Suomen Antropologi Volume 37, 3/2012
Special Issue: Change, Choice and Identity Politics in Contemporary Health Care
A Medical Anthropological Perspective
Guest editors: Marja-Liisa Honkasalo and Susanne Ådahl
When ‘to Choose’ is ‘to Care’: Informed dissent and the case of paediatric vaccinations
Suomen Antropologi: Journal of the Finnish Anthropological Society 37(3) 2012: 8-23.
In Italy paediatric vaccinations are compulsory and perceived as a normal practice of good, responsible parenting, not a matter of choice. Still, a minority of parents reclaim the right to choose. Vaccinations are a complex field of debate for diverse reasons: they concern the delicate issue of children’s health; severe, chronic and debilitating conditions are present even if only in potentia and choice is necessarily delegated to parents. This paper illustrates discursive, practical and legal negotiations undertaken by parents claiming the right to choose in their encounters with biomedical experts. Parents have to deal with a social, medical and legal system that strongly discourages exemption from vaccination but, at the same time, biomedical experts often give ambiguous and contradictory information. According to parents, uncertainty and inconsistency is created by the strong pressure to foster vaccinations exerted by pharmaceutical companies on national health systems. The paper does not aim to give a judgment of value on different perspectives; it offers a reflection on the fact that the main elements included in the logic of care may be unattainable when health management is multifaceted and linked to wide networks of economic interests.
The Freedom Machine: Home-based dialysis and caring for the Self
Suomen Antropologi: Journal of the Finnish Anthropological Society 37(3) 2012: 24-41.
In recent years policy-making in the Nordic welfare states has been steadily moving from a position where responsibility for health was lodged within society, to where it is becoming the responsibility of the individual, turning patients into ‘customers’ of the health care system. The ideology of self-care management is part of this growing trend, even for patients whose therapeutic regime includes the use of high-tech medicine and devices in a home environment. This article is based on the experiences of one such group of patients: those suffering from kidney failure and undergoing home-based haemodialysis care. Taking as its point of focus the metaphor of freedom, used by medical professionals involved in marketing the option of home-based dialysis, the article outlines how it impacts on the issue of care and of choosing this particular form of care. The qualitative data used in the article is based on interviews conducted with homedialysis users in Finland, whose experiences of dialysis circle around the theme of achieving freedom in using the dialysis machine by progressing through three stages; acceptance, integration and autonomy. The article is structured around these questions: What is freedom in the context of home-based haemodialysis? To what extent does self-managed care liberate patients and their family members?
Living by Numbers: The dynamic interplay of asymptomatic conditions and low cost measurement technologies in the cases of two women in the Danish provinces
Suomen Antropologi: Journal of the Finnish Anthropological Society 37(3) 2012: 42-56.
In recent years medical anthropologists have been busy trying to keep up with the many new developments and changes that are taking place in the fields of medicine and health care. In spite of new scientific discoveries being made in the fields of DNA-research and biotechnology, however, some of the most significant changes that have taken place in the everyday lives of senior Danes are fairly mundane—namely the ones related to the advent of preventive health. Where in the past health care was primarily thought of in terms of therapeutic treatment of health failures, the emergence of preventive health has brought about a situation where health risks are increasingly being medicated and where ‘good health’ in the form of physical exercise and healthy diets has become a moral imperative. Based on insights from ongoing ethnographic fieldwork among older adults in a provincial area in Denmark, this article traces how numerical expressions of the body have become pivotal for the everyday practices of older adults and the work they perform on themselves.
The Sociality of the Pill: Biomedicalization of HIV in a South African township
Suomen Antropologi: Journal of the Finnish Anthropological Society 37(3) 2012: 57-74.
The (bio)medicalization thesis is here studied through interviews with a voluntary HIV treatment counsellors in an urban township in South Africa. The counsellors are patients themselves, but are formally engaged in treatment programs as volunteer counsellors for other patients. They form a vocal support and advocacy group within the clinic where they volunteer, as well as in the community and society at large. I will examine how they talk about their own views on expertise and knowledge, health care, authority and involvement. The paper will suggest that these patients represent their own position, their work and knowledge about the illness and its treatment in a way that does not fit well into dichotomies like the demanding consumer patient versus the passive recipient of treatment; the autonomous patient living with a disease versus the patient defined by medical authority; expert versus lay knowledge. These patients, rather, describe their lives, care and survival as an entangled net of different relations that sustain them, a net of relations that produces healthier embodiment including both human and non-human actors: for example, food, laboratory results, transport to the clinic, and last but not least, the pills. The pills are there only through political decisions and funding, therefore adding the dimension of rights and global injustice to the spectrum of questions that the biomedicalization thesis should consider.
