different forms of incertitude within their historical contexts to illuminate why vaccination practices differ in the Cascades region and Bangui. A more nuanced approach to incomplete knowledge, situated in political, economic, and social histories of the state and vaccination, can contribute to more appropriate global health strategies to improve HBV prevention.
    March 31, 2016   doi: 10.1111/maq.12187   open full text
  • Cancer and the Comics: Graphic Narratives and Biolegitimate Lives.
    Juliet McMullin.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 31, 2016
    Cancer graphic narratives, I argue, are part of a medical imaginary that includes representations of difference and biomedical technology that engage Fassin's (2009) concept of biolegitimacy. Framed in three parts, the argument first draws on discourses about cancer graphic narratives from graphic medicine scholars and authors to demonstrate a construction of universal suffering. Second, I examine tropes of hope and difference as a biotechnical embrace. Finally, I consider biosociality within the context of this imaginary and the construction of a meaningful life. Autobiographical graphic narrative as a creative genre that seeks to give voice to individual illness experiences in the context of biomedicine raises anthropological questions about the interplay between the ordinary and biolegitmate. Cancer graphic narratives deconstruct the big events to demonstrate the ordinary ways that a life constructed as different becomes valued through access to medical technologies.
    March 31, 2016   doi: 10.1111/maq.12172   open full text
  • Toward an Anthropology of Insurance and Health Reform: An Introduction to the Special Issue.
    Amy Dao, Jessica Mulligan.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 29, 2016
    This article introduces a special issue of Medical Anthropology Quarterly on health insurance and health reform. We begin by reviewing anthropological contributions to the study of financial models for health care and then discuss the unique contributions offered by the articles of this collection. The contributors demonstrate how insurance accentuates—but does not resolve tensions between granting universal access to care and rationing limited resources, between social solidarity and individual responsibility, and between private markets and public goods. Insurance does not have a single meaning, logic, or effect but needs to be viewed in practice, in context, and from multiple vantage points. As the field of insurance studies in the social sciences grows and as health reforms across the globe continue to use insurance to restructure the organization of health care, it is incumbent on medical anthropologists to undertake a renewed and concerted study of health insurance and health systems.
    March 29, 2016   doi: 10.1111/maq.12271   open full text
  • Gatekeepers as Care Providers: The Care Work of Patient‐centered Medical Home Clerical Staff.
    Samantha L. Solimeo, Sarah S. Ono, Kenda R. Stewart, Michelle A. Lampman, Gary E. Rosenthal, Greg L. Stewart.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 28, 2016
    International implementation of the patient‐centered medical home (PCMH) model for delivering primary care has dramatically increased in the last decade. A majority of research on PCMH's impact has emphasized the care provided by clinically trained staff. In this article, we report our ethnographic analysis of data collected from Department of Veterans Affairs staff implementing PACT, the VA version of PCMH. Teams were trained to use within‐team delegation, largely accomplished through attention to clinical licensure, to differentiate staff in providing efficient, patient‐centered care. In doing so, PACT may reinforce a clinically defined culture of care that countermands PCMH ideals. Such competing rubrics for care are brought into relief through a focus on the care work performed by clerks. Ethnographic analysis identifies clerks’ care as a kind of emotional dirty work, signaling important areas for future anthropological study of the relationships among patient‐centered care, stigma, and clinical authority.
    March 28, 2016   doi: 10.1111/maq.12281   open full text
  • Recreating Virginity in Iran: Hymenoplasty as a Form of Resistance.
    Azal Ahmadi.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 14, 2016
    Hymenoplasty is a controversial surgery in Iran, where a woman's failure to present herself as virginal for marriage may result in severe social repercussions. Critical literature surrounding this clandestine surgery is sparse. During ethnographic fieldwork in Tehran, I interviewed women who have and have not undergone hymenoplasty and physicians who perform it. Using a Foucauldian framework, I argue that the medicalization of virginity is a form of female social control in Iran. The resulting narratives and discourses suggest that hymenoplasty is a covert form of resistance against socioculturally prescribed sexual inegalitarianism that restricts women to the social sphere of premarital chastity. By manipulating the medicalization of virginity, women inadvertently resist dichotomous gendered classifications that constrain them as either the deviant woman who has premarital sex or the normal woman who remains virginal until marriage. These women deviate from a fixed notion of gender embodiment, eroding socioculturally constituted categorical boundary markers regarding femininity.
    March 14, 2016   doi: 10.1111/maq.12202   open full text
  • An Elephant in the Consultation Room?: Configuring Down Syndrome in British Antenatal Care.
    Gareth M. Thomas.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 14, 2016
    This article is based on an ethnographic study of prenatal screening for Down syndrome in two British health care institutions. Drawing on observations of everyday hospital life and interviews with health care professionals, I identify how a discussion of Down syndrome is avoided during prenatal screening consultations. This relative silence is created and upheld because of three things: (1) the British public is considered as knowing what Down syndrome is; (2) the organization of care dictates that the condition is not classified as important enough to justify an explanation within consultations; and (3) professionals frequently admit to having minimal knowledge of Down syndrome. This absence, together with the condition being categorized as a risk or problem, helps produce and uphold its status as a negative pregnancy outcome. I conclude by highlighting the contributions that this article has for anthropologically exploring how ideas around disability intersect with the proliferation of reproductive technologies.
    March 14, 2016   doi: 10.1111/maq.12222   open full text
  • On the Margins of Pharmaceutical Citizenship: Not Taking HIV Medication in the “Treatment Revolution” Era.
