Medical Anthropology Research Articles

Bloodstream: notes towards an anthropology of digital logistics in healthcare.

Based on ethnographic research in northern Ghana, this article explores the complex logistics of blood and the ways in which the availability of blood has been transformed through the introduction of drones. We explore how drone services affect this ecosystem of supply and contribute to reshaping the practices of physicians, nurses, facility pharmacists and stock managers, as well as the expectations and experiences of patients and their families. Situated at the interface of medical anthropology, critical studies of infrastructure and anthropological studies of digital innovations in healthcare, our paper attends to the emerging anthropological research on medical logistics as a means of connecting people with medical resources. It demonstrates the fundamentally ambivalent nature of technological innovation: on the one hand, drones have fueled health workers' hopes and transformed access to blood. On the other hand, their introduction has also led to connectivity without stock. In line with STS scholarship, we highlight the important role of the physical properties of objects such as blood in shaping their circulation.

Narratives of Personhood and Caregiving in Ontario Long-Term Care Homes During COVID-19

Drawing on narratives recorded from family members of residents in long-term care homes in Ontario, Canada, during the 2020 COVID-19 lockdown, in this paper, I present a two-pronged argument. First, following Taylor (2008) and Seaman (2018, 2020) I suggest that family caregiving for residents of long-term care homes helps to sustain residents’ personhood: the recognition of their identity as an ongoing participant in their social universe. The second part of my argument is that caregiving is a multifaceted and paradoxical endeavour. While caregiving can be a transformative and reciprocal practice of self-actualization (cf. Kleinman 2012; Kleinman and van der Geest 2009), at times it can also be troubled, ambivalent, and stressful (Cook and Trumble 2020). At its best, caregiving is a two-way street, enabling the maintenance of personhood for the care recipient, and validating the caregiver’s sense of ‘moral agency,’ or what medical anthropologist Neely Myers (2015, 13) defines as the capacity to be recognized in one’s local sphere as a good person who can make intimate connections to others. When caregiving goes awry, however, it leads to frustration, despair, and a sense of moral failure for the caregiver. For the care recipient, non-recognition and the loss of personhood can lead to social death and may also hasten physical decline. I conclude that for both professional and family caregivers of long-term care residents, systemic improvement of social and material support is needed to mitigate the challenges inherent in the recognition of personhood in caregiving relationships.

Seeking Knowledge in and for Troubled Times: The Edinburgh Centre for Medical Anthropology, MAT, and a Shared Vision

Editorial for the September Issue, 2024

Explanatory models in real-world clinical interactions at a pediatric cancer center in Guatemala.

Explanatory models (EMs) are used in medical anthropology to characterize individual understandings of illness. This study investigated how interdisciplinary clinical interactions elicited caregiver EMs at a pediatric cancer center in Guatemala. This qualitative study included caregivers of 20 children with newly diagnosed cancer at Unidad Nacional de Oncología Pediátrica (UNOP) in Guatemala City, Guatemala. UNOP's diagnostic process includes social work intake, psychoeducation with a psychologist, and a diagnostic conversation with an oncologist and psychologist. Audio-recordings from the diagnostic process and a semi-structured interview were obtained, transcribed, and translated from Spanish. Transcripts were coded using a priori codes based on the five explanatory model (EM) components (occurrence, causation, pathophysiology, course of sickness, and treatment), as well as disease, and illness accounts. Thematic content analysis explored the EM framework as applied to diagnostic interactions between families and clinicians. All five components of the EM were addressed during the diagnostic process at UNOP. Clinicians, particularly psychologists, initiated conversation about the EM more than caregivers. When prompted, caregivers discussed all aspects of the EM but only rarely mentioned pathophysiology. Disease accounts were primarily described by clinicians, while caregivers used illness accounts to describe cancer causation. Clinicians validated existence of both disease and illness accounts. UNOP's interdisciplinary team elicited families' beliefs and facilitated in-depth discussion of all aspects of the EM, leading to a shared understanding of cancer and its treatment. Utilizing the EM framework in clinical practice may support culturally-competent pediatric cancer care.

