Medicine Anthropology Theory
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‘Medicine in Name Only’: Mistrust and COVID-19 Among the Crowded Rohingya Refugee Camps in Bangladesh
No full textThis article is an anthropological examination of the health-seeking behaviours of Rohingya refugees living in crowded camps in Bangladesh, in the context of the COVID-19 pandemic. One international organisation providing medical care in the Kutupalong camp has found non-cooperation among the residents regarding the health facilities on offer to them. This ethnography highlights the Rohingya refugees’ active ‘mistrust’ (Carey 2017) of these medical services. We argue that these prevalent forms of mistrust provide a lens through which their individual life trajectories and politics can be understood in the context of the history of their systemic oppression by the Myanmar government. We reflect on the precarity and vulnerability of the Rohingya refugees, within which they identify mistrust as a source of resistance and protection. The mistrust of the Rohingya communities also highlights their attempts to communicate with a global public (Canetti 1960) and exhibits the ‘crowd politics’ (Chowdhury 2019) within a continued statelessness which is engendered by the Bangladeshi and Myanmar governments. This article makes an original contribution to the discussion of trust, mistrust, and rumour in society, identifying ‘the crowd’ as a site of resistance, and providing an account of the distinctive experience of the Rohingyas as refugees, and their health-seeking behaviour in the camp
Cruel Apprenticeship: National Imaginaries in China’s Operating Rooms
No full textDoctors learn to be doctors through clinical or therapeutic apprenticeships. By following, observing, and being mentored by more experienced physicians, trainees at various stages acquire embodied knowledge, affects, and ethics via both taught and hidden curricula. Previous research has demonstrated how biomedical training reproduces the social authority of scientific knowledge. This research article examines how for Chinese surgeons, apprenticeship not only immerses individuals within the scientific logics and hierarchical norms of biomedicine, but also embeds trainees within scientific imaginaries on a national scale. Drawing on ethnographic fieldwork in a Chinese academic hospital and a surrounding network of community hospitals, I examine how apprenticeship for Chinese surgical trainees extends beyond medical school and residency programmes, both in terms of temporality and geography. I examine how ‘technonational’ narratives, which permeate medical practice in China, impact the affects and ethics embodied by Chinese surgical trainees, and argue that changes in training expectations and the scope of training generates entanglements, dreams, and attachments which are cruel in their optimism. Thus, the therapeutic apprenticeship of Chinese surgical training reveals a ‘cruel apprenticeship’, a framing which encourages further exploration of the political and ethical stakes which permeate medical training and practice
Silent Questions: (Not) Talking about Dying in the Pearl River Delta
No full textThis Field Notes contribution describes the difficulty of confronting the topic of dying in conversations with terminally ill persons in the Pearl River Delta region in the People’s Republic of China (PRC), and how the ethnographer responded to this difficulty in a way she did not expect. While there is probably no ideal conversation starter for this subject anywhere in the world, bringing up the topic of approaching death is particularly challenging in China. First, it is considered impolite and harmful to communicate to a person directly that she is dying. Second, a terminal diagnosis is not necessarily received as though fatality is an inevitable consequence. After more than a few instances of feeling awkward and unequipped to talk to terminally ill persons during fieldwork, the author came to a realisation: encouraging those who are dying to communicate their experience of dying is not about finding a suitable opening line; rather, it is about silent presence, which may be the best invitation to speak. 
“Our Blood Itself Is Disabled!”: Haemoglobinopathy, Certificate Anxiety, and Contested Constitutionalism in Disability Legislation in India
No full textOn 28 December 2016, the Government of India passed a national disability act which for the first time recognised genetic blood disorders—thalassemia, sickle cell disease, and haemophilia—as disabilities, entitling affected individuals to affirmative action. While it was welcomed by patient communities, this policy decision also sowed seeds of collective anxieties regarding the assessment of the required degree of disability in affected individuals. Thirteen months later, a set of national guidelines were published that dictated the procedures for determining whether a patient meets this ‘benchmark disability’ standard, thus materialising the collective anxieties of blood disorder patient communities. Utilising ‘patchwork ethnography’ as a methodology, in this article I focus on haemoglobinopathy (thalassemia and sickle cell disease) patient communities in India to investigate the ‘certificate anxieties’ that stem from the difficulties of certifying disability percentage for those with genetic blood disorders. These anxieties arise from the tensions between a (bio)constitutional reordering of disability categories and the contestations of these categories, which are rooted in articulations of citizenship rights. I argue that such contested constitutionalisms give rise to productive tensions in State–(disabled) citizen relations that have the potential to realign institutions with citizens’ accounts of social justice
Reconsidering the Declaration of ‘Crisis’ While Living through One