    Asha Persson, Christy E. Newman, Limin Mao, John Wit.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. February 15, 2016
    With the expanding pharmaceuticalization of public health, anthropologists have begun to examine how biomedicine's promissory discourses of normalization and demarginalization give rise to new practices of and criteria for citizenship. Much of this work focuses on the biomedicine–citizenship nexus in less‐developed, resource‐poor contexts. But how do we understand this relationship in resource‐rich settings where medicines are readily available, often affordable, and a highly commonplace response to illness? In particular, what does it mean to not use pharmaceuticals for a treatable infectious disease in this context? We are interested in these questions in relation to the recent push for early and universal treatment for HIV infection in Australia for the twin purposes of individual and community health. Drawing on Ecks's concept of pharmaceutical citizenship, we examine the implications for citizenship among people with HIV who refuse or delay recommended medication. We find that moral and normative expectations emerging in the new HIV “treatment revolution” have the capacity to both demarginalize and marginalize people with HIV.
    February 15, 2016   doi: 10.1111/maq.12274   open full text
  • Medical Cosmopolitanism in Global Dubai: A Twenty‐first‐century Transnational Intracytoplasmic Sperm Injection (ICSI) Depot.
    Marcia C. Inhorn.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. February 15, 2016
    Dubai—one of the seven United Arab Emirates and the Middle East's only “global city”—is gaining a reputation as a transnational medical tourism hub. Characterized by its “medical cosmopolitanism,” Dubai is now attracting medical travelers from around the world, some of whom are seeking assisted conception. Dubai is fast becoming known as a new transnational “reprohub” for intracytoplasmic sperm injection (ICSI), the variant of in vitro fertilization designed to overcome male infertility. Based on ethnographic research conducted in one of the country's most cosmopolitan clinics, this article explores the ICSI treatment quests of infertile men coming to Dubai from scores of other nations. The case of an infertile British‐Moroccan man is highlighted to demonstrate why ICSI is a particularly compelling “masculine hope technology” for infertile Muslim men. Thus, Muslim men who face barriers to ICSI access in their home countries may become “reprotravelers” to Dubai, an emergent ICSI depot.
    February 15, 2016   doi: 10.1111/maq.12275   open full text
  • “Make Sure Somebody Will Survive from This”: Transformative Practices of Hope among Danish Organ Donor Families.
    Anja M. B. Jensen.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. February 15, 2016
    Based on anthropological fieldwork among Danish organ donor families and hospital staff in neurointensive care units, this article explores the transformative practices of hope in Danish organ donation. Focusing on various phases of the organ donation process, I demonstrate how families and professionals practice hope in astounding ways: when hoping for organs, when hoping for the end of patient suffering, when hoping for the usability of the donor body, and when hoping to help future donor families by sharing painful experiences. By focusing on such practices and transformations of hope, this article sheds light on the social negotiations of life and death among families and staffs in medical contexts and describes how the dignity of the deceased donor and the usability of the donor body are closely connected in family attempts to make donation decisions meaningful during and after a tragic death.
    February 15, 2016   doi: 10.1111/maq.12278   open full text
  • Transactions in Suffering: Mothers, Daughters, and Chronic Disease Comorbidities in New Delhi, India.
    Lesley Jo Weaver.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. February 09, 2016
    The biomedical definition of comorbidity belies the complexity of its lived experience. This article draws on case studies of women with diabetes and various comorbidities in New Delhi, India, to explore intergenerational transactions surrounding suffering in contexts of comorbidity. The analysis synthesizes sociological theories of chronic disease work (Corbin and Strauss 1985), psychological theories of caregiver burnout (Figley 1995), and anthropological approaches to suffering and legitimacy (Das 1997) to explore how, when, and by whom women's comorbid sources of suffering become routinized, or normalized, in everyday life. The analysis demonstrates, first, that comorbid suffering is not simply a matter of the addition of a second source of suffering to an existing one; rather, it comprises complex interactions between suffering, disability, family dynamics, and quality of life. Second, it illustrates several social routes through which comorbid suffering can fade into the background of everyday life, even when it is severe. Close attention to how suffering works in cases of comorbidity will be important as comorbid conditions become increasingly commonplace around the world. This article is protected by copyright. All rights reserved
    February 09, 2016   doi: 10.1111/maq.12283   open full text
  • “I Hope I Get Movie‐star Teeth”: Doing the Exceptional Normal in Orthodontic Practice for Young People.
    Anette Wickström.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. February 02, 2016
    Orthodontics offer young people the chance to improve their bite and adjust their appearances. The most common reasons for orthodontic treatment concern general dentists’, parents’ or children's dissatisfaction with the esthetics of the bite. My aim is to analyze how esthetic norms are used during three activities preceding possible treatment with fixed appliances. The evaluation indexes signal definitiveness and are the essential grounds for decision‐making. In parallel, practitioners and patients refer to self‐perceived satisfaction with appearances. Visualizations of divergences and the improved future bite become part of an interactive process that upholds what I conceptualize as “the exceptional normal.” Insights into this process contribute to a better understanding of how medical practices intended to measure and safeguard children's and young people's health at the same time mobilize patients to look and feel better. The article is based on an ethnographic study at two orthodontic clinics.
    February 02, 2016   doi: 10.1111/maq.12247   open full text
  • The Global Context of Vaccine Refusal: Insights from a Systematic Comparative Ethnography of the Global Polio Eradication Initiative.
    Svea Closser, Anat Rosenthal, Kenneth Maes, Judith Justice, Kelly Cox, Patricia A. Omidian, Ismaila Zango Mohammed, Aminu Mohammed Dukku, Adam D. Koon, Laetitia Nyirazinyoye.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. January 27, 2016
    Many of medical anthropology's most pressing research questions require an understanding how infections, money, and ideas move around the globe. The Global Polio Eradication Initiative (GPEI) is a $9 billion project that has delivered 20 billion doses of oral polio vaccine in campaigns across the world. With its array of global activities, it cannot be comprehensively explored by the traditional anthropological method of research at one field site. This article describes an ethnographic study of the GPEI, a collaborative effort between researchers at eight sites in seven countries. We developed a methodology grounded in nuanced understandings of local context but structured to allow analysis of global trends. Here, we examine polio vaccine acceptance and refusal to understand how global phenomena—in this case, policy decisions by donors and global health organizations to support vaccination campaigns rather than building health systems—shape local behavior.