The medical anthropology of Viktor v. Weizsacker: ethical consequences

The medical anthropology of Viktor v. Weizsacker: ethical consequences

Arc of interference: Medical anthropology for worlds on edge By JoãoBiehl, VincanneAdams (Eds.), Durham, NC: Duke University Press. 2023. 385 pp.

Arc of interference: Medical anthropology for worlds on edge By JoãoBiehl, VincanneAdams (Eds.), Durham, NC: Duke University Press. 2023. 385 pp.

Ethnomedical Study of Traditional Medicinal Plants for Cough and Tuberculosis (TB) of the Helong Tribe on Semau Island, Kupang Regency, East Nusa Tenggara

The Helong people in Kupang Regency, NTT Province, have experienced being exposed to cough and tuberculosis (TB). Therefore, it is believed that this community has also long since developed their local knowledge and traditional ways to prevent and treat the disease. In general, this study aims to analyze and find the concept of the Helong Tribe community and ethnomedical practices for the prevention and treatment of cough and tuberculosis (TB). This research is a medical anthropology research using a qualitative research method with an ethnographic approach, which is supported by laboratory research and literature studies. Field research was carried out on Semau Island, NTT Province, involving traditional medicine. The results of the research conducted in the form of interviews with traditional medicine practitioners in the Helong tribe obtained as many as 31 plants used in treatment, and there were 3 plants used to treat cough, including hemorrhagic cough/tuberculosis, namely plants: white banyan (Ficus benjamina L), mesocarp palm fruit (Borassus flabellifer L.) and white flower (Clerodendrum costatum R.Br). The three plants that are suspected to have the ability to treat cough and cough up blood carried out preliminary tests of antibacterial activity against bacteria that generally cause stones, namely Staphylococcus aureus bacteria. The results obtained for ethanol extract of white banyan leaves (Ficus benjamina L) with a concentration of 25% b/v with a diameter of 16.53 mm, 50% b/v with a diameter of 16.33 mm, and 75% b/v with a diameter of 16.56 mm. Mesocarp ethanol extract of palm fruit (Borassus flabellifer L.) At a concentration of 25% b/v with an inhibitory zone diameter of 11.60 mm, a concentration of 50% b/v with an inhibitory zone diameter of 12.30 mm, a concentration of 75% b/v with an inhibitory zone diameter of 13.40 mm, for white flowers (Clerodendrum costatum R.Br) at a concentration of 25%b/v with an inhibitory zone diameter of 9.41 mm, a concentration of 50% b/v of 10.36 mm and a concentration of 75% b/v of 11.24 mm. This means that the three plants have antibacterial activity against Staphylococcus aureus bacteria. Furthermore, for the antibacterial activity test against Mycobacterium tuberculosis bacteria for white banyan plants (Ficus benjamina L.), mesocarp of palm fruit (Borassus flabellifer L.), and white flowers (Clerodendrum costatum R.Br) by the MODS (Microscopically Observed Drug Susceptibility) method, it was obtained that the three plants at concentrations of 250 ppm, 500 ppm, and 1000 ppm were only seen to have the growth of Micobacterium tuberculosis bacteria in the second week. Passive control with INH observation until week IV did not see any bacterial growth, while for negative control in the first week, the growth of Mycobacterium tuberculosis bacteria was seen. It can be concluded that a concentration greater than 1000 ppm is needed for the three plants to inhibit the growth of Mycobacterium tuberculosis bacteria.

Suffering without Remedy: The Medically Unexplained Symptoms of Fibromyalgia Syndrome and Long COVID

The term “Medically Unexplained Symptoms” (MUS) describes chronic symptoms for which medical investigations fail to reveal a specific pathology or biomarker. Even as MUS are among the most prevalent chronic health problems in the global north, patients who experience them reside in a nebulous space. Such nebulousness is heightened for women patients. Moreover, women report MUS at higher rates than men. In this review essay, we analyze the medicalization and feminization processes vis-à-vis MUS by focusing on two particular syndromes: Fibromyalgia (FMS) and Long COVID (LC). FMS and LC present clear parallels that allow us to trace an unhappy marriage of women and MUS. We demonstrate how the medical constructions of these two syndromes as knowledge categories are representations of medical uncertainty vis-a-vis women patients. We then scrutinize the resulting gendered consequences of these categories for the illness experience. We conclude our review by calling for a cultural reorientation in our thinking about MUS that centers a recognition that the origins and manifestations of a great deal of human suffering reside outside of medicine’s ways of knowing. In so doing, we connect to foundational claims in medical anthropology and sociology; namely, that illness is more than disease, and health cannot be achieved primarily via biomedical means.

