Medical Anthropology

Bureaucracy and Surveillance-Care: The Partograph in Tanzanian Maternity Care
Strong AE
Based on fieldwork in maternity wards in Tanzania, I argue that the partograph - a graphical representation of a pregnant woman's labor - far exceeds its intended role as tracking and surveillance of labor progress. Through surveillance and its concomitant documentation, nurses, especially, also utilize this document to co-create care for themselves and their colleagues. These forms of care proliferate largely unseen by global health systems but are vital for understanding the meeting point of bureaucracy, surveillance, and care and the dynamics of maternity care in this and other lower resource settings. Nurses use the partograph to generate novel forms of surveillance-care.
Research, HIV/AIDS, and Turning into a Key Population in Indonesia: An Ethnographic Oral History
Hegarty B, Thajib F, Handayani AP, Mallay R and Marischa A
The history of HIV/AIDS is often told from the Global North, a viewpoint that is naturalized in policies and programs that privilege biomedical models of treatment and prevention. This article explores how one Indonesian transgender population known as became the subject of various forms of research since the 1980s. Research was one way that waria came to be classified as part of the key population of "transgender people." Drawing on an oral history project conducted in 2021/2022, we show how - while necessarily hierarchical - ethnographic accounts of other HIV/AIDS histories can rethink fundamental global health concepts.
Travelling Thai Surrogate Mothers: Required and Restricted Mobility in Transnational Surrogacy
Nilsson E
In response to the changing landscape of transnational surrogacy, the industry has introduced flexible business models requiring women to move within and across borders to act as surrogate mothers. However, knowledge about their experiences remain vague, particularly concerning women traveling abroad under illegal conditions. Building upon interviews with Thai surrogate mothers, I demonstrate how their im/mobility reveals critical insights into labor conditions and power relations and is formed within the global reproductive industry as well as the specific national context. I also argue that the women's im/mobility and flexibility are central when making themselves bioavailable for the global surrogacy market.
"Canary in the Coal Mine": Hope and Emergency in the Management of Measles
Rabi M
Exploring the relationship between governmental infectious disease management and emergency systems, I examine the turn to emergency in European measles management during the resurgence of the disease between 2017 and 2020. While measles management was shaped by hope for disease eradication and as a progressive pursuit of elimination, amid growing concerns with vaccination coverage, hope was redirected toward reversing regression in the struggle against infectious disease. I argue that perception of and action on public health issues as emergencies is intricately tied to change in the fundamental construct of governmental infectious disease management, regardless of change in the disease or its categorization.
The Persistence of Traditional Healing for Mental Illness Among the Korekore People in Rushinga District, Zimbabwe
Jakarasi M
Despite concerted attempts by colonial governments to stamp out traditional healing practices, the Korekore-speaking Shona people have continued to seek healing for mental illness from traditional healers in present-day Zimbabwe. In this article, I discuss the health-seeking trajectories of Korekore people when confronted with mental illness, particularly when and why they seek out traditional healing, and the role that traditional healers play in the quest for therapy.
On the Affectivity of Touch: Enacting Bodies in Dutch Osteopathy
Groenevelt I and Slatman J
Osteopathy is a complementary treatment method that targets motor restrictions and enhances motility through touch. While recent studies have explored the functions, dimensions, and effects of touch in osteopathy, there is a lack of research on how touch renders bodies intelligible - or bodies, for that matter. In this article, we use the verb to explore how bodies become known by and to Dutch osteopaths, and how the senses play a role in this. Our analysis shows how touch allows osteopaths to affect and be affected by their patients' bodies - as well as by their own.
Correction
Time and ADHD in Danish Families: Mutual Affect Through Rhythm
Rasmussen GV, Meinert L and Flaherty MG
Based on fieldwork in Danish families living with ADHD, we expand on Nielsen's insight that ADHD is experienced as a state of desynchronization by showing how family members' rhythms mutually affect each other. We argue that ADHD is not only a biological and psychiatric condition, but also a temporal and socially responsive phenomenon. The intensity of ADHD is influenced by mutual affect in families and by general life circumstances. Families constitute bodily networks through which sensations, moods, rhythms, and practices spread and are passed down through generations. Yet, families use various time work strategies to manage rhythm affect.
