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Medical Anthropology Quarterly

Eric Plemons
Since 2014, public and private insurance coverage for transgender Americans' surgical care has increased exponentially. Training clinicians and equipping institutions to meet the surge in demand has not been as rapid. Through ethnographic research at a surgical workshop focused on trans- genital reconstruction and in a U.S. hospital working to grow its transgender health program, this article shows that effects of the decades-long insurance exclusion of trans- surgery are not easily remedied through the recent event of its inclusion because patient access is not the only thing that has been restricted by coverage denial...
November 8, 2018: Medical Anthropology Quarterly
Mark D Fleming, Janet K Shim, Irene Yen, Meredith Van Natta, Christoph Hanssmann, Nancy J Burke
Hospitals throughout the United States are implementing new forms of care delivery meant to address social needs for structurally vulnerable patients as a strategy to prevent emergency department visits and hospitalizations and to thereby reduce costs. This article examines how the deployment of social assistance within a neoliberal institutional logic involves the negotiation and alignment of economistic values with ethics of care. We focus on care practices meant to stabilize the socioeconomic conditions of the most expensive patients in the health care system-the "super-utilizers"-through the provisioning of basic resources such as housing, food, transportation, and social support...
October 6, 2018: Medical Anthropology Quarterly
Susan L Erikson
Evidence from Sierra Leone reveals the significant limitations of big data in disease detection and containment efforts. Early in the 2014-2016 Ebola epidemic in West Africa, media heralded HealthMap's ability to detect the outbreak from newsfeeds. Later, big data-specifically, call detail record data collected from millions of cell phones-was hyped as useful for stopping the disease by tracking contagious people. It did not work. In this article, I trace the causes of big data's containment failures. During epidemics, big data experiments can have opportunity costs: namely, forestalling urgent response...
September 2018: Medical Anthropology Quarterly
Natali Valdez
The rapidly shifting field of epigenetics has expanded scientific understanding of how environmental conditions affect gene expression and development. This article focuses on two ongoing clinical trials-one in the United States and one in the United Kingdom-that have used epigenetics as the conceptual basis for testing the relationship between nutrition and obesity during pregnancy. Drawing on ethnographic research, I highlight the different ways that clinical scientists interpret epigenetics to target particular domains of the environment for prenatal intervention...
September 2018: Medical Anthropology Quarterly
Julia Hornberger
The counterfeiting of medication is increasingly seen as a major threat to health, especially in the light of both the everyday reliance on and a broadening of world-wide access to pharmaceuticals. Exaggerated or real, this threat has inaugurated, this article argues, a shift from a drug safety regime to a drug security regime that governs the flow of pharmaceuticals and brings together markets, police, and health actors in new ways. This entails a shift from soft disciplinary means aimed at incremental and continued inclusion of defaulters, to one of drastically sovereign measures of exclusion and banishment aimed at fake goods and the people associated with them, in the name of health...
September 2018: Medical Anthropology Quarterly
Lauren Carruth