Training for teaching medical anthropology in Egypt/the Arab region

Training for teaching medical anthropology in Egypt/the Arab region

Qualitative protocol to support detection of the early presentation and diagnosis of mycetoma in Sudan

The neglected tropical disease (NTD) mycetoma is a chronic and progressively destructive infectious disease endemic in Sudan. There is a growing body of scientific research on mycetoma -causes, transmission, treatment, and impact from a clinical and biomedical perspective. However, there is further need for in-depth medical anthropology research on the disease to successfully translate biomedical advances into elimination and control programmes. Given this background the NIHR Global Health Research Unit on NTDs at Brighton and Sussex Medical School is leading multidisciplinary research on skin NTDs, including mycetoma, with a medical anthropology research component exploring how community engagement can lead to earlier presentation of mycetoma in Sudan. This protocol paper sets out the research aims and methods to generate new knowledge on mycetoma in Sudan once the political situation becomes stable and it is safe to carry out global health research once again. We continue to develop appropriate community engagement intervention strategies, while activities like training and capacity strengthening get underway remotely. In what follows we situate this study in the NIHR Research Unit on NTDs and alongside social science research on mycetoma. This study is part of the programme of research conducted by the NIHR Research Unit on NTDs at Brighton and Sussex Medical School (BSMS). Phase I of the Unit was conducted from 2018–2021. Below we detail key findings from Phase I that have informed our more recent work in Phase II (2021)(2022)(2023)(2024)(2025)(2026). It also sits alongside the Social Sciences for Severe Stigmatising Skin Conditions (5-S) Foundation also at BSMS (‘NIHR 5S Foundation -BSMS’ n.d., 5). The 5-S foundation examines the cultural, social, economic, and policy contexts of podoconiosis, mycetoma, and scabies in relation to the dynamics and dimensions of stigma. This study differs from the aims of the 5S Foundation in that it specifically focuses on the role community engagement can have in the early presentation and diagnosis of mycetoma in Sudan.

MEDICAL PLURALISM IN BRITISH PUNJAB: NECESSITY OF COEXISTENCE, CONVERGENCE IN DIVERSE SOCIO-CULTURAL FABRIC

This research paper explores the coexistence and convergence of plural healthcare practices in British Punjab with a prime focus on the need for a diverse social order to accommodate multiple healthcare setups. The interdisciplinary conceptual framework of this research rests on the debate around the dynamics of medical pluralism and its implications for healthcare delivery, while combining medical anthropology, and historical sociology. to understand. The objective is to explore how different medical systems, both indigenous and contemporary, influence and interact with each other, hence serving as the driving forces towards their coexistence and sometimes convergence of these systems. The findings reveal a complex and dynamic landscape of medical pluralism in the then British Punjab, with traditional Ayurvedic, Unani, and homoeopathic practices showcasing interactions between traditional and Western medical practices. The findings reveal that recognizing and integrating various medical traditions and practices is crucial for ensuring accessible and effective healthcare services for the population.

Anthropologies of health policy

In this introduction to our special issue, we take a wide view of the history and epistemic stakes of anthropological and ethnographic approaches to health policy. Drawing on the history of critical medical anthropology, the anthropology of policy, and critical policy studies, we show how anthropologies of health policy are particularly essential in this current moment, as policy production becomes increasingly abstracted and even more entwined with specific forms of evidence making. Taken together, the contributors of this special issue argue that anthropology’s interventions into health policy are essential in three ways. First, they shed light on the practices of policy ‘communities’, the pragmatic parameters under which they work, and the central logics under which health policy actors are operating. Second, they examine the effects of policy implementation upon those intended to be the subjects of health policy, highlighting the effects of policy for those marginalised by gender, race, and caste. Here, anthropology provides a view into the ‘lived experience’ of those targeted by health policy, but it also demands that anthropologists provide ‘counter-stories’ and ‘counter-evidences’ that dismantle narrow systems of policy knowledge production. Finally, anthropological attention provides an essential lens into the things that carry over in the act of policy reform—the past reverberations and imperial inheritances. Together with our contributors, we call for anthropologies of health policy that work to highlight and dismantle such inheritances.

