The “Last Child”: Lone Family Caregivers in St. Croix,US Virgin Islands

ABSTRACT

I investigate local explanations for a common family configuration of care for older relatives on the island of St. Croix, U.S. Virgin Islands: the “lone family caregiver.” Through the examination of a paradigm case emerging from these explanations, I argue that local logics can divest some children of obligations to care for their older parents. I suggest that this case is an important addition to recent discussions within the anthropology of care that emphasize how families practice “care across distance,” as it offers an alternative example of how families manage care in the context of migration.     

Cosmic Experiments: Remaking Materialism and Daoist Ethic “Outside of the Establishment”

ABSTRACT

In this article, I discuss recent experiments in ‘classical’ (gudian) Chinese medicine. As the marketization and privatization of health care deepens and enters uncharted territories in China, a cohort of young practitioners and entrepreneurs have begun their quest for the ‘primordial spirit’ of traditional Chinese medicine by setting up their own businesses where they engage in clinical, pedagogical, and entrepreneurial practices outside of state-run institutions. I argue that these explorations in classical Chinese medicine, which focus on classical texts and Daoist analytics, do not aim to restore spirituality to the scientized and secularized theory of traditional Chinese medicine. Nor are they symptomatic of withdrawals from the modern world. Rather, these ‘cosmic experiments’ need to be understood in relation to dialectical and historical materialisms as modes of knowledge production and political alliance. In challenging the status of materialist theory and the process of theorization in traditional Chinese medicine and postsocialist life more broadly speaking, advocates of classical Chinese medicine imagine nondialectical materialisms as immanent ways of thinking, doing, and being in the world.     

Living with HIV as Donor Aid Declines in Tanzania

ABSTRACT

Fluctuations in global health funding can significantly impact the lives of people who depend on donor-funded programs for life-long care. In this article, I examine shifting HIV policies that expanded antiretroviral therapy (ART) while reducing “care” services meant to improve ART access and adherence. I describe how these changes were experienced by HIV+ women accessing ART at a hospital in Tanzania in 2011–2012, highlighting their increasing precarity and uncertainty for care amidst donor instability and eroding program services. This research suggests that stable funding in support of long-term care services is important to help HIV+ people maintain life-long ART.     

“Dirty like a Tenant”: Migration and Embodied Dispositions in Malawi

ABSTRACT

Much has been written about how structural (e.g. colonialism) and social (e.g. gender) determinants shape embodied health outcomes. However, little attention has been paid to the ways that marginalized populations become complicit in their own oppression. Ethnographic data collected over two years at a rural public hospital in Malawi show that the tobacco political economy produces significant intra-rural inequalities that result in the exclusion of migrant farm workers, called “tenants,” from HIV care. Using an analytical framework informed by Bourdieu’s concepts of social field and habitus, I illustrate how social inequalities persist unchallenged, even by the most disadvantaged people.     

Political Therapeutics: Dialogues and Frictions Around Care and Cure

ABSTRACT

In 1978, Italy passed a law establishing the abolition of the mental hospital. Up to that time, the traditional asylums were still governed by the 1904 law that positioned psychiatry within the criminal justice system by assigning it the function of custodia (control, custody) rather than of cura (care). In the 1960s and 1970s, Italian psychiatrist Franco Basaglia initiated a movement of de-institutionalization of the mentally ill that revolutionized psychiatric care in Italy. It also had a deep impact on restructuring the psychiatric system in other European and Latin American countries. In this article, I discuss the different psychiatric practices and imaginaries that resulted from the movement of democratic psychiatry and Basaglia’s visions for a community-based and diagnosis-free care of the mentally ill. I ethnographically trace what I call the “Basaglia effect” in today’s psychiatric practices, and focus on ethnopsychiatry as a counter clinic that emerged from Basaglia’s legacy. I reflect on the frictions between care and cure that ethnopsychiatry re-articulates and works with in the context of contemporary migrations to Europe.     

Twelve tips for teaching oncology to non-oncologists

Abstract

Background: Teaching subspecialty care to trainees who are not pursuing that subspecialty poses many challenges. These challenges are amplified in the teaching of oncology to non-oncologists because there are more new therapies emerging in oncology than in any other discipline, and there are few oncologic issues managed by generalists without consultation. Concurrently, there is an increasing need for generalists to manage many aspects of care for patients with cancer.

Aim: To provide 12 tips for oncologists to use to educate trainees on their oncology rotations.

Method: The tips provided are based upon the available literature and the authors’ own experience.

Results: The 12 tips presented offer specific strategies for oncologists to enhance their teaching by selection of appropriate content and enhancing delivery. Focus is placed on aspects of oncology that trainees are likely to encounter as a generalist or non-cancer subspecialist. While oncology is used as the case study, these strategies are adaptable to any subspecialty area.