    January 27, 2016   doi: 10.1111/maq.12254   open full text
  • Huichol Migrant Laborers and Pesticides: Structural Violence and Cultural Confounders.
    Jennie Gamlin.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. January 27, 2016
    Every year, around two thousand Huichol families migrate from their homelands in the highlands of northwestern Mexico to the coastal region of Nayarit State, where they are employed on small plantations to pick and thread tobacco leaves. During their four‐month stay, they live, work, eat, and sleep in the open air next to the tobacco fields, exposing themselves to an unknown cocktail of pesticides all day, every day. In this article, I describe how these indigenous migrants are more at risk to pesticides because historical and contemporary structural factors ensure that they live and work in the way of harm. I discuss the economic, social, political, and racial inequalities that exist in their every‐day environment and how these forms of structural violence are mitigated by their intersection with local cultural contexts and their specific indigenous lifeworld.
    January 27, 2016   doi: 10.1111/maq.12249   open full text
  • The Effects of Water Insecurity and Emotional Distress on Civic Action for Improved Water Infrastructure in Rural South Africa.
    Nicola Bulled.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. January 18, 2016
    The South African constitution ratifies water as a human right. Yet millions of citizens remain disconnected from the national water infrastructure. Drawing on data collected in 2013–2014 from women in northern South Africa, this study explores “water citizenship”—individual civic engagement related to improving water service provision. Literature indicates that water insecurity is associated with emotional distress and that water‐related emotional distress influences citizen engagement. I extend these lines of research by assessing the connection that water insecurity and emotional distress may collectively have with civic engagement to improve access to water infrastructure.
    January 18, 2016   doi: 10.1111/maq.12270   open full text
  • Culture and the Immune System: Cultural Consonance in Social Support and C‐reactive Protein in Urban Brazil.
    William W. Dressler, Mauro C. Balieiro, Rosane P. Ribeiro, José Ernesto dos Santos.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. January 18, 2016
    In this article, we examine the distribution of a marker of immune system stimulation—C‐reactive protein—in urban Brazil. Social relationships are associated with immunostimulation, and we argue that cultural dimensions of social support, assessed by cultural consonance, are important in this process. Cultural consonance is the degree to which individuals, in their own beliefs and behaviors, approximate shared cultural models. A measure of cultural consonance in social support, based on a cultural consensus analysis regarding sources and patterns of social support in Brazil, was developed. In a survey of 258 persons, the association of cultural consonance in social support and C‐reactive protein was examined, controlling for age, sex, body mass index, low‐density lipoprotein cholesterol, depressive symptoms, and a social network index. Lower cultural consonance in social support was associated with higher C‐reactive protein. Implications of these results for future research are discussed.
    January 18, 2016   doi: 10.1111/maq.12213   open full text
  • The Council on Anthropology and Reproduction (CAR) Opposes Legislation that Creates Barriers to Safe Abortion Care.

    Medical Anthropology Quarterly / Medical Anthropological Quarterly. December 06, 2015
    There is no abstract available for this paper.
    December 06, 2015   doi: 10.1111/maq.12265   open full text
  • Disordered Eating/Eating Disorder: Hidden Perils of the Nation's Fight against Fat.
    Susan Greenhalgh.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. October 21, 2015
    The nation's fight against fat has not reduced obesity, but it has had other worrying effects. Mental health researchers have raised the possibility that the intense pressures to lose weight have heightened the risks of developing eating disorders, especially among the young. Medical anthropology can help connect the dots between the war on fat and disordered eating, identifying specific mechanisms, pathways, and contextual forces that may lie beyond the scope of biomedical and psychiatric research. This article develops a biocitizenship approach that focuses on the pathologization of heaviness, the necessity of having a thin, fit body to belonging to the category of worthy citizen, and the work of pervasive fat‐talk in defining who can belong. Ethnographic narratives from California illuminate the dynamics in individual lives, while lending powerful support to the idea that the battle against fat is worsening disordered eating and eating disorders among vulnerable young people.
    October 21, 2015   doi: 10.1111/maq.12257   open full text
  • Beyond Comorbidity: A Critical Perspective of Syndemic Depression and Diabetes in Cross‐cultural Contexts.
    Emily Mendenhall.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 15, 2015
    This article examines the comorbidity concept in medical anthropology. I argue that the dearth of articles on comorbidity in medical anthropology may result from the rise of syndemic theory. Syndemics recognize how social realities shape individual illness experiences as well as distribution of diseases across populations. I discuss synergistic interactions foundational to the syndemics construct through my research of depression and diabetes comorbidity in vulnerable populations from urban United States, India, and South Africa. I argue that social and economic factors that cluster with depression and diabetes alone and together exemplify the biosocial processes that are at the heart of syndemics. In doing so, I illustrate how social, cultural, and economic factors shape individual‐level experiences of co‐occurring diseases despite similar population‐level trends. Finally, I discuss the relevance of syndemics for the fields of medicine and public health while cautioning what must not be lost in translation across disciplines.
    May 15, 2015   doi: 10.1111/maq.12215   open full text
  • The Social Life of Health Insurance in Low‐ to Middle‐income Countries: An Anthropological Research Agenda.
    Amy Dao, Mark Nichter.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 27, 2015
    The following article identifies new areas for engaged medical anthropological research on health insurance in low‐ and middle‐income countries (LMICs). Based on a review of the literature and pilot research, we identify gaps in how insurance is understood, administered, used, and abused. We provide a historical overview of insurance as an emerging global health panacea and then offer brief assessments of three high‐profile attempts to provide universal health coverage. Considerable research on health insurance in LMICs has been quantitative and focused on a limited set of outcomes. To advance the field, we identify eight productive areas for future ethnographic research that will add depth to our understanding of the social life and impact of health insurance in LMICs. Anthropologists can provide unique insights into shifting health and financial practices that accompany insurance coverage, while documenting insurance programs as they evolve and respond to contingencies.