Social medicine and the social sciences in Latin America: conceptual tensions for the transformation of public health in the 20th centuryMedicina social e ciências sociais na América Latina: tensões conceituais para a transformação da saúde pública no século XX

The development of public health in Latin America during the 20th century combined, early on, the social medicine framework on the social, political, and environmental origins of disease with the contributions of medical anthropological fieldwork. Despite the hegemony of the medical model, the surge of the preventive medicine framework further legitimized the involvement of social scientists in the study of the multicausality of disease. However, the limitations brought by the preventive medicine model's lack of historical and political contextualization gave way to the Latin American social medicine movement, which was grounded in historical materialism, and the development of both critical epidemiology and critical medical anthropology.

The ancient people of Balinese: a study of health status based on paleopathology remains

Humans have been constantly exposed to the environment in their daily activities, which may result in some pathological changes. Paleopathology research is rare, particularly on ancient humans who lived in Bali, Indonesia. This research is intended to gain more insight into the history of diseases and the community in the past to assist future health researchers. This study was conducted to understand variation in disease among the ancient populations in Bali, Indonesia. The study examines skeletons from the Gilimanuk, Semawang, and Pacung Sembiran sites in Bali, Indonesia, collected from 1964 to 2008. A total of 336 individuals were identified, including 63 adult males, 75 adult females, and 56 adults whose sex could not be determined. In addition, 142 children were included in the analysis. The examination of the individuals revealed the presence of various dental pathological changes, such as caries and enamel hypoplasia, as well as periodontitis. Furthermore, several bone-related diseases and abnormalities were identified, such as osteophytes, fractures, porotic hyperostosis, and spina bifida occulta. Available evidence suggests a similarity in the types of pathological changes among the ancient populations of Gilimanuk, Semawang, and Pacung Sembiran. While a comprehensive explanation of the paleopathological variations observed in these populations necessitates further investigation, the present findings hold considerable value for medical experts and anthropologists seeking to better understand patterns of disease distribution among ancient Indonesian populations. This study was funded by the Directorate General of Higher Education, Research, and Technology of the Ministry of Education, Culture, Research, and Technology of Indonesia for the fiscal year 2023.

A crisis of confidence? Intervening in vaccine hesitancy in North Dakota.

In November 2020, North Dakota reported a higher number of cases and deaths per capita from COVID-19 than any other state in the United States. Several months later, it reported one of the country's highest rates of vaccine hesitancy, leading to the development and implementation of the state-funded and physician-led "Vaccine Champion" ("VaxChamp") program. Glossing the primary problem as one of "provider confidence," the VaxChamp program emphasized a standardized, scalable intervention that targeted healthcare providers directly, and patients only indirectly. Although the program hit its quantitative benchmarks, a qualitative inquiry into the program's history and context reveals multiple crises of confidence, many beyond the bioscientific domain of the program's focus. Drawing from work in medical and linguistic anthropology, we describe and analyze the "multiple levers of vaccine confidence" at play in the intervention and its surrounding context, as well as how these crises of confidence emerged.

Reimagining Rural Health Equity: Understanding Disparities And Orienting Policy, Practice, And Research In Rural America.

A narrative has taken hold that public health has failed the US. We argue instead that the US has chronically failed public health, and nowhere have these failures been more apparent than in rural regions. Decades of underinvestment in rural communities, health care, and public health institutions left rural America uniquely vulnerable to the COVID-19 pandemic. Rural communities outpaced urban ones in deaths, and many rural institutions and communities sustained significant impacts. At the same time, the pandemic prompted creative actions to meet urgent health and social needs, and it illuminated opportunities to address long-standing rural challenges. This article draws on our cross-disciplinary expertise in public health and medical anthropology, as well as our research on COVID-19 and rural health equity in northern New England. In this Commentary, we articulate five principles to inform research, practice, and policy efforts in rural America. We contend that advancing rural health equity beyond the pandemic requires understanding the forces that generate rural disparities and designing policies and practices that account for rural disadvantage.

