Moving for Cures: Breast Cancer and Mobility in Italy

I combine the theoretical tools of medical anthropology and the framework of mobility studies to explore the intranational movements of women with breast cancer from Southern and Northern Italy. Differences include patients’ technical and moral evaluations of doctors, that influence the patients’ definitions of cure and illness experiences through their mobility and immobility. These (im)mobilities are, in turn, linked to the material and symbolic inequalities between Southern and Northern Italy and to the stigma attached to the south. These (im)mobilities suggest the need to further articulate the concept of cure.     

Dementia Care Work in Singapore: Embodied Relations and Power Dynamics

Based on research at a dementia day-care center in Singapore, I discuss how embodied care relations proceed amidst cultural expectations on aging, dementia, and care work. Engaging with approaches that conceptualize “care” as either empathy or control, I argue that care between older people with dementia, their families, and care workers can be understood as a reiterative, dialogic process whereby care participants strive to keep pace with each other, however briefly, due to cognitive decline, care workers’ own limitations, and particular family difficulties. Care vacillates between practices of control, surveillance, and recognition, and comprises dynamic rather than enduring power relations.     

Everyday Care and Precarity: Buddhaghosa and Thai Social Story-Making

ABSTRACT

In this article, Buddhaghosa’s fifth century philosophy provides a productive framework for deciphering contemporary social caregiving in Thailand. In particular, his work and the tradition it inspired helps bring forth a local theory of mind and related narrative forms that, when utilized in examination of group patterns of interaction, illuminate the intertwining of care and precarity in everyday practices of providing for others. In turn, I call for experimentation in anthropological storytelling, including ensemble work, to ensure that habits of professional practice do justice to the care manifest in the precarious conditions in which anthropologists so often engage.     

Distressed Work: Chronic Imperatives and Distress in Covid-19 Critical Care

This ethnographic study introduces the term “distressed work” to describe the emergence of chronic frictions between moral imperatives for health care workers to keep working and the dramatic increase in distress during the Covid-19 pandemic. Interviews and observant participation conducted in a hospital intensive care unit during the Covid-19 pandemic reveal how health care workers connected job duties with extraordinary emotional, physical, and moral burdens. We explore tensions between perceived obligations of health care professionals and the structural contexts of work. Key findings cluster around the moral imperatives of health care work and the distress that work engendered as work spaces, senses of vocation, patient and family interactions, and end-of-life care shifted. While the danger of working beyond limits has long been an ordinary feature of health care work, it has now become a chronic crisis. Assessing this problem in terms of distressed work and its structural contexts can better address effective, worker-informed responses to current health care labor dilemmas.     

Precarity,Assemblages, and Indonesian Elder Care

ABSTRACT

The provision (or failure) of care reflects and produces vulnerability in old age. Reliable and appropriate care widely affects the imagination of “good care” of older Indonesians in North Sulawesi. Yet, their striving for better life goes with the growing chronification of conditions and processes with unpredictable endings. Three factors shape such uncertainty in elder care in North Sulawesi: (1) unsustainable, fragile care arrangements; (2) progressive-degenerative non-communicable diseases and aging impairments; and (3) structural insecurity in elder care and health-care institutions. Older persons mitigate the degree of chronifying care uncertainty by expanding social spaces, but often in normatively less accepted ways.     

Neurodegeneration and the Intersubjectivities of Care

ABSTRACT

Caring for a family member or friend with a serious health condition is a common feature of social life. Often, such care is framed as a burden, an unwelcome rupture in the fabric of everyday life. We draw on research conducted in Australia and the UK to examine care in the everyday lives of people living with and caring for neurodegenerative diseases and to trouble care as a burden. Participants in our studies mobilized practices of care to collaboratively produce a “good life”. We argue that above all, care is a relational, enacted practice requiring examination in its local context.     

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.     

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.     

Damaged and Deserving: On Care in a Veteran Treatment Court

ABSTRACT

In this article, I describe the life-sustaining but inherently coercive labor of care in a veteran treatment court (VTC), a “helping court” in which veterans charged with less-severe offenses can avoid jail by completing a 12- to 18-month therapeutic and rehabilitative program. This privileged medico-legal status is intertwined with the moral economy of military service in the contemporary US and resonates with the politics of American war-making. I argue that the caring work of the court helps produce the subject of veteran disorder, simultaneously enabling life-sustaining practices and constraining the forms of life that veteran offenders can inhabit.     

Demedicalizing Health: The Kitchen as a Site of Care

Attention to culinary care can enrich the framing of health within medical anthropology. We focus on care practices in six Latin American kitchens to illuminate forms of health not located within a singular human subject. In these kitchens, women cared not for individuals but for meals, targeting the health of families and landscapes. Many medical anthropologists have critiqued health for its associations with biomedicine/biocapitalism, some even taking a stance ‘against health.’ Although sympathetic to this critique, our focus on women’s practices of caring for health through food highlights dissonances between clinical and nonclinical forms of health. We call for the development of an expanded vocabulary of health that recognizes health care treatment strategies that do not target solely the human body but also social, political, and environmental afflictions.     