Making Sure She Eats Right: Absent-Presence, Articulation, and Surveillance-Care in Senegalese Men's Maternal Support
Powis R
In Senegal, where pregnancy is "women's business," men's roles in prenatal and postpartum care are mediated by gendered expectations of what expectant fathers are allowed to know and do. Expectant fathers' roles map onto masculine expectations of the authoritative, sovereign head-of-household. Using the state-authored , I argue that state surveillance is refracted through preexisting masculine prenatal care roles, and that men willingly articulate themselves to the role of the surveillance state by relying on the Handbook as a guide for how to watch their pregnant partners and make sure they are adhering to its guidance.
Un/Diagnosed: Family Experience of Genomic Diagnoses and the Re-Making of (Rare) Disease in the UK
Costa A
Drawing on three years of ethnographic engagement with the rare disease community in the United Kingdom and Europe, this article explores the experiences of families who seek and (sometimes) receive a genomic diagnosis. I trace how families learn to enact unexplained symptoms and common disabilities as rare, genetic disorders, and how they coordinate genomic and non-genomic ways of "doing" disease within and beyond the clinic. These experiences shed light on the socio-material processes through which genomic variants become "diseases" (or fail to do so), and on the implications for those whose lives have become entangled with the genomic agenda.
Not-Quite-Dead: Ontological Careographies and the Ambiguous Fetal Body in the Context of Disability-Selective Pregnancy Termination in Austria
Siegl V
Starting from the unsettling ambiguity of the aborted but not-quite-dead fetus, I scrutinize how clinical staff interpret, decide on, and grapple with fetal life signs following disability-selective pregnancy terminations in Austria. Understanding their practices as attempts to provide certainty in a context of ontological and moral uncertainty, I conceptualize them as acts of care that contribute to an intricate "ontological careography" and facilitate classifying the not-quite-dead as an already-dead fetus. I show that the interpretation of life signs is not a simple matter of biological "facts" - what is ultimately at stake is the active making of life and death.
Dangerous Knowledge and Proxy-Reasons: A Kurdish Woman's Therapeutic Attempts
Weiss N
Jihan, a former Kurdish guerilla fighter, struggles to gain medical treatment for the health problems she suffers as a result of war and trauma. The provision of care in Turkey has been motivated by ethno-political security concerns. Therefore, medical encounters are characterized by silences, not-knowing and of averting danger. Based on theories of ignorance, I explore how experiences of war and torture constitute dangerous knowledge that are difficult to share in a context, without a guaranteed therapeutic safe space. Patient and doctor navigate mistrust, silences and proxy-reasons in an attempt to deal with the traumata and violent experiences left unsaid.
Healing with Ayahuasca the Plant Teacher: Psychedelic Metaphoricity and Polyontologies
Gearin AK
Shamans, neo-shamans, atheists, and others describe gaining special knowledge from drinking ayahuasca, supporting the cross-cultural idea of ayahuasca as a plant teacher. While secular enthusiasts interpret this metaphorically, animists and others take it literally. This article examines ontological collisions at a healing retreat in the Peruvian Amazon, considering Shipibo shamans and their international clients. It explores how embodied experiences, such as purging and visions, inform both literal and metaphorical views of healing and illness. By addressing incommensurable ontologies, the article highlights how a polyontological framework approaches ontological collision without necessarily privileging specific ways of knowing.
In/Visible - A Photographic Journey Into the Lives of Egg Donors in Spain
Perler L and Sánchez Pérez T
The result of a collaboration between an anthropologist and a photographer, in this photo essay we aim to visualize the medical process of egg donation and the quotidian lives of egg donors in Spain. By extending their biographies beyond the moment of extraction, we shed light on the intertwined messiness of medical procedures and everyday life and the precarious circumstances in which egg donation takes place in Spain today. Our aim is to highlight the participants who, although they matter most in the egg donation economy, are concealed: the egg donors.
Framing the Labor of Paid Egg Donors in Iran: Marginality, Gendered Care, and Divine Reward
Bonyad T
Despite the economic incentives evidenced in the recruitment strategies of the Iranian fertility industry for egg donors, the official discourse put forward by policymakers conveys egg donation as an altruistic act. Drawing on ethnographic fieldwork in two fertility clinics in Tehran, I center the narratives of paid egg donors to investigate how multiple meanings are attributed to egg donation as a form of labor, demonstrating how reproductive inequalities are perpetuated in this context. Following feminist theorists of reproductive bioeconomies, I argue that Iranian donors experience and articulate their participation in local egg market through the prism of their economic marginality, gendered responsibilities, and religiously informed beliefs, including divine reward.
