Medical Bureaucracy Research Articles

Autoimmunities after COVID: An Interview with Cindy Patton

Cindy Patton is Professor Emeritus of Sociology and Anthropology at Simon Fraser University in Vancouver, Canada. An early AIDS activist in Boston, she holds a PhD in Communications from the University of Massachusetts, Amherst. After inaugurating her academic career at Temple University (Rhetoric and Community) and Emory University (Graduate Institute of the Liberal Arts), she accepted a Canada Research Chair in Community, Culture and Health at Simon Fraser (2003-15). In that capacity, she worked with more than two dozen groups to develop small community-driven projects related to HIV/AIDS, housing, social welfare, mental health, while achieving, culminating in the creation of the Community Health Online Digital Research Resource, a catalogued, open-access, full-text collection of the materials from those groups (www.chodarr.org). Her academic publications span the social study of medicine, especially AIDS; social movement theory; gender studies; and media studies. She is the coeditor of Queer Diasporas (2000) and a special issue of Cultural Studies on Pierre Bourdieu (2003). She is the author of such works as Globalizing AIDS (2002), Cinematic Identity: Anatomy of a Problem Film (1997), Fatal Advice: How Safe-Sex Education Went Wrong (1996), Inventing AIDS (1990), and LA Plays Itself/Boys in the Sand: A Queer Film Classic (2014). Taken collectively, Patton’s scholarship and activism has laid the foundation for insights in the health humanities, particularly AIDS studies, that consider the inextricable connections between epidemiology and ideology. Patton’s theorizations of stigma and discrimination patterns, her deconstruction of “truth” discourses subtending science, her critical re-evaluations of axioms associated with risk, safe sex, community, and knowledge production have been crucial interventions in the understanding of health and illness as cultural and discursive scripts. Among Patton’s most enduring contributions has been her theorization of how “African AIDS” was invented and circulated—that is, the notion of geographically bifurcated HIV pandemics split by the essential linkage between Africa and blackness generally with pathogenesis. Equally influential has been her elaboration of the insurgent queer research practices that fused with antiracist struggle to combat this split. In the interview below, Travis Alexander and Nishant Shahani engage Patton in a discussion on a range of topics—from (dis)continuities between the HIV/AIDS and COVID pandemics to the role of queer activism in forging epidemiological counter-publics and the geopolitics of medical bureaucracy.

MEDICAL BUREAUCRACIES AND THE ROLE OF SOCIAL PERCEPTION IN THE PROFESSIONALIZATION OF NURSING: A PHENOMENOLOGICAL STUDY CONDUCTED IN ISTANBUL

This research is a qualitative field study conducted to investigate how the nursing perception of medical bureaucracies and society affects the professionalization process of the nursing profession. In the research, data were collected through in-depth face-to-face interviews with 20 nurses working in different medical departments of public and private hospitals in Istanbul between September 2018 and June 2019. In order to collect the data, after reviewing the relevant literature, an introductory personal information form, consisting of 10 questions and an individual interview form, consisting of 14 questions were given. The study, which is based on a phenomenological approach, tries to understand how the nursing profession is in the professionalization process, the position of nursing in the health system as a profession, and how to be influential on the nursing image of the society by viewing and understanding the nurses' own observations and experiences. According to the findings of the study, the most difficult factor in the professionalization process of the nursing profession is that, because it is determinative of the ambiguous position of nursing in the health system and the erroneous image of the nurse in society, there are significant uncertainties in the job description of nurses. In addition, it is seen that the weakness of professional nurse organizations, the differences in education levels, and being seen in the category of non-physician “assistant” health personnel have effects that make it difficult to professionalize nursing.

The experiences of a regional Aboriginal community accessing primary health care during times of crisis.