Ways of Doing: Restorative Practices,Governmentality, and Provider Conduct in Post-Apartheid Health Care

In this article, we consider the conduct of post-apartheid health care in a policy context directed toward entrenching democracy, ensuring treatment-adherent patients, and creating a healthy populace actively responsible for their own health. We ask how tuberculosis treatment, antiretroviral therapy, and maternal services are delivered within South Africa’s health system, an institutional site of colonial and apartheid injustice, and democratic reform. Using Foucauldian and post-Foucauldian notions of governmentality, we explore provider ways of doing to, for, and with patients in three health subdistricts. Although restorative provider engagements are expected in policy, older authoritarian and paternalistic norms persist in practice. These challenge and reshape, even ‘undo’ democratic assertions of citizenship, while producing compliant, self-responsible patients. Alongside the need to address pervasive structural barriers to health care, a restorative approach requires community participation, provider accountability, and a health system that does with providers as much as providers who do with patients.     

Analyzing Social Spaces: Relational Citizenship for Patients Leaving Mental Health Care Institutions

“Citizenship” is a term from political theory. The term has moved from the relationship between the individual and the state toward addressing the position of ‘others’ in society. Here, I am concerned with people with long-term mental health problems. I explore the possibilities of ethnographically studying this rather more cultural understanding of citizenship with the use of the concept of relational citizenship, attending to people who leave Dutch institutions for mental health care. Relational citizenship assumes that people become citizens through interactions, whereby they create particular relations and social spaces. Rather than studying the citizen as a particular individual, citizenship becomes a matter of sociality. In this article, I consider what social spaces these relationships create and what values and mechanisms keep people together. I argue that the notion of neighborhood as a form of community, although built implicitly or explicitly into mental health care policy, is no longer the most plausible model to understand social spaces.     

The Limits of Autonomy: Ideals in Care for People with Learning Disabilities

In the Netherlands, autonomy is a key ideal in visions of care for people with learning disability. This ideal can lead to tension when clients, in the opinion of their caregivers, overuse alcohol or drugs. In this article, we analyze how professional caregivers understand the ideal of autonomy in care for people with learning disability, and articulate the tacit attempts of caregivers to provide “good care,” which can be understood as care for relationships. This relational view includes caregivers, care recipients, and their networks and infrastructures in the vision of care.     

Frequent Callers: “Good Care” with ICTs in Indian Transnational Families

ABSTRACT

In the context of transnational family life, everyday information and communication technologies (ICTs) are key members of transnational care collectives. Through the approach of material semiotics to care as a relational practice between people and nonhuman entities, I explore frequent calling as one aspect of these collectives. I analyze the practice of frequent calling on phone and webcam between elderly parents living in Kerala, South India, and their adult children who work abroad as nurses. When family members are scattered around the world, frequent calling becomes a way to enact “good care” at a distance.

MALAYALAM ABSTRACT

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Caring for Premature Life and Death: The Relational Dynamics of Detachment in a NICU

Drawing on fieldwork in a neonatal intensive care unit (NICU) in Chiang Mai during 2010 and 2012, I examine neonatal care as a contingent entanglement of technological and ethical relationships with vulnerable others. Along the continuum of universal antenatal and delivery care, neonatal medicine becomes a normative part of reproductive health care in Chiang Mai. As the NICU opens its door to sick newborns whose belonging to kinship and the nation-state is uncertain, neonatal care requires deliberate practices to incorporate them into life-sustaining connections. By tracing medical staff’s effort to be accountable to their fragile patients, I show that withdrawing of intensive care is relational work that requires affective involvement and distancing through commensality, prosthetic extensions, and karmic network. This specific mode of care, which is premised on the combination of unconditional openness and careful detachment, offers insight into a possible enactment of hospitality within biomedical institutions.     

Numbers that Matter: Right to Health and Peruvian Maternal Strategies

ABSTRACT

The rights to health and to culturally respectful care are inextricably linked in the documents supporting Peruvian Maternal Health Policy. Strategies of Intercultural Birthing and Maternal Waiting Houses were purported to reduce maternal deaths, while extending the right to health to marginalized indigenous women. Based on 17 months of field research in Peru, I argue that the narrow focus on achieving “good numbers” creates and sustains coercive modes of strategy applications. As a result, the on-the-ground implementation of these innovative strategies made them incompatible with right to health and culturally respectful care approaches.     

Pacing Climate Precarity: Food,Care and Sovereignty in Iñupiaq Alaska

ABSTRACT

At what pace do storytellers represent climate change in the “rapidly changing” Arctic? Popular and scholarly narratives of Indigenous vulnerability too often address climate change as a singular event that reorganizes local lifeworlds in unprecedented ways. On the ground however, contemporary climate impacts, such as “food insecurity,” are refracted through a range of simultaneous and cumulative ecological, social, and political structures that can precede and/or unfold slower than climate change. These factors include the intergenerational relations of care within communities, as well as multiple political challenges to their continuance. Throughout Iñupiaq Alaska, hunting is practiced as a form of care and sovereignty undergirding healthy, resilient, and collective Indigenous futures.     

“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.     

The New Wallet Biopsy and Involuntary Patient Transfers Abroad: How Physicians Can Help Protect Patients

The Emergency Medical Treatment and Active Labor Act in 1986 was intended to bring an end to incidents of “patient dumping.” However, due to the conflation of various federal legislative provisions, hospitals faced with the prospect of long-term unreimbursed care of an immigrant patient, whether legally present in the United States or not, are in some cases having such patients transported to another country. These transfers are often being effectuated without patient consent. After an overview of the flaws in the legal system that have effectively encouraged such patient transfers, this essay uses a clinical case to demonstrate how physicians can collaborate with an interdisciplinary team and with family members to ensure that the best interests of immigrant patients are met. Finally, the essay calls on physicians to advocate for the development of hospital policies and practices that will protect patients from international patient dumping.