Conclusion: Oncologists and other subspecialists can be core medical educators.     

The Care of “Small Things”: Aging and Dignity in Rwanda

ABSTRACT

In Rwanda, disruptions to family and social life as a result of the 1994 genocide, and the economic transformations in its aftermath, have complicated the fabric of elder care across the country. In this article, I focus on how elderly Rwandans are reconfiguring their care networks – many of which were destroyed during the genocide – by acting as caregivers and care receivers for each other on a daily basis. Although emotionally and physically taxing, elderly Rwandans emphasize that the “small things” embedded in the giving and receiving of care are intricately connected to how personal and collective dignity is cultivated.     

Interprofessional learning through shadowing: Insights and lessons learned

Background: Interprofessional education (IPE) aims to improve patient outcomes. Interprofessional shadowing improves students’ knowledge of different roles and attitudes toward other professionals.

Aim: This study evaluates (1) how pre-clinical medical students describe the roles of the healthcare professionals they shadowed, and (2) whether shadowing can be used to introduce medical students to the benefits of interprofessional collaboration, and if so, in what ways.

Methods: Second-year medical students shadow another discipline and write a reflection on the shadowed discipline (SD)’s role and collaboration in patient care. A non-proportional stratified random sample of these reflections was coded during an iterative process. Any number of the 13 possible codes could be assigned to each reflection. Codes relevant to the research questions underwent narrative analysis.

Results: The most frequent codes were “specific function of SD” (88%), “SD’s general purpose” (86%), and “value of SD’s role” (68%). One-third of reflections referenced “communication,” and one-third mentioned “teamwork.” Insights gained included an appreciation for interprofessional care and a global perspective on patient care, extending beyond the inpatient encounter.

Conclusion: Through shadowing, students achieve several IPE core competencies and a broader perspective on patient care. Shadowing is an effective pedagogical method for IPE in the pre-clerkship curriculum.     

Much More than a Clinic: Chicago’s Free Health Centers 1968-1972

ABSTRACT

Drawing on archival evidence, I document the emergence and florescence of three free health clinics in Chicago in the late 1960s. I trace the centers’ forceful removal by the city’s Board of Health, and their subsequent replacement by Federally Qualified Health Centers (FHQCs). I argue that the demise of the free centers is exemplary of a broader trend in US health policy of regulating and diminishing the health care options of poor Americans. By highlighting the stark contrast between Chicago’s free health centers of the 1960s and the health care services offered by contemporary FQHCs, I reveal a gradual shift from health care rights to accessing care in the US health care safety net.     

Empty Spaces

“I'm Jewish, you know, and my mother said, ‘Always trust the rabbis.’” I never heard Mr. Weisman's refrain from his own lips. I never heard him say any words all. By the time I met him he was in a vegetative state, a man on the precipice of invisibility—white hair, thin pale limbs, melting into sheets of the same color. When I think about Mr. Weisman, I see empty spaces—the absence of his voice, the too‐large bed for his shrinking frame, the always‐empty chair by his bedside, and most of all, the myriad gaps in his life story. He was what in hospitals is often called a “patient alone”: someone who lacks decisional capacity and has no surrogate to make medical decisions for him. Mr. Weisman's aloneness prompted his primary team to consult our bioethics service in order to formulate goals of care for him, including the possibility of hospice care.     

Race-ing Time: Clinical Temporalities and Inequality in Public Prenatal Care

ABSTRACT

Analysis of clinical temporalities, or the social organization of time in the clinic, offers insights into how racism coheres in pregnant bodies and institutions, with implications for health care experiences for patients and providers. Based on research at a public prenatal clinic, I argue that long patient wait-times and pressure on providers to speed up are temporal instantiations of the same racist structures that shape public health care in the US. Through these temporal experiences, racialized patient populations and staff who work in racialized systems of public health care encounter the lesser value assigned to their time, bodies, and labor.     

Cultivating the Therapeutic Self in China

ABSTRACT

Facing intensified market competition and rapid social change, many Chinese are experiencing increased mental distress. In this article, I examine how psychological training and interventions play a vital part in cultivating a new self among urban middle-classes. I ask how the Chinese notion, ziwo (self), is turned into an object of intense inquiry and how therapeutic techniques are deployed for self-development. The new forms of the self, however, continue to intersect with and complicate the existing social nexus, cultural sensibilities, and notions of personhood. My ethnography explores how this therapeutic work contributes to intricate forms of subject-making that challenge such conceptual binaries as the private versus social self, the inner versus outer life, and psychological versus social problems. Thus, what is emerging is not a usual “neoliberalism” story of self-advancement, but a more complicated picture based on assemblages.     