"The Best I Could": Future Orientations for Danish Women with Gestational Diabetes
Brueckner Johansen A and Navne LE
The introduction of personalized medicine marks a shift in pregnancy-related screening, from fetal to maternal health risks putting the pregnant woman's future orientations center stage. Drawing on fieldwork from pregnancy outpatient clinics and 11 interviews with pregnant women diagnosed with gestational diabetes and offered genetic testing, we use their experiences of time to explore how futurity is reshaped by notions of early detection and at-riskness. We offer the concept of "future prism" to capture how multiple situations of orienting toward the future shape and circumscribe one's experience of the future - an orientation that makes genetic testing almost impossible to refuse.
Ethical and Epistemological Implications of Conducting Ethnographic Fieldwork as a Researcher-cum-Clinician in Brussels, Belgium
Lafaut D and Dikomitis L
We draw on ethnographic fieldwork conducted in Brussels (Belgium) on the health care experiences of undocumented migrants. We explore the implications of the double position of the ethnographer, who is both a researcher and a practicing doctor. We describe how the intimate knowledge the ethnographer-cum-clinician holds about the health care system influenced and shaped the data collection, analysis and subsequent policy recommendations. We examine the ethical dilemmas in conducting research from an engaged position about care practices toward vulnerable populations in one's own professional field. We conclude with recommendations on how to challenge and interrupt complexities faced by multi-positioned ethnographers.
Collective Sensemaking and Healthcare Workers' Ripple Effect Influencing Vaccine Hesitancy in West Michigan
Hedges K and Willson M
The social efficacy of vaccines has been a central concern around COVID-19 vaccine uptake rates. As partners on the Vaccinate West Michigan Coalition, we conducted a rapid ethnographic assessment project among adults living in West Michigan. Three case studies are presented to convey the nuanced context around decisions with a focus on the influence of fear, trust, and the ripple effect of healthcare workers' (HCW) beliefs around vaccines. While HCWs' attitudes and beliefs influence their patients, the unique contribution of this study is its focus on how HCWs' perceptions influence friends and family members.
Vulnerable Lives, Irrelevant Deaths? Dying Alone and Receiving Flawed Care in an Institution for the Aged in Lima, Peru
Zegarra Chiappori M
This ethnographic exploration of death in the Peruvian context draws on fieldwork among abandoned-both by their families and the state-older adults in a shelter for the homeless in Lima, Peru. I examine the conditions and local forces that shape the ways people at this institution socially and physically die. My argument is that people in this long-term care facility who have lived entire lives on the margins, usually, end up having irrelevant deaths to their families, other residents of the institution, and the Peruvian state. At this shelter, dying in an irrelevant way means dying without companionship from family members and receiving poor and flawed care from the institution that shelters them.
Precarity and Hope at the Intersections of HIV and Cervical Cancer in a Johannesburg Clinic
Stadler J and Scorgie F
In a tragically ironic twist, antiretroviral therapy (ART) that promised an end to AIDS ushered in a syndemic of viral cancers, transforming hope to despair. In this article we draw from the illness narratives of HIV positive women attending a cervical cancer screening clinic in Johannesburg, South Africa, and chart their pathways from HIV to cancer, and their quest for treatment. Our interlocutors described protracted struggles to access surgical procedures to prevent the onset of cervical cancer. Dealt a double blow of HIV and cervical cancer, women's narratives reveal the intersections of exposure to pathogens and the precarity of hope.
Sitting in Wait: Everyday Caregiving Practices for People with Dementia in Rural South Africa
Brear MR, Nkovana T and Manderson L
Practice theories offer potential to reveal, understand, and attribute value to the everyday thoughts and actions of dementia caregivers. Drawing on ethnographic data from research in rural South Africa, on everyday dementia care practices, we highlight the profound importance of mundane practices - especially "sitting in wait" - for optimizing wellbeing of people with dementia who are cared for at home. We draw attention to the structural drivers of homebased (informal) care, which is underpinned by state inaction. This situates the act of sitting in wait as both an act of care and an embodied form of structural powerlessness.