The importance of primary health care (PHC) to Aboriginal Australians is widely acknowledged, as is the underservicing of the Aboriginal Australian population. Aboriginal People continue to face significant obstacles when accessing and using health care services. This study identifies environmental factors (beyond personal and service delivery) that functioned as barriers and enablers to Aboriginal Australians' experiences accessing PHC during crises and recommends approaches during future events. This research utilised a case study approach. Data were collected through in-depth interviews and analysed using thematic analysis. The study was set in Lakes Entrance, a regional Victorian locality with a sizable Aboriginal community, which was affected by bushfires during 2019/2020 and COVID-19 restrictions during 2020-2021. Participants were 18 Aboriginal People over the age of 18 living in the locality during either bushfires or COVID-19. The barriers identified included the impact on PHC access of priorities other than health, including housing; financial constraints; difficulties with transport; medical bureaucracy and the physical environment of the health care setting, including appointment-making processes; interactions with medical reception staff; and waiting room environments. Enablers identified included the supportive role of the local Aboriginal Community Controlled Health Organisations (ACCHO) and their staff, which was highlighted in participant responses. The preference of many Aboriginal people to access PHC via their local ACCHO, rather than mainstream health care services, appears even more salient during crises than in normal times. This research identified that ACCHOs are ideally placed to promote and protect the health of Aboriginal communities during crises. Results may help direct interventions to improve PHC access and experiences for regional Aboriginal communities both during and outside periods of crisis.

Linear regression model and least square method for experimental identification of AMBU bag in simple ventilator

PurposeIn the COVID-19 outbreak periods, people's life has been deranged, leading to disrupt the world. Firstly, the number of deaths is growing and has the potential to surpass the highest level at any time. Secondly, the pandemic broke many countries' fortified lines of epidemic prevention and gave people a more honest view of its seriousness. Finally, the pandemic has an impact on life, and the economy led to a shortage in medical, including a lack of clinicians, facilities and medical equipment. One of those, a simple ventilator is a necessary piece of medical equipment since it might be useful for a COVID-19 patient's treatment. In some cases, the COVID-19 patients require to be treated by modern ventilators to reduce lung damage. Therefore, the addition of simple ventilators is a necessity to relieve high work pressure on medical bureaucracies. Some low-income countries aim to build a simple ventilator for primary care and palliative care using locally accessible and low-cost components. One of the simple principles for producing airflow is to squeeze an artificial manual breathing unit (AMBU) iterative with grippers, which imitates the motion of human fingers. Unfortunately, the squeezing angle of grippers is not proportional to the exhaust air volume from the AMBU bag. This paper aims to model the AMBU bag by a mathematical equation that enables to implement on a simple controller to operate a bag-valve-mask (BVM) ventilator with high accuracy performance.Design/methodology/approachThis paper provides a curvature function to estimate the air volume exhausting from the AMBU bag. Since the determination of the curvature function is sophisticated, the coefficients of the curvature function are approximated by a quadratic function through the experimental identification method. To obtain the high accuracy performance, a linear regression model and a least square method are employed to investigate the characteristic of the BVM ventilator's grippers angle with respect to the airflow volume produced by the AMBU bag.FindingsThis paper investigates the correlation between the exhausting airflow of the AMBU bag and the grippers angle of the BVM ventilator.Originality/valueThe experimental results validated that the regression model of the characteristic of the exhausting airflow of the AMBU bag with respect to the grippers' angle has been fitted with a coefficient over 98% within the range of 350–750 ml.

Qua Iboe by motorcycle and launch: brokering public health coverage in 1960s Southeastern Nigeria

ABSTRACT Long an expatriate-run concern, leprosy control was subsumed as a key component of rural public health in the years following Nigerian Independence in 1960 by the enlisting of a cadre of African inspectors, deployed across an existing institutional landscape by a newly Nigerianized medical bureaucracy. The performative norms of leprosy control, once thoroughly colonial and suffused with the ripe vocabulary of a long-entrenched missionary diaspora, were renovated at the heart of a new concern with rural public health more broadly, as the needs, expectations and hierarchies encoded in relations between patient, court, bureaucrat and medical worker shifted and settled in accordance with new political horizons. For health workers, issues of patient and worker mobility, drug delivery, patient and community expectation, and their own physical and financial security were dramatized in a series of commentaries, complaints and reports denoting deeply felt anxieties over the viability of careers in the service of Nigerian health. This article outlines struggles surrounding leprosy control and rural public health work in the Qua Iboe Mission catchment, administered by the newly created Ikot Ekpene Medical Field Unit. It documents a shift in medical work from European missionary to national and technocratic, the foregrounding of concerns with African (worker and patient) welfare and mobility, and the emergence of novel post-colonial forms of public health advocacy and politics along the highways and byways of Ibibio- and Annang-speaking areas of southeastern Nigeria in the 1960s.