    March 27, 2015   doi: 10.1111/maq.12191   open full text
  • Gendering the Burden of Care: Health Reform and the Paradox of Community Participation in Western Belize.
    Beth A. Uzwiak, Siobhan Curran.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 27, 2015
    Belizean health policy supports a primary health care (PHC) strategy of universal access, community participation, and multisectoral collaboration. The principals of PHC were a key part of Belize's emergent national identity and built on existing community‐based health strategies. Ethnographic research in western Belize, however, reveals that ongoing health reform is removing providers from participatory arenas. In this article, we foreground a particular moment in Belizean health history—the rise and demise of multisectoral collaboration—to question what can constitute meaningful community participation in the midst of health reform. Many allied health providers continue to believe in the potential of PHC to alleviate the structural causations of poor health and to invest in PHC despite a lack of state support. This means that providers, the majority women, are palliating the consequences of neoliberal reform; it also means that they provide spaces of contestation to the consumer “logic” of this reform.
    March 27, 2015   doi: 10.1111/maq.12195   open full text
  • Neoliberal Justice and the Transformation of the Moral: The Privatization of the Right to Health Care in Colombia.
    César Ernesto Abadía‐Barrero.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 27, 2015
    Neoliberal reforms have transformed the legislative scope and everyday dynamics around the right to health care from welfare state social contracts to insurance markets administered by transnational financial capital. This article presents experiences of health care–seeking treatment, judicial rulings about the right to health care, and market‐based health care legislation in Colombia. When insurance companies deny services, citizens petition the judiciary to issue a writ affirming their right to health care. The judiciary evaluates the finances of all relevant parties to rule whether a service should be provided and who should be responsible for the costs. A 2011 law claimed that citizens who demand, physicians who prescribe, and judges who grant uncovered services use the system's limited economic resources and undermine the state's capacity to expand coverage to the poor. This article shows how the consolidation of neoliberal ideology in health care requires the transformation of moral values around life.
    March 27, 2015   doi: 10.1111/maq.12161   open full text
  • Is There a Role for Complementary and Alternative Medicine in Preventive and Promotive Health? An Anthropological Assessment in the Context of U.S. Health Reform.
    Jennifer Jo Thompson, Mark Nichter.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 25, 2015
    Chronic conditions associated with lifestyle and modifiable behaviors are the leading causes of morbidity and mortality in the United States. The implementation of the Affordable Care Act offers an historic opportunity to consider novel approaches to addressing the nation's public health concerns. We adopt an anticipatory anthropological perspective to consider lifestyle behavior change as common ground shared by practitioners of both biomedicine and common forms of complementary and alternative medicine (CAM). At issue is whether CAM practitioners might play a more proactive and publicly endorsed role in delivering preventive and promotive health services to address these needs. Recognizing that this is a contentious issue, we consider two constructive roles for engaged medical anthropologists: (1) as culture brokers helping to facilitate interprofessional communities of preventive and promotive health practice and (2) in collaboration with health service researchers developing patient‐near evaluations of preventive and promotive health services on patient well‐being and behavior change. [health reform, complementary and alternative medicine, Affordable Care Act, health promotion]
    March 25, 2015   doi: 10.1111/maq.12153   open full text
  • Insurance Accounts: The Cultural Logics of Health Care Financing.
    Jessica Mulligan.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 25, 2015
    The financial exuberance that eventually culminated in the recent world economic crisis also ushered in dramatic shifts in how health care is financed, administered, and imagined. Drawing on research conducted in the mid‐2000s at a health insurance company in Puerto Rico, this article shows how health care has been financialized in many ways that include: (1) privatizing public services; (2) engineering new insurance products like high deductible plans and health savings accounts; (3) applying financial techniques to premium payments to yield maximum profitability; (4) a managerial focus on shareholder value; and (5) prioritizing mergers and financial speculation. The article argues that financial techniques obfuscate how much health care costs, foster widespread gaming of reimbursement systems that drives up prices, and “unpool” risk by devolving financial and moral responsibility for health care onto individual consumers.[insurance, health reform, managed care, financialization, Medicare]
    March 25, 2015   doi: 10.1111/maq.12157   open full text
  • Ectoparasitic Syndemics: Polymicrobial Tick‐borne Disease Interactions in a Changing Anthropogenic Landscape.
    Merrill Singer, Nicola Bulled.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. December 14, 2014
    Based on an assessment of the available research, this article uses syndemic theory to suggest the role of adverse bio–social interactions in increasing the total disease burden of tick‐borne infections in local populations. Given the worldwide distribution of ticks, capacity for coinfection, the anthropogenic role in environmental changes that facilitate tick dissemination and contact, evidence of syndemic interaction in tick‐borne diseases, and growing impact of ticks on global health, tick‐borne syndemics reveal fundamental ways in which human beings are not simply agents of environmental change but objects of that change as well.
    December 14, 2014   doi: 10.1111/maq.12163   open full text
  • Keeping up with the Cadillacs: What Health Insurance Disparities, Moral Hazard, and the Cadillac Tax Mean to The Patient Protection and Affordable Care Act.
    Rebecca Adkins Fletcher.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. July 30, 2014
    A major goal of The Patient Protection and Affordable Care Act is to broaden health care access through the extension of insurance coverage. However, little attention has been given to growing disparities in access to health care among the insured, as trends to reduce benefits and increase cost sharing (deductibles, co‐pays) reduce affordability and access. Through a political economic perspective that critiques moral hazard, this article draws from ethnographic research with the United Steelworkers (USW) at a steel mill and the Retail, Wholesale and Department Store Union (RWDSU) at a food‐processing plant in urban Central Appalachia. In so doing, this article describes difficulties of health care affordability on the eve of reform for differentially insured working families with employer‐sponsored health insurance. Additionally, this article argues that the proposed Cadillac tax on high‐cost health plans will increase problems with appropriate health care access and medical financial burden for many families.
