Medicine Anthropology Theory
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Positioning Human Microbiome DTC Tests On the Search for Health, Data and Alternatives Amid the Financialisation of Life
No full textEarly during my fieldwork on the social life of the microbiome in Toronto, I was asked ‘Do you believe in microbiome testing?’ This question invited me to evaluate the science of the direct-to-consumer (DTC) test. In this Position Piece, I consider this question in a more expansive manner so as to position the test in its social and economic context. The distribution and public uptake of such a DTC test require scientific expertise but also marketing, capital investments, and clinical labour. This test requires consumers to do the work of stool collection and the reproductive labour of diet changes in their domestic spaces. I have learned that the microbiome is part of the quest for alternative ways of living and being healthy. Broadening the question to consider more than just the science expands the frame from one of scientific efficacy and individual consumption to one that considers the financialisation of health and the politics and environments of post-Pasteurian and post-industrial contexts
\u27Stay Home, Stay Safe\u27: Proximity as Vitality and Vulnerability Under Lockdown
No full textFrom March to May 2020 in the UK, measures that became known across the world as ‘lockdown’ curtailed personal freedoms in order to curb the spread of the SARS-CoV-2 Coronavirus. While initial criticisms of lockdown focused on the adverse impacts of social isolation on wellbeing, this research article explores how lockdown creates new and altered proximities and intimacies as well as distances. During the initial UK lockdown, the ‘household’ and ‘home’ were deployed in public rhetoric as default spaces of care and security in the face of widespread isolation and uncertainty. However, emergent proximities created by bringing people together in the assumed safety of home also deepened existing inequalities and vulnerabilities. Using anthropological theory, third sector evidence, and ethnographic interview data we explore this process. We argue that understanding proximity and intimacy as fundamentally ambivalent, not normatively affirming, is central to recognising how pandemic responses such as lockdown reinforce and reproduce existing forms of inequality and violence
Patient Pathways and Diagnostic Value in Sierra Leone
No full textWhat is the value of a diagnostic test? Most obviously for primary healthcare settings, laboratory tests can inform clinical decision making about treatment and patient management. Their predominant value in this context is therefore medical. But what about when that healthcare setting is chronically under-resourced, healthcare workers (including laboratory workers) are underpaid, and government supply chains fail to deliver basic laboratory supplies? In this contribution to the Field Notes section, we describe a Community Health Centre (CHC) in Sierra Leone where such conditions have given rise to a quasi-private laboratory service within the public health facility. Through detailed ethnographic description of patients’ diagnostic pathways through the facility, we examine and assess the impact on patient care when the medical and economic value of diagnostic tests diverge
Learning to See Cancer in Early Detection Research
No full textThis article explores how scientists learn to detect ‘pre-cancer’, a new diagnostic category defined by the risk of developing the titular disease. This process entails the observation of ‘raw signals’ that stand for potential molecular and metabolic changes in animal and human tissues and their validation as ‘candidate biomarkers’. I draw on ethnographic fieldwork conducted alongside a multidisciplinary group of researchers—physicists, biologists, mathematicians, computer scientists, and engineers, among others—all of whom worked as part of a research programme investigating the early signs and detection of cancer in the UK. ‘Signals’ detected through scientific experiments are intimately entangled with the sensing technologies and analytical techniques used. As previously unknown microscopic realities emerge, scientists seek to negotiate the uncertainty surrounding the identification and validation of signals as candidate biomarkers before they can be tested in clinical trials
When Refugees Care for Refugees in Lebanon: Providing Contextually Appropriate Care from the Ground Up
No full textDespite a surge in initiatives to integrate foreign-trained physicians into local health systems and a drive to learn from localised humanitarian initiatives under the COVID-19 pandemic, we still know little about the on-the-ground strategies developed by refugee doctors to meet the needs of refugee patients. In Lebanon, displaced Syrian health professionals have mounted informal, local responses to care for displaced Syrian patients. Drawing on ethnographic work shadowing these healthcare providers across their medical and non-medical activities, we explore how clinical encounters characterised by shared histories of displacement can inform humanitarian medicine. Our findings shed light on the creation of breathing spaces in crises. In particular, our study reveals how displaced healthcare workers cope with uncertainty, documents how displaced healthcare workers expand the category of ‘appropriate care’ to take into account the economic and safety challenges faced by patients, and locates the category of ‘informality’ within a complex landscape of myriad actors in Lebanon. This research article shows that refugee-to-refugee healthcare is not restricted to improvised clinical encounters between ‘frontliners’ and ‘victims of war’. Rather, it is proactively enacted from the ground up to foster appropriate care relationships in the midst of violent, repeated, and protracted disruptions to systems of care
Covid-19 Temporalities: Ruptures of Everyday Life in Urban Burkina Faso
No full textGlobalisation intensifies global interconnectedness; reorders time and space; and stretches social, political, and economic practices across boundaries. However, globalisation is not a linear process; it takes place in discrete phases of short and concentrated bursts. The COVID-19 pandemic is one such time-space burst, or ‘eruption’. In this paper, we focus on COVID-19 as an ‘emerging epidemic’ from the perspective of citizens in Bobo-Dioulasso, the second-largest city in Burkina Faso. We explore how these citizens experience ruptures of their everyday life due to COVID-19 and how their understandings and responses to the pandemic were shaped in a context of instability and political turbulence. We are inspired by Giddens’s notion of ‘time-space distanciation’, which refers to ‘the condition under which time and space are organized so as to connect presence and absence’. We focus on the temporality of the pandemic by looking at a specific period during the pandemic, during which the government of Burkina Faso introduced a number of restrictions as preventive measures at a time when COVID-19 as a disease was still an absent phenomenon for most people. The pandemic had not (yet) infected large numbers of people in the country and most people did not yet have any experiences of the disease. We argue that the local responses to the pandemic and the various control measures during this period must be understood in the wider context of Burkina Faso’s specific socio-economic, political, and security situations, which are distinctly fragile
Race, Racism and Anthropology: Decolonising Health Inequality in a Time of Covid-19
No full textIn the United Kingdom, the government’s failure to consistently record the race and ethnicity of those who have died from COVID-19 and the disproportionate mortality impact of the virus on Black, Asian and Minority Ethnic (BAME) communities speaks to a systemic failure to account for the interplay between the social construction of race and the lived experience of racism, itself presented biologically as ‘poor health’. This failure has run for far longer and far deeper than many would care to admit. In this article, I use my own positionality as a ‘Mixed-Race Black’ woman to argue that the unique place of medical anthropology to sit at the intersection of the social, political, biological, and ecological means it can provide alternative approaches to understanding the disproportionate impacts of the pandemic and lay some foundations for repair strategies that encompass the patterns, processes, and constructs of health inequality