Overload of Medical Documentation: A Disincentive for Healthcare Professionals.

This review addresses the theories concerning the development and functioning of medical bureaucracy creating an excess of the patient records. An ever-growing number of medical files comply with the typical development of the bureaucratic management of an entrepreneurial organization, an essential feature of which is the life cycle of documentation. When the life cycle ends, an update is created with a multiplication of forms and items to be filled out, resembling that of what happens with the outdated computer program. Yet medical records should have a logical and well-functioning structure using the language of computer science in the form of a cascade or evolutionary model. Further, we believe that mass computerization, in contradistinction to the primary predestination purpose, increases the number of time-consuming medical records, with the evidence that it enhances the occupational burnout among physicians. Clear and concise medical documentation is necessary to handle economic and legal issues in medicine. However, the creation of medical records sits at the crux between a health-conscious provision of the best evidence-driven treatment and the continuum of care and a potential health detriment caused by taking away the time and care devoted to the patient by healthcare professionals. We submit that the hitherto pattern of creating medical records requires a turnabout to attain the intended reasons and user-friendliness for practical ends.

A study on the Introduction and Use of Cold Damage Diseases-related Literature in the Early Joseon Dynasty: Focusing on Publishing, Citation, and Textbooks.

The status or role of Shanghan Lun (Treatise on Cold Damage Diseases) in Joseon is quite different compared to neighboring China and Japan. This is a unique aspect that distinguishes Joseon's medicine from other East Asian countries at that time. Prior studies have conducted research on non-professional books of Shanghan Lun; however, this study aims to analyze the transmission and utilization of professional books of Shanghan Lun. In the citations of medical books in the first half of Joseon period, the domestic introduction of professional books of Shanghan Lun used at the time occurred mostly from the mid-thirteenth century to the first half of the fifteenth century. In particular, the version of professional books of Shanghan Lun quoted in Euibangyoochui (Classified Collection of Medical Prescriptions) were centered on the Yuan edition. In other words, the acceptance of the theory of Cold Damage Diseases was based on the Yuan's medicine. Professional books of Shanghan Lun, which were published separately during the compilation or publication of Euibangyoochui, were intentionally selected. It is important to identify their characteristics. First of all, Shanghan Leishu (Classified Book of Cold Damage) was used as a textbook of Cold Damage in the first half of Joseon dynasty because the author of this book, Yang Shizhen and his practice acted as the basic text. The nature of Shanghan Leishu, which pursued the integration of "several symptoms of internal medicine" and "Cold Damage" instead of pursuing independent medicine of Cold Damage with different internal medicines, may have had some influence in forming the uniqueness of Joseon's medicine of Cold Damage. Shanghanfu (Harm Caused by Cold: A Poem) was an introduction for easy access to formal Cold Damage's content. Shanghanfu is presumed to be a medical book made out of prose poems, the core of Shanghanzhizhangtu. Non-professional books of Shanghanlun have also been cited in the first half of Joseon period's medical texts in relation to Cold Damage. However, these books were not used as textbooks in medical bureaucracy's education. The exclusion of major Cold Damage-related texts from the medical bureaucracy's education may have hampered the development of Joseon's Cold Damage medicine.

The Change of the Status of Joseon Medical Bureaucrats in the 15th and 16th Centuries.