    July 30, 2014   doi: 10.1111/maq.12120   open full text
  • A Biocultural Perspective on Fictive Kinship in the Andes: Social Support and Women's Immune Function in El Alto, Bolivia.
    Kathryn Hicks.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. May 14, 2014
    This article examines the influence of emotional and instrumental support on women's immune function, a biomarker of stress, in the city of El Alto, Bolivia. It tests the prediction that instrumental support is protective of immune function for women living in this marginal environment. Qualitative and quantitative ethnographic methods were employed to assess perceived emotional and instrumental support and common sources of support; multiple linear regression analysis was used to model the relationship between social support and antibodies to the Epstein‐Barr virus. These analyses provided no evidence that instrumental social support is related to women's health, but there is some evidence that emotional support from compadres helps protect immune function.
    May 14, 2014   doi: 10.1111/maq.12102   open full text
  • “I Didn't Feel Like I Was a Person Anymore”: Realigning Full Adult Personhood after Ostomy Surgery.
    Michelle Ramirez, Andrea Altschuler, Carmit McMullen, Marcia Grant, Mark Hornbrook, Robert Krouse.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. April 30, 2014
    Colorectal cancer (CRC) is the third most common cancer in the United States. For some CRC patients, cancer treatment involves creating a permanent or temporary intestinal ostomy. Having an ostomy often results in complex social and physical concerns—including unpredictable and at times publicly noticeable bowel output. In this article, we discuss findings from 30 in‐depth interviews with female CRC survivors with ostomies in the western United States. We highlight how having an ostomy disrupts culturally sanctioned practices of continence that mark the attainment of full‐adult personhood. We discuss how survivors reclaim a sense of full personhood after ostomy surgery through a process of realignment that entails both learning how to manage ostomy equipment to conceal bowel activity and reappraising their illness and suffering. We suggest that the anthropological categories of personhood and personhood realignment be incorporated into research and interventions aimed at increasing support among cancer survivors living with bodily impairments.
    April 30, 2014   doi: 10.1111/maq.12095   open full text
  • How Women in Bangladesh Confront the Stigma of Childlessness: Agency, Resilience, and Resistance.
    Papreen Nahar, Sjaak Geest.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. April 22, 2014
    In a context where motherhood is an integral part of a woman's stereotype, being childless is a devastating experience. We explore how these so‐called deviant women manage this situation. The objective of this article is to contribute to the debate regarding infertile women's agency, resilience, and resistance. This article is based on anthropological fieldwork among urban middle‐class and rural poor women. Their life histories reveal that childless women in Bangladesh, a pro‐natalist, patriarchal society, are not passive victims, but rather actively fight their stigmatization and manage to survive. The childless women follow overt and covert strategies to overcome their stigmatized identity and create space for themselves in various innovative ways. The women do not resist in a coordinated way as a group, but do so individually. Given the collective nature of a society like rural Bangladesh, we believe that the women's individual acts will eventually have collective effects.
    April 22, 2014   doi: 10.1111/maq.12094   open full text
  • First‐Class Health: Amenity Wards, Health Insurance, and Normalizing Health Care Inequalities in Tanzania.
    James Ellison.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. April 21, 2014
    In 2008, a government hospital in southwest Tanzania added a “first‐class ward,” which, unlike existing inpatient wards defined by sex, age, and ailment, would treat patients according to their wealth. A generation ago, Tanzanians viewed health care as a right of citizenship. In the 1980s and 1990s, structural adjustment programs and user fees reduced people's access to biomedical attention. Tanzania currently promotes “amenity” wards and health insurance to increase health care availability, generate revenue from patients and potential patients, and better integrate for‐profit care. In this article, I examine people's discussions of these changes, drawing on ethnographic fieldwork in the 2000s and 1990s. I argue that Tanzanians criticize unequal access to care and health insurance, although the systemic structuring of inequalities is becoming normalized. People transform the language of socialism to frame individualized market‐based care as mutual interdependence and moral necessity, articulating a new biomedical citizenship.
    April 21, 2014   doi: 10.1111/maq.12086   open full text
  • ARVs and ARTs: Medicoscapes and the Unequal Place‐making for Biomedical Treatments in sub‐Saharan Africa.
    Viola Hörbst, Angelika Wolf.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. April 21, 2014
    Asking why some diseases gain global attention whereas others are neglected, we present two case studies that demonstrate the unequal treatment and financing options available for HIV/AIDS versus infertility treatments. We track three key phenomena central to understanding the unequal public attention given to certain ailments: peace and security, subordination of the social to the biological, and a “global” quality. Existing concepts such as global assemblages or therapeutic citizenship are quite limited when it comes to bodily conditions that result in social suffering and do not satisfy the conditions of advocacy. Since it is not enough to observe “flowing” and “moving,” we propose the concept of medicoscapes, to acknowledge that such activities simultaneously entail channeling and carving out. Medicoscapes enhance the analysis of linkages between different health conditions regardless of whether they are biological or social and how they interconnect places, sites, and people.
    April 21, 2014   doi: 10.1111/maq.12091   open full text
  • Material Proximities and Hotspots: Toward an Anthropology of Viral Hemorrhagic Fevers.
    Hannah Brown, Ann H. Kelly.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. April 21, 2014
    This article outlines a research program for an anthropology of viral hemorrhagic fevers (collectively known as VHFs). It begins by reviewing the social science literature on Ebola, Marburg, and Lassa fevers and charting areas for future ethnographic attention. We theoretically elaborate the hotspot as a way of integrating analysis of the two routes of VHF infection: from animal reservoirs to humans and between humans. Drawing together recent anthropological investigations of human–animal entanglements with an ethnographic interest in the social production of space, we seek to enrich conceptualizations of viral movement by elaborating the circumstances through which viruses, humans, objects, and animals come into contact. We suggest that attention to the material proximities—between animals, humans, and objects—that constitute the hotspot opens a frontier site for critical and methodological development in medical anthropology and for future collaborations in VHF management and control.