Everyday Ethnography: Interpreting and ‘doing’ empowerment and protection care imperatives in a supported-living environment for intellectually disabled adults. Findings from experiences as a support worker
Suomen Antropologi: Journal of the Finnish Anthropological Society 37(3) 2012: 75-88.
This paper details findings from my own experiences as a support worker working in a UK-based supported-living home (previously residential care) for adults with intellectual (learning) disabilities. These findings, along with other previous research, which investigated access to health and social care for this population (Redley, Banks, Foody and Holland 2012), have formed the basis of my doctoral research—an ethnographic study of this environment—which, since submitting this paper, has now commenced. Importantly, the experiences to which I refer are drawn my own perceptions of the nature of the supportedliving setting in which I worked. Although, it is not possible to remove my perceptions as a researcher from my experiences as a support worker, what is relayed in this paper is not formally connected with my previous work as a researcher.
In recent years, social care services have begun to alter the way that full-time support is provided to recipients of services. These changes are set within a larger context of reform that is premised upon empowerment, through independence and choice. Such principles require individual self-determination, and the introduction of this ethos in the lives of adults who are limited in intellectual functioning has been questioned. In undertaking employment as a support worker within an organisation providing support to adults with intellectual disability, my intention was to begin to gain direct insight into how, or whether, changes in the nature of services and models of care that are provided in an everyday supported-living home for people with intellectual disabilities are impacting upon daily care practices and relations between service providers and service recipients.
‘I certainly hope ethnography survives’: An interview with Margaret Lock
Suomen Antropologi: Journal of the Finnish Anthropological Society 37(3) 2012: 89-96.
Margaret Lock and Susanne Ådahl.
Suomen Antropologi: Journal of the Finnish Anthropological Society 37(3) 2012: 97-102.
Karen Armstrong: Douglas W. Hollan and C. Jason Throop (eds). The Anthropology of Empathy: Experiencing the Lives of Others in Pacific Societies (97)
Michael Amundsen: Laimonas Breidis. Vilnius: City of Strangers. Mariusz Czepczynski. Cultural Landscapes of Post-Socialist Cities: Representation of Powers and Needs (99)
Interesting New Publications
Suomen Antropologi: Journal of the Finnish Anthropological Society 37(3) 2012: 103.
Árnason, Arnar, Nicolas Ellison, Jo Vergunst and Andrew Whitehouse (eds) 2012. Landscapes Beyond Land: Routes, Aesthetics, Narratives. Berghahn Books.
Bloch, Maurice 2012. Anthropology and the Cognitive Challenge. Cambridge University Press.
Hastrup, Kirsten and Karen Fog Olwig 2012. Climate Change and Human Mobility: Global Challenges to the Social Sciences. Cambridge University Press.
Lemonnier, Pierre 2012. Mundane Objects: Materiality and Non-Verbal Communication. Left Coast Press.
McGovern, Mike 2012. Unmasking the State: Making Guinea Modern. Chicago University Press.
Moberg, Mark 2012. Engaging Anthropological Theory: A Social and Political History. Routledge.
Schielke, Samuli and Liza Debevec (eds) 2012. Ordinary Lives and Grand Schemes: An Anthropology of Everyday Religion. Berghahn Books.
Scott, James C. 2012. Two Cheers for Anarchism: Six Easy Pieces on Autonomy, Dignity, and Meaningful Work and Play. Princeton University Press.
Taussig, Michael 2012. Beauty and the Beast. University of Chicago Press.
Uimonen, Paula 2012. Digital Drama: Teaching and Learning Art and Media in Tanzania. Routledge
West, Paige 2012. From Modern Production to Imagined Primitive: The Social World of Coffee from Papua New Guinea. Duke University Press.
White, Jenny 2012. Muslim Nationalism and the New Turks. Princeton University Press