In the 15th century, Joseon dynasty's goal for the stabilization of the ruling system, the ideological freedom of the era, and the necessity of medicine due to the introduction of Jin and Yuan dynasty's medicine led to the increased interest in medicine by the nobility along with tolerant practice. The practice of reading medical books is a good example of this institutional demonstration. However, by the end of the 15th century, a noticeable change had taken place. Within the nobility, there was an ideological rigidity regarding technology other than those of Confucianism, as the nobility became concentrated on the principles of Neo-Confucianism. In addition, as the publication of large-scale editions such as Ŭibangyuch'wi (the Classified Collection of Medical Prescriptions) came to an end, they have become less inclined to nurture talent at the level of the central government as in the previous period. In addition, as the discrimination against illegitimate children became stronger, technical bureaucrats such as medical officials, which were open to illegitimate children, came to be seen in increasingly disdainful and differentiated manners. From the late Sejong period to the early Seongjong period, the entrance of illegitimate sons into the medical bureaucracy solidified the negligence of medicine by the nobility. After then, the medical bureaucracy came to be monopolized by illegitimate sons. As for illegitimate sons, they were not allowed to enter society through Confucian practices, and as such, the only way for them to enter the government was by continuing to gain experience as technical bureaucrats. Technical posts that became dominated by illegitimate sons became an object of contempt by the nobility, and the cycle reproduced itself with the social perception that legitimate sons of the nobility could not become a medical official. Medical officials from the Yi clan of Yangseong had been legitimate sons and passers of the civil service examination in the 15th century. However, in the 16th century, only illegitimate sons became medical officials. The formation of Jungin (middleclass) in technical posts since the middle of the Joseon period is also related to this phenomenon. The Yi clan of Yangseong that produced medical officials for 130years over four generations since Yi Hyoji, a medical book reading official, is an exemplary case of the change in the social perception in the early Joseon period regarding medical bureaucrats.

Domesticating Organ Transplant: Familial Sacrifice and National Aspiration in Mexico. Megan Crowley-Matoka. Durham, NC: Duke University Press, 2016, 316 pp. $25.95, paper. ISBN 978-0-8223-6067-4.

Domesticating Organ Transplant: Familial Sacrifice and National Aspiration in Mexico. Megan Crowley-Matoka. Durham, NC: Duke University Press, 2016, 316 pp. $25.95, paper. ISBN 978-0-8223-6067-4.

Kate’s Journey: Introducing Students to the Human Side of Aging Services and Supports

Although using novels to teach aging is not a new concept, teaching the human side of long-term services and supports from the perspective of the care recipient via novels has not been thoroughly explored. Literature often reflects societal norms and issues; thus, the use of a novel in the classroom allows for critical reflection and analysis of self and other, particularly when engaging students in aging concepts and experiences of growing old. This article describes the employment of Kate Quinton’s Days (1984), a novel that brings into focus the important, and often forgotten, human side of aging services and supports. Additionally, the novel focuses on administrative and medical bureaucracy within the context of home health, and family dynamics that come into play with issues of aging and long-term care. Students may have had limited exposure to various aspects of aging and care that play out in the novel, and bringing the character Kate and her life story into the classroom allows for discussions that would not otherwise be as meaningful or instructive. The authors found that students related in important ways to Kate and went beyond the “system” to consider the lived experience of care and support as we age.

Connecting medical professionalism and large bureaucracies in the changing hospital governance

Background It is commonly agreed that organizations are changing due to reinforced managerial structures, increasingly demanding clients, and governments’ attempts to better regulate professional services and firms. However, according to recent evidence the paths of change result from complex interconnections between organizational and professional spheres at the workplace level. Nonetheless, there is still not …

IAN DOWBIGGIN. The Quest for Mental Health: A Tale of Science, Medicine, Scandal, Sorrow, and Mass Society.

This book is a sweeping, synthetic history of the “struggle to achieve psychological wellness” from the late eighteenth century to the present (p. 2). Ian Dowbiggin, who has previously published on such subjects as the history of psychiatry, eugenics, and euthanasia, admirably fulfills the mission of the Cambridge Essential Histories series in which the book appears: to provide narrative, argument-driven histories for use in undergraduate survey and upper-division courses. The book contends that the rise of “therapism” has not increased happiness but has instead lowered people's threshold for emotional pain and rendered them more dependent on psychological professionals and state and medical bureaucracies. Yet The Quest for Mental Health is less a polemic than an introductory history of the psychological professions, popular movements and state-supported efforts to promote mental health, and changing attitudes toward personal woe and help-seeking. While the book includes fascinating material on countries ranging from India to Russia to Japan, it focuses predominantly on North America and Western Europe.