The woman is the active agent: General practitioners and the agentive displacement of abortion in Ireland.

After the legalization of abortion in 2018, Ireland needed clinicians to become abortion providers and make this political win a medical reality. Yet Irish doctors had next-to-no training in abortion care, and barriers ranging from stigma to economic pressures in the healthcare system impacted doctors' desire to volunteer. How did hundreds of Irish doctors make the shift from family doctor to abortion provider? Drawing on ethnographic research conducted between 2017 and 2020, this article explores the process by which Irish general practitioners became abortion providers, attending to the material impact of medical technologies on that journey. Drawing from medical anthropologists who have examined similar themes of agency, pharmaceuticals, and medico-legal frameworks within the topic of assisted dying, I build on Anita Hannig's idea of "agentive displacement" to frame the productive impact of abortion pills on this transition.

Uneven geographies of COVID‐19: Reviewing geographical research agendas and concepts from a syndemics perspective

AbstractBuilding upon a review of geographic research agendas and concepts related to the uneven geographies of COVID‐19, this first of three articles debates the benefits of geographic analyses to the syndemic approach and, vice versa, of a syndemics perspective to geographic analyses. The syndemics perspective was proposed by critical medical anthropologists. It seeks to deepen the understanding of the structural dimensions and processes that lead to the convergence and cascading of multiple epidemics in specific population groups. Geographers have also highlighted the intersections of multiple health or other crises during COVID‐19, when the pandemic and global health emergency coincided with and escalated existing structural inequalities produced by the climate crisis, environmental degradation, political conflicts and war, socio‐economic disparities and poverty, social divisions, racism, hatred and violence, mental health problems and stress. Geographers have mobilized concepts such as scale, territory, borders and intersectionality to unravel the uneven unfolding and consequences of the global health emergency for diverse population groups. We therefore argue that geography has a lot to contribute to the understanding of the spatial and contextual dimensions of COVID‐19 as a pandemic as well as a syndemic – but it has so far not actively employed the latter concept's analytical lens. Mobilizing the syndemics approach can contribute to more comprehensive accounts of the structural dimensions and processes that continue and cascade in pandemics.

The technology or the child? Moving beyond technological fixes in deaf education in India and elsewhere

ABSTRACT As cochlear implants become the gold standard in intervening on deafness around the world, teachers of deaf children are increasingly expected to have technological expertise and to ensure that cochlear implants, and other hearing technology, are being used and that they are working. Students are only considered “ready to learn” if they are using their technology. Drawing from ethnographic research and semi-structured interviews with educators, families, surgeons, speech and language therapists, and audiologists in Indian cities, this article mobilises two conceptual frameworks from medical anthropology and public health – the “biotechnical embrace” and the “structural competency framework” to argue that teachers of deaf children, both in India and internationally, need to think and work beyond technology. Ultimately, focusing on a child does not mean focusing (only) on technology but rather on seeing a child as enmeshed in social, political, educational, and economic structures and relations. Expanding educators’ focus to consider micro and macro scales is especially urgent now, as countries around the world implement programmes in which technology is the goal.

Which Ethnography? Whose Ethnography? Medical anthropology's Epistemic Sensibilities Among Health Ethnographies.

Medical anthropologists working in interdisciplinary teams often articulate expertise with respect to ethnography. Yet increasingly, health scientists utilize ethnographic methods. Through a comparative review of health ethnographies, and autoethnographic observations from interdisciplinary research, we find that anthropological ethnographies and health science ethnographies are founded on different epistemic sensibilities. Differences center on temporalities of research, writing processes, sites of social intervention, uses of theory, and analytic processes. Understanding what distinguishes anthropological ethnography from health science ethnography enables medical anthropologists - who sometimes straddle these two ethnographic modes - to better articulate their epistemic positionality and facilitate interdisciplinary research collaborations.