    April 21, 2014   doi: 10.1111/maq.12092   open full text
  • Ethnography, Fidelity, and the Evidence that Anthropology Adds: Supplementing the Fidelity Process in a Clinical Trial of Supported Employment.
    Carolyn Smith‐Morris, Gilberto Lopez, Lisa Ottomanelli, Lance Goetz, Kimberly Dixon‐Lawson.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. April 21, 2014
    This discussion considers the role and findings of ethnographic research within a clinical trial of supported employment for veterans with spinal cord injury. Contributing to qualitative evaluation research and to debates over anthropological evidence vis‐à‐vis clinical trials, we demonstrate how enactors of a randomized controlled trial can simultaneously attend to both the trial's evidentiary and procedural requirements and to the lived experiences and needs of patients and clinicians. Three major findings are described: (1) contextual information essential to fidelity efforts within the trial; (2) the role of human interrelationships and idiosyncratic networks in the trial's success; and (3) a mapping of the power and authority structures relevant to the staff's ability to perform the protocol. We emphasize strengths of anthropological ethnography in clinical trials that include the provision of complementary, qualitative data, the capture of otherwise unmeasured parts of the trial, and the realization of important information for the translation of the clinical findings into new settings.
    April 21, 2014   doi: 10.1111/maq.12093   open full text
  • Everyday Narratives on Race and Health in Brazil.
    Anna Pagano.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. April 10, 2014
    In 2006, Brazil approved a groundbreaking policy aimed at reducing significant racial health inequalities among its citizens. Like health disparities programs in the United States, Brazil's policy is based on the assumptions that racial identity and racism are important health determinants and that citizens who identify as “black” suffer disproportionately from a number of health problems. How do these assumptions compare to Brazilian citizens’ conceptions of racial identity and health inequalities? To address this question, I present ethnographic data from two years of fieldwork in Brazilian public clinics and low‐income neighborhoods. I show that a majority of research participants made no connection between race and better or worse health. Of those who perceived health inequalities by race, most believed that white Brazilians had more health problems than black or brown Brazilians. Finally, I consider the implications of these ethnographic findings for Brazil's health disparities campaign.
    April 10, 2014   doi: 10.1111/maq.12076   open full text
  • Framework Negotiations: Diagnostic Insights among Alternative Medical Practitioners Participating in Integrative Medicine Case Conferences.
    Ellen J. Salkeld.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 27, 2014
    Medical anthropology concerns itself with cultural interpretations of health and illness in complex pluralistic societies whose members incorporate multiple strategies to address health issues. This research explored the variety of complementary and alternative medicine (CAM) topics introduced into biomedically structured clinical evaluation. A field study of routine case conferences held within a clinical fellowship program in integrative medicine (IM) provided the ideal setting to explore contrasting conceptualizations of disease. Study results yielded five core sources of information sought by CAM practitioners, typically not addressed in biomedicine: social relations history within family of origin, emotional health, energetic health, spiritual health, and in‐depth nutritional evaluation.
    March 27, 2014   doi: 10.1111/maq.12074   open full text
  • Navigating and Circumventing a Fragmented Health System: The Patient's Pathway in the Sierra Madre Region of Chiapas, Mexico.
    Rose Leonard Molina, Daniel Palazuelos.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. March 06, 2014
    Mexico has implemented several important reforms in how health care for its poorest is financed and delivered. Seguro Popular, in particular, a recently implemented social insurance program, aims to provide new funds for a previously underfunded state‐based safety net system. Through in‐depth ethnographic structured interviews with impoverished farmers in the state of Chiapas, this article presents an analysis of Seguro Popular from the perspective of a highly underserved beneficiary group. Specific points of tension among the various stakeholders—the government system (including public clinics, hospitals, and vertical programs), community members, private doctors, and pharmacies—are highlighted and discussed. Ethnographic data presented in this article expose distinct gaps between national health policy rhetoric and the reality of access to health services at the community level in a highly marginalized municipality in one of Mexico's poorest states. These insights have important implications for the structure and implementation of on‐going reforms.
    March 06, 2014   doi: 10.1111/maq.12071   open full text
  • Definitions and the Experience of Fertility Problems: Infertile and Sub‐fertile Women, Childless Mothers, and Honorary Mothers in Two Southern Nigerian Communities.
    Bruce Whitehouse, Marida Hollos.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. February 27, 2014
    Although infertility causes women considerable grief, social stigma, and economic deprivation, scholars have paid little attention to infertility's definitions that may depart from the standard Western usage and how such definitions influence the way women experience the condition. This article, by listening to individual women's experiences of infertility in two Nigerian communities, examines these definitions and differentiates between culturally salient categories of infertility. In distinguishing between different kinds of childless women and those with low fertility, we intend to enhance understandings of infertility by considering women's subjective understandings of the condition and thus moving beyond the current medical definition. By comparing women's experiences in two different ethnic groups in Nigeria, we show how distinct forms of kinship structures and social organizations shape the ways low fertility is defined, managed, and experienced.
    February 27, 2014   doi: 10.1111/maq.12075   open full text
  • Fallen Uterus: Social Suffering, Bodily Vigor, and Social Support among Women in Rural Mexico.
    Vania Smith‐Oka.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. January 06, 2014
    This article focuses on rural indigenous Mexican women's experiences with uterine prolapse, particularly the illness's expression of social suffering. Drawing on ethnographic research conducted during 2004–2005 and 2007 in a Nahua village in the state of Veracruz, the article analyzes the multifactorial nature of women's social suffering. Results show that the roots of uterine displacement for the women lie in lack of social relations and in perceptions of bodily vigor. Additionally, inequality present in the women's interactions with mainstream Mexico brings into focus the larger structural factors that shape their reproductive health. The implications of research on the effect of social support on women's embodiment of social suffering can extend beyond one illness, linking it to broader issues shaping the health of marginalized populations.
    January 06, 2014   doi: 10.1111/maq.12064   open full text
  • Critical Anthropology of Global Health “Takes a Stand” Statement: A Critical Medical Anthropological Approach to the U.S.'s Affordable Care Act.