Maldynia orMalocchio

In the editorial Chronification to Maldynia [1] in Pain Med. 2011;993–5, naming issues are raised. Suggesting that the adjective, chronic , should, by itself , label pain or other symptom complexes as diseases rather than disorders or states is in the arena of medical or medical insurance bureaucracy. Or, it may be thought to be a way to officially elevate the medical status of pain in all of its expressions. Maldynia is being proposed as the replacement for syndromes of chronic pain. It has the flavor of an attempt, again, to serve as this era's escape from full and open discussion of a major feature of the suffering processes, which accompany so many of these chronic pain …

Introduction: Centre and periphery in the eighteenth-century Habsburg ‘medical empire’

This paper introduces a collection of essays exploring different aspects of the relationship between medical knowledge and administration in the Habsburg Monarchy. The collection brings together a range of perspectives upon the confrontation between programmes for centralised medical bureaucracy emanating from Vienna, and their implementation in a variety of different cultural, linguistic, social and practical circumstances. Such confrontations raise issues about the nature and limits of enlightened universalism, the relationship between knowledge and government in the seventeenth and eighteenth centuries, and the similarities between the processes of centralisation and the issues addressed by historians of empire. The case of Gerard van Swieten, Catholic Dutch medical practitioner appointed as the chief physician to the Habsburg Imperial family, is used to illustrate some of the main issues involved.

Doctors, Lies and the Addiction Bureaucracy

Almost everything you know about heroin addiction is wrong. Not only is it wrong, but it is obviously wrong. Heroin is not highly addictive; withdrawal from it is not medically serious; addicts do not become criminals to feed their habit; addicts do not need any medical assistance to stop taking heroin; and contrary to received wisdom, heroin addiction most certainly is a moral or spiritual problem. A literary tradition dating back to De Quincey and Coleridge, and continuing up to the deeply sociopathic William Burroughs and beyond, has misled all Western societies for generations about the nature of heroin addiction. These writers' self-dramatizing and dishonest accounts of their own addiction have been accepted uncritically, and have been more influential by far in forming public attitudes than the whole of pharmacological science. As a result, a self-serving, self-perpetuating and completely useless medical bureaucracy has been set up to deal with the problem.

Chimborazo: The Confederacy's Largest Hospital (review)

