Medicine Anthropology Theory
Not a member yet
559 research outputs found
Sort by
Moments of Uncertainty: Exploring How an App-Based Oral HIV Self-Testing Strategy Fits in Communities ‘Living Under’ HIV Risk
No full textFeasibility and acceptability research for HIV self-testing (HIVST) often emphasises the importance of good test conduct and correct test interpretation for knowing one’s HIV result while overlooking the ways in which different uncertainties and meanings emerge around testing. Using empirical examples from a quantitative study assessing an app-based strategy in Cape Town, South Africa, this research article explores the practice of HIVST and how people deal with uncertainties while using the app in question, named ‘HIVSmart!’. We use the concept of ‘living under’ to explore the practices of HIV testing for those who fit the definition of being ‘at risk’ of HIV (note that an individual’s HIV status must be unknown in order for them to fit this definition) and to understand how an app-based HIVST strategy fits within these practices. We show how the app and oral self-test—as well as knowledge around HIV risk behaviours, comparisons between different testing methods, and the guidance and presence of healthcare staff—alleviate as well as generate uncertainty and constitute HIV status as an ongoing process. The effective implementation of new strategies for HIVST requires consideration of multiple aspects of the testing process, including local understandings of HIV risk, access to healthcare staff, and the meaning of certain test methods within a particular context
Infrastructural Instability, Value, and Laboratory Work in a Public Hospital in Sierra Leone
No full textThis research article examines the relationship between infrastructural instability and laboratory work in a public referral hospital in Sierra Leone. Drawing on ethnographic fieldwork conducted inside the hospital’s wards and clinical laboratory, I show how attending to infrastructure and materiality (i.e., laboratory spaces, diagnostic equipment, and supply chains) provides insight into the different kinds of value that laboratory work holds for laboratory technicians, clinicians, hospital administrators, and international donors. Through the case study of a newly arrived non-functioning diagnostic instrument, I reveal the institutional undervaluing of both the laboratory and the improvisation work performed by lab technicians to stabilise unstable equipment. Infrastructural instability in the laboratory enables the generation of new kinds of value, including economic and social value for laboratory technicians themselves, but undermines the clinical value of laboratory tests for clinicians and patients. By discussing the everyday practices, challenges, and meanings of laboratory work in a context of infrastructural instability, I aim to draw attention to the clinical laboratory space as a field site worthy of (more) anthropological inquiry and health systems research and contribute new insights about improvisation, instability, and diagnostic value creation in under-resourced settings
Breathing and Dying in 2020
No full textEvery ethnographer balances participation and observation during fieldwork in their own unique way. For those whose primary role is participation, field notes represent an avenue for reflecting on trends that may not be immediately obvious when one is mired in the ethnographic setting. The author, an emergency physician and anthropologist, reflects on racial injustices and transformations in biomedical rituals to do with death and dying, from the front lines of the COVID-19 pandemic
Prognostic Calibrations Throughout Outpatient Encounters for Families Living with Congenital Heart Defects in Denmark
No full textAlthough many suffering from congenital heart defects (CHDs) have seen their conditions become chronic in Denmark today, the risk of complications, deteriorations, and further surgical interventions often lurk in the future. Building on fieldwork in outpatient clinics in Denmark and the homes of families living with CHDs, I explore the role outpatient encounters play in families’ efforts to understand and navigate the prognoses of CHDs by examining how they become routine punctuations and images of uncertainty, and how they play into families’ efforts to prepare for futures where CHDs might develop negatively while also trying to keep such scenarios at bay. I argue that these encounters exemplify, generate, and tentatively curb the particular uncertainties of living with CHDs. Hence, I suggest that they can be thought of as prognostic calibrations—a conceptual oxymoron that encapsulates the anxiety and uncertainty that I show persist around CHD prognoses despite many efforts by families and healthcare staff to establish routine, a sense of security, and certainty
Molecular Sovereignty: Building a Blood Screening Test for the Brazilian Nation
No full textThis article interrogates the relationship between the development of national diagnostic technologies and the exercise of sovereignty, by analysing a Brazilian project to produce a nucleic acid test (NAT) for the country’s blood screening programme. The concept of ‘molecular sovereignty’ is proposed to demonstrate that exercising sovereignty demands not only technological resources but also a sufficiently powerful and national imaginary to support local knowledge production as a means of advancing national healthcare priorities. First, this research article contextualises the political importance of blood safety for Brazil during its transition to democracy in the 1980s and the creation of its universal healthcare system. Then, it investigates how adopting the NAT led the state to invest in the production of a national technology. Third, the article unpacks the diagnostic test to consider how certain aspects of the project might ultimately strengthen the ability of global capital to cross national boundaries and create new markets. Lastly, it discusses how the project ended up creating a centralised and ‘closed’ system to avoid leaving the country vulnerable to the entry of global diagnostic companies. This case demonstrates how the molecularisation of blood, through the construction of a unified healthcare system driven by the constitutional right to health, can be deployed to construct imagined communities on the scale of a nation