    Sarah Horton, Cesar Abadía, Jessica Mulligan, Jennifer Jo Thompson.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. January 06, 2014
    The Affordable Care Act (ACA) of 2010—the U.S.'s first major health care reform in over half a century—has sparked new debates in the United States about individual responsibility, the collective good, and the social contract. Although the ACA aims to reduce the number of the uninsured through the simultaneous expansion of the private insurance industry and government‐funded Medicaid, critics charge it merely expands rather than reforms the existing fragmented and costly employer‐based health care system. Focusing in particular on the ACA's individual mandate and its planned Medicaid expansion, this statement charts a course for ethnographic contributions to the on‐the‐ground impact of the ACA while showcasing ways critical medical anthropologists can join the debate. We conclude with ways that anthropologists may use critiques of the ACA as a platform from which to denaturalize assumptions of “cost” and “profit” that underpin the global spread of market‐based medicine more broadly.
    January 06, 2014   doi: 10.1111/maq.12065   open full text
  • Nobody's Child: The Role of Trauma and Interpersonal Violence in Women's Pathways to Incarceration and Resultant Service Needs.
    Catherine Mitchell Fuentes.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. November 27, 2013
    With the rate of women's incarceration significantly outpacing that of men's, combined with the fact that the United States has the highest incarceration rate in the world, there is an urgent need to delineate incarcerated women's pathways to crime and subsequent service needs. This article reports findings of modified participant observation and qualitative research conducted from 2008 to 2010 with women incarcerated in a large, county jail in North Carolina addressing these issues. Thirty life history interviews, nine focus groups, and 60 questionnaires reveal the centrality of trauma, particularly in the form of interpersonal violence (i.e., sexual, physical, and/or emotional abuse in adulthood and/or childhood), in incarcerated women's lives. In the absence of positive resources (e.g., counseling, family/friend support), women's attempts to cope with trauma increase their risks for incarceration as well as further trauma. In addition to providing trauma‐based treatment, decreasing women's recidivism requires macro‐level examinations of policies that marginalize women economically and socially.
    November 27, 2013   doi: 10.1111/maq.12058   open full text
  • For the Sake of Others: Reciprocal Webs of Obligation and the Pursuit of Transplantation as a Caring Act.
    Laura Lynn Heinemann.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. November 08, 2013
    This article highlights reciprocal webs of care and moral obligations toward kin during transplantation, using an expansive notion of “care” to include both its obvious and more hidden forms. Evidence from 24 months of ethnographic fieldwork among transplant patients, their loved ones, and clinical personnel in the U.S. Midwest suggests that patients are simultaneously caregivers to others and are considered vital members of reciprocal webs of care without whom their kin networks could not effectively operate. Transplantation can become a person's main, perhaps only hope of fulfilling ongoing obligations to others, so pursuing a transplant becomes not a matter of choice, but rather a moral orientation. A potential implication of these findings is that rather quotidian and conventional (even if contested) notions of what kin ought to do and be for each other may be among the underpinnings of high‐tech biomedical practices like transplantation.
    November 08, 2013   doi: 10.1111/maq.12060   open full text
  • Making Sense of HIV in Southeastern Nigeria.
    Kate Winskell, Peter J. Brown, Amy E. Patterson, Camilla Burkot, Benjamin C. Mbakwem.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 26, 2013
    Fictional narratives have rarely been used in medical anthropological research. This article illustrates the value of such narratives by examining how young people in southeastern Nigeria navigate the cultural resources available to them to make sense of HIV in their creative writing. Using thematic data analysis and narrative‐based methodologies, it analyzes a sample (N = 120) from 1,849 narratives submitted by Nigerian youth to the 2005 Scenarios from Africa scriptwriting contest on the theme of HIV. The narratives are characterized by five salient themes: tragedy arising from the incompatibility of sex outside marriage and kinship obligations; female vulnerability and blame; peer pressure and moral ambivalence; conservative Christian sexual morality; and the social and family consequences of HIV. We consider the strengths and limitations of this narrative approach from a theoretical perspective and by juxtaposing our findings with those generated by Daniel Jordan Smith using standard ethnographic research methods with a similar Igbo youth population.
    June 26, 2013   doi: 10.1111/maq.12023   open full text
  • Conceiving Modernity.
    Shannon Ward.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 26, 2013
    This article examines the trope of reproduction in narratives of Tibetan refugees living in Dharamsala, India. As they make sense of their personal histories, Tibetan refugees invoke a collective story that mirrors human rights literature on Tibet. Women come into contact with this literature through its incorporation into a political discourse expressed by the exile government and health institutions. The article traces facets of this discourse that deal centrally with reproduction. Political discourse on reproduction articulates pronatalism as a solution to the refugee community's concern with survival, and the discourse frames modernity as a site of violence through China's reproductive regulations. And yet, Tibetan refugees also employ the notion of modernity when discussing their own free reproductive decision‐making, positioning modern reproductive interventions in opposition to Indian society. The article demonstrates that Tibetan refugees navigate competing figurations of modernity by expressing political resistance and affiliation through the idiom of reproduction.
    June 26, 2013   doi: 10.1111/maq.12022   open full text
  • Legacy, Legitimacy, and Possibility.
    Alison Swartz.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 26, 2013
    In South Africa, the response to HIV and TB epidemics is complex, varied, and contextually defined. “Task‐shifting” and a movement toward a decentralized model of care have led to an increased reliance on community health workers (CHWs) providing health care services to residents of impoverished, peri‐urban areas. Public health policy tends to present CHWs as a homogeneous group, with little attention paid to the nuances of experience, motivation, and understanding, which distinguish these care workers from one another and from other kinds of health workers. An exploration of the layered meanings of providing community health care services under financially, politically, and socially difficult conditions reveals clear distinctions of experience across the generations. Many older CHWs say that ubuntu, a notion of shared African humanity, is being “killed off” by the younger generation, whereas younger CHWs often describe older women as being “jealous” of the opportunities that this younger generation has for education, training, and employment. The structure of the South African health system, past and present responses to disease epidemics, and the legacy of apartheid's structural violence have amplified these generational differences among CHWs. Using ethnographic data collected from approximately 20 CHWS in a peri‐urban settlement in Cape Town, South Africa, I explore how CHWs experience and understand legitimacy in the moral economy of care. A call for closer attention to the experiences of CHWs is critical when designing public health policies for the delivery of health care services in impoverished communities in South Africa.
    June 26, 2013   doi: 10.1111/maq.12020   open full text
  • Children's Roles in Tuberculosis Treatment Regimes.
    Jean Hunleth.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 26, 2013
    In Zambia, the burden of HIV‐related diseases such as tuberculosis has received substantial international attention. Zambians experience and participate in a range of globally produced programs to manage TB and cure TB sufferers. Guided by WHO's Directly Observed Treatment, Short‐course protocol, TB treatment regimens now emphasize adherence to medications as the primary way to achieve cure. This article aims to understand how adherence models enter into the daily lives of children who live with and care for adult TB patients in an area disproportionately affected by the disease. I suggest that children domesticate adherence models, using them as strategies to safeguard identities, relationships, livelihoods, and futures that are increasingly under threat in the age of HIV. They draw on TB treatment and the hope and agency it affords to hold onto a version of childhood in which they are cared for by adults who will advocate for their well‐being.
    June 26, 2013   doi: 10.1111/maq.12028   open full text
  • Genes, Race, and Culture in Clinical Care.
    Linda M. Hunt, Nicole D. Truesdell, Meta J. Kreiner.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 26, 2013
    Race, although an unscientific concept, remains prominent in health research and clinical guidelines, and is routinely invoked in clinical practice. In interviews with 58 primary care clinicians we explored how they understand and apply concepts of racial difference. We found wide agreement that race is important to consider in clinical care. They explained the effect of race on health, drawing on common assumptions about the biological, class, and cultural characteristics of racial minorities. They identified specific race‐based clinical strategies for only a handful of conditions and were inconsistent in the details of what they said should be done for minority patients. We conclude that using race in clinical medicine promotes and maintains the illusion of inherent racial differences and may result in minority patients receiving care aimed at presumed racial group characteristics, rather than care selected as specifically appropriate for them as individuals.
    June 26, 2013   doi: 10.1111/maq.12026   open full text
  • Folding Paper Swans, Modeling Lives.
    Keren Mazuz.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 20, 2013
    This article examines the practices of folding paper swans by Filipina migrants employed as live‐in caregivers for elderly, dying patients in Israel. These practices create a microsystem model of adjustment through precise, small‐scale, and repetitive movements. This microsystem synchronizes a tripartite process: the swan's process of construction, the patient's process of decay, and the caregiver's process of self‐creation. In the short term, the microsystem is sustained, but in the long term, the microsystem contains within it the seeds of its own self‐destruction, as the patient eventually dies, the caregiver is reassigned to another patient or deported, and the swans are gifted. Therefore, the swan folding expands both medical anthropology understanding of caregiving as a ritual and the phenomenology of global caregivers who use immediately accessible materials—paper and glue—as an imaginative tool for ordering their daily experiences as dislocated and marginalized workers.
    June 20, 2013   doi: 10.1111/maq.12024   open full text
  • Can Medicine Be Aesthetic?
    Alexander Edmonds.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 19, 2013
    This article analyzes tensions between aesthetics and health in medicine. The blurring of distinctions between reconstructive and cosmetic procedures, and the linking of plastic surgery with other medical treatments, have added to the legitimacy of an emerging “aesthetic medicine.” As cosmetic surgeries become linked to other medical procedures with perceived greater medical necessity, health and aesthetics become entangled. One consequence is that medical needs are magnified while perceptions of the risks of surgery are minimized. Drawing on ethnographic work on plastic surgery, as well as other studies of obstetrics and cosmetic surgery, I illustrate this entanglement of health and aesthetics within the field of women's reproductive health care in Brazil. I argue that while it would be difficult to wholly disentangle aesthetics and health, analysis of how risk–benefit calculations are made in clinical practice offers a useful critical strategy for illuminating ethical problems posed by aesthetic medicine.
    June 19, 2013   doi: 10.1111/maq.12025   open full text
  • Health Beliefs and Behavior.
    Kate Senior, Richard Chenhall.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 19, 2013
    Recently, social determinants of health frameworks are receiving some criticism in that they do not engage with questions related to individual subjectivity and agency as they relate to health decision‐making behavior. This article examines the different ways in which people living in a remote Arnhem Land community in the Northern Territory of Australia, take responsibility for their own health and the extent to which they are able to prevent illness. A number of related sub‐questions are explored relating to how people perceive their health and their role in health care in their community, including their engagement with the health clinic, traditional medicines, and the influence of sorcery on ill health and sickness.
    June 19, 2013   doi: 10.1111/maq.12021   open full text
  • The Efficacy and Self‐Efficacy of Treatment.
    Mike Poltorak.
    Medical Anthropology Quarterly / Medical Anthropological Quarterly. June 19, 2013
    This article argues for a shift from an evaluation of the efficacy of “traditional medicine” to an analysis of the influence of notions of efficacy on health seeking and health outcomes. Studies on the therapeutic value of traditional medicine tend to focus on countering or engaging with biomedical models to explain the process and efficacy of healing. Less examined is how efficacy is evaluated by traditional healers and patients themselves. Ethnographic research focused on health seeking and language use in Tonga reveals a diversity of claims of efficacy that relate to the social and epistemological positions of healers, health workers, and patients. Using the celebrated case of a man who was cured by a healer after the hospital could do no more for him facilitates greater epistemological dialogue and poses a challenge to the current efficacy consensuses in medical anthropology and Tonga.
    June 19, 2013   doi: 10.1111/maq.12027   open full text