No full textWhat counts as a ‘crisis’? How do we determine an ‘emergency’? Who gets to do so, and what exactly is at stake? Scholarly examinations of ‘crises’, including, most notably, seminal work by Janet Roitman (2013), frequently underscores how the ‘crisis imaginary’ is employed to rapidly and unjustifiably expand State power. Certainly, State responses to the COVID-19 pandemic have amply demonstrated this critique, as was noted early on by both Agamben (2020) and Chomsky (2020). Nonetheless, regardless of its political manipulations, crisis can also be understood as a phenomenological state, as there exist moments during which we collectively experience being plunged into a radically different time-space that is perhaps best conceptualised as a ‘collective critical event’. Such ‘extraordinary’ times have been denoted as events beyond the scope of narration (Briggs 2003); ‘failure[s] of the grammar of the ordinary’ (Das 2007); or moments of incredulity that surpass our capacities of narration. By focusing on the languaging of the COVID-19 pandemic in Aotearoa/New Zealand, this Position Piece grapples with how to reconcile the insights offered by critiques of the political deployment of claims of ‘crises’ with anthropological and other phenomenological accounts of experiences of moments of profound upheaval
Colonial Entanglements and African Health Worlds
No full textFollowing Ann Stoler’s (2016) idea of colonial and (post)colonial history as recursive, a history which folds back upon itself, emerging in new shapes and forms yet still carrying the formations that they are folded into, and Achille Mbembe’s argument that in the (post)colony the ‘past and present are entangled in hydra-headed ways’ (Mbembe and Hofmeyr 2006), this Review essay puts into conversation three recent publications: Marrku Hokkanen’s Medicine, Mobility and Empire (2017), Simukai Chigudu’s The Political Life of an Epidemic (2020), and Luke Messac’s No More to Spend (2020). I argue that these books help elucidate the transitions from colonial to postcolonial biomedicine in Africa and show what has endured. Focusing on books that look at a small part of south-eastern Africa, the essay examines how detailed historical analysis of the colonial creation of the medical world in the region can allow a temporally entangled understanding of medicine in the (post)colony. In particular, I observe how these three books highlight the impact of colonial logics of spatiality on African medical and healthcare worlds and suggest that paying careful attention to the colonial entanglements of African health worlds is crucial to understanding their contemporary shapes and forms. 
Assisted Reproductive Technologies: A Grey Zone in the Zika Epidemic in Brazil?
No full textIn this article, I address an issue that emerged during my ethnographic fieldwork in Brazil in 2018, which received little attention during the Zika virus outbreak that took place in the country during 2015–17. My fieldwork revealed that, interestingly, despite the epidemic and its associated risk of birth defects, some couples who were attending a fertility clinic (most of whom came from a middle- or upper-class background, with access to private health care) chose to take the risk of a pregnancy instead of delaying their plans. I argue that this case study of assisted reproductive technology (ART) is a ‘grey zone’ whose investigation aids understanding of how the Zika epidemic was managed in Brazil. By looking at the potentiality of pregnancies and prospective babies for (infertile) couples, we can analyse how fertility clinics influenced the ability of couples to engage in ART during the epidemic and explore which kinds of reproductive services were offered to patients during this time. More broadly, this case study permits the examination of how the specific case of ART sheds light on the issue of risk/reward in wider reproductive decision-making during the epidemic. In many ways, I conclude, one can say that the Zika virus epidemic came to challenge both the timing of reproduction and the choice to become pregnant
The Tyranny of Numbers: How e-Health Record Transparency Affects Patients’ Health Perceptions and Conversations with Physicians
No full textAll Danish adults have access to their electronic medical records on the e-health platform Sundhed.dk, which is intended as a means to empower patients. But what happens when patients see their paraclinical test results presented as numbers which are flagged as either ‘normal’ or ‘abnormal’? Based on fieldwork in general practices and consultations, and on observations of individuals living with chronic illnesses, we investigated how patients and physicians interpret and interact with such numerical values, creating, as we argue through the words of Gregory Bateson, ‘epistemological errors’. We show how health record transparency blurs the patient’s senses and understanding and makes it harder for them to interpret their state of health and to trust the clinical judgement of health professionals. We argue that the immediate access to test results triggers a runaway process in which numerical values (be they normal or abnormal in comparison with a standard point of reference) transform into a threat to life itself. As such, our ethnography underlines the intricate contradiction between the trust placed in biomedical sciences and the uncertainty involved in testing, diagnosing, and treating. Patients’ access to all test results leads to a quest for certainty—one never fully obtainable, which thus instead mobilises new uncertainties
The Innovation Imperative in Global Health: Gendered Futurity in the Sayana® Press
No full textIn this Position Piece, we explore the hegemony of innovation and the construction of gendered futures in global health through the Sayana® Press, a device that delivers a version of the contraceptive drug commonly known as Depo-Provera. The device has generated tremendous enthusiasm amongst global family planning advocates for its effectiveness and ease of use, including administration by community level providers and self-injection. Claims about its potential are compelling: advocates hope it will dramatically increase access to contraceptives, and thereby unlock the social and material emancipatory promise of family planning. We offer preliminary observations about Sayana Press as an ethnographic and discursive object and further the scholarly conversation on humanitarian design by considering the gendered dimensions of global health technologies. The advent of Sayana Press reflects several significant trends in global health including the intensification of the innovation imperative and the bypassing of investments in infrastructure—both bolstered by the recent rise of the ‘self-care agenda’. Further, we suggest that global health technologies are also techniques in the Foucauldian sense—scripting new subjectivities and bodily norms towards gendered futurities. Finally, we note the dual role of the state in sexual and reproductive health as both source and object of reproductive governance