Entangled Bodies: Jews,Bedouins, and the Making of the Secular Israeli

ABSTRACT

Taking Israel’s National Health Insurance Law as a point of entry, in this article I probe how notions of equality and citizenship, secularism, and religion become entangled in the experience of Negev/Naqab Bedouins, who are Palestinian citizens of Israel. Drawing on ethnographic and archival research, I show how Jewish citizens have come to represent the secular and modern citizens in the region, while Bedouins, although mandated and claimed by policy and providers to be the ‘same’ and ‘equal,’ are always already imagined and characterized as other. Universal health care and the daily manner in which biomedicine is practiced in southern Israel provides an avenue for examining the Jewish valences medicine carries in southern Israel, Israel’s boundaries of inclusion, and the connection between biomedicine and secularism.     

Truth Telling,Companionship, and Witness: An Agenda for Narrative Ethics

Narrative ethics holds that if you ask someone what goodness is, as a basis of action, most people will first appeal to various abstractions, each of which can be defined only by other abstractions that in turn require further definition. If you persist in asking what each of these abstractions actually means, eventually that person will have to tell you a story and expect you to recognize goodness in the story. Goodness and badness need stories to make them thinkable and to translate them into individual and collective actions. Yet after more than two decades of considering the issue, I do not believe that a collection of stories can by itself guide actions in ways that are sufficient to respond to ethical troubles in institutional settings. The question will always remain open for me, but my present belief is that narrative bioethics is always hyphenated, in the sense that guidance from stories needs to be allied with other ethical guidance. Each side of the hyphen qualifies the other side. The hyphenation I will argue for in this essay is “narrative‐deontology.”     

Callahanian Bioethics

For someone with an outsized influence on a field he helped to create, Dan Callahan was anything but overbearing. Physically compact, thin, and wiry in older age, he spoke at the rapid speed of his mind. Soon after I met him—when I was on the cusp of what would become a year‐long residency at The Hastings Center—I found myself seated in his decidedly quaint living room. Dan told a story that evening, one of many that has stuck in my head. It seemed to encapsulate his moral mindset and, in a way, his broader vision for bioethics. I am sure he has told the story many times to many people, but here it is as I recall it.     

Paces of Costly Care: Rare Disease Drug Access in Canada

ABSTRACT

Pharmaceutical industry representatives and public drug plan managers hold competing visions of drug access, ones I theorize as “fast” and “slow” care paces. The relationship between free market imaginaries and population-based biopolitics is negotiated through these paces from within the flexible political category of rare disease. In this article, I explore expensive rare disease drug access in Canada’s universal health system through a temporal lens. I show how two families navigate these powerful negotiations, asserting themselves as deserving of resources while finding ways to consider life and death outside of this clash between health system pragmatics and pharmaceutical promise.     

Obstetric Violence Observatory: Contributions of Argentina to the International Debate

ABSTRACT

In Latin America, over the past decade, the term “obstetric violence” has become part of the legal framework. Specific laws against obstetric violence – gender-based violence and the violation of human rights – exist in Venezuela, Argentina, Mexico, Brazil and Uruguay. In Europe, the issue is raised by human rights organizations, social movements and academics, but no country has yet passed legislation on the matter. In this article, I focus on the contribution of Argentina to this international debate, particularly with respect to the implementation of the Obstetric Violence Observatory.     

Twelve tips for developing palliative care teaching in an undergraduate curriculum for medical students

Abstract

Palliative care is the holistic care of patients with advanced, progressive incurable illness. Palliative care is well recognized as an essential component of medical student curricula. However, teaching is variable within medical schools. Using current literature, these tips aim to highlight key points necessary to facilitate the development and delivery of palliative care teaching to medical students. The key practice points include: clinical exposure to patients with palliative care needs and those that are dying, being compulsory (and integrated) across the course, summative and formative assessments to encourage learning, support from within the university for curricular time and development, visits to a hospice/inpatient palliative care facility, emphasis on clinically based learning later in the course, teaching by specialists in palliative care as well as specialists in other areas including Family Doctors/General Practitioners, innovative teaching methods and inter-professional learning to develop teaching.     

Validation of the self-assessment teamwork tool (SATT) in a cohort of nursing and medical students

Abstract

Introduction: Poor teamwork has been implicated in medical error and teamwork training has been shown to improve patient care. Simulation is an effective educational method for teamwork training. Post-simulation reflection aims to promote learning and we have previously developed a self-assessment teamwork tool (SATT) for health students to measure teamwork performance. This study aimed to evaluate the psychometric properties of a revised self-assessment teamwork tool.

Methods: The tool was tested in 257 medical and nursing students after their participation in one of several mass casualty simulations.

Results: Using exploratory and confirmatory factor analysis, the revised self-assessment teamwork tool was shown to have strong construct validity, high reliability, and the construct demonstrated invariance across groups (Medicine & Nursing).

Conclusions: The modified SATT was shown to be a reliable and valid student self-assessment tool. The SATT is a quick and practical method of guiding students’ reflection on important teamwork skills.