Reviewed by: Chimborazo: The Confederacy’s Largest Hospital Elizabeth White Nelson Chimborazo: The Confederacy’s Largest Hospital. By Carol C. Green. (Knoxville: University of Tennessee Press, 2004. Pp. 200. Cloth $29.00.) It is a pleasure to read a "success story" about Civil War medicine. Carol Green's history of Chimborazo helps counter the popular belief that Civil War medicine was always characterized by filth, disorganization, and brutal surgical practices. Green also provides a compelling story of Confederate administrative success. Although the Confederacy lacked the established medical department of the Union Army, the absence of existing medical bureaucracy had unexpected advantages. Because Confederate surgeons viewed their service to the Confederate Army as a temporary situation rather than a career, there was greater continuity of staff in Confederate hospitals than in Union hospitals, where surgeons often requested transfers in the interest of advancing their military careers. Samuel Preston Moore served as Surgeon General for the Confederacy for the duration of the war, whereas four men filled that position for the Union. Chimborazo was a new facility, located outside the city of Richmond on a plateau with good ventilation and easy access to the York River Railroad. Dr. James Brown McCaw, a respected Richmond physician, was responsible for the planning and administration of Chimborazo. The pavilion plan that McCaw adopted was based on British hospital design, influenced in part by Florence Nightingale's writing after the Crimean War. Large-scale hospitals were regarded with suspicion at the beginning of the war since most men had never experienced medical care outside the home. Patients and families alike feared that the care in a hospital would be inferior to home care, and many soldiers preferred to stay in camp and be nursed by their comrades rather than risk the dangers of a hospital. The success of Chimborazo, Green argues, can be measured not only by its relatively low mortality rate of 11.39 percent but also by the positive reports of the patients who received care at the hospital (65). [End Page 330] Although patients with similar ailments, especially those with infectious diseases, were housed together, the hospital wards were more broadly organized by state. This arrangement allowed comrades to remain together, and it eliminated jealousy when food and supply shipments were sent by individual states. As supplies became increasingly scarce, the staff of Chimborazo had to fall back on their own resources and discrepancies between state contributions caused significant tension. By careful management, McCaw was able to continue to provide adequate care even in the face of substantial shortages of medicine, fuel, and food by the last year of the war. Despite concerted efforts to maintain sanitary surroundings, rats remained a common part of ward life. Rat stories abounded. One matron controlled a group of unruly and unhappy patients by "reminding them of her willingness to stew the rats they had caught when the cook refused" (76). Another patient attributed his successful recovery to the assistance of a "rat surgeon," who chewed off a troublesome growth on his wound during the night, revealing the healthy flesh beneath (141). These stories help illustrate the unsavory realities of hospital life that even the most diligent administrators and nurses could not prevent. Unlike Union hospitals, which increasingly relied on women to provide a workforce of nurses, much of the nursing done in Confederate hospitals was done by male slaves, who were hired for wages by their masters. Women served as matrons, and did their share of nursing care in that role, but they did not make up the majority of nurses. This demographic difference from Northern hospitals may explain why Green's story of doctor-nurse relations seems more harmonious than its Northern counterpart. Dr. McCaw's ties to the Medical College of Virginia and his editorship of the newly founded Confederate States Medical and Surgical Journal contributed to the professional quality of medical care at Chimborazo. Green's discussion of McCaw's compassion and professional interests help to counter the image of Civil War physicians as incompetent, drunken hacks and the notion that administrators routinely turned a blind eye to these abuses. By challenging common assumptions about administrative incompetence and medical negligence, Green makes an...

Book Review: The ceremonial order of the clinic: parents, doctors and medical bureaucracies

Book Review: The ceremonial order of the clinic: parents, doctors and medical bureaucracies

Innovation and leadership in a mental health facility.

For 3 1/2 years an occupational therapist persevered in efforts to introduce an innovative outpatient service of multidisciplinary team case management within a general community hospital. The service was intended to meet the needs of discharged clients with severe mental illnesses who were attempting to live successfully and satisfactorily in the community. The reality of attempting to initiate change in medical bureaucracies involves ongoing negotiation and persuasion, issues of power and politics, differing cultural visions, and strongly committed leadership. This case study describes the developmental process of innovation and the contribution of occupational therapy philosophy and practice to the therapist's emergent leadership in promoting cultural change. Some of the lessons to be learned from this case study by others who would attempt institutional innovation include articulating a clear vision that uses new language, building coalitions, and being flexible and persistent.

The Myth of the Golden Years:

Adjusting to old age requires more than coming to terms with eventual physical decline. It also demands accepting the permanent loss of loved ones. This autobiographical account describes both positive and negative experiences during the seventh decade of life. My coping skills have been enhanced by previous employment as a mental health professional. As an older woman, I have been forced to become my own social worker, acting on my own behalf with medical and other bureaucracies. And, as a retired social worker, I have the ability to evaluate the skills and limitations of those care providers who have been called upon to assist me in coping with the problems of old age.

Medical Power and Social Knowledge.

PART ONE: INTRODUCTION Medical Sociology Religion and Medicine From Sin to Sickness PART TWO: CONCEPTS OF DISEASE AND SICKNESS On Being Sick Madness and Psychiatry - Colin Samson Women's Complaints Patriarchy and Illness Aging, Dying and Death PART THREE: SOCIAL ORGANIZATION OF MEDICAL POWER Professions, Knowledge and Power Medical Bureaucracies The Hospital, the Clinic and Modern Society Capitalism, Class and Illness Comparative Health Systems The Globalization of Medical Power PART FOUR: CONCLUSION The Regulation of Bodies Risk Society and the New Regime of Disease The Expanding Field of the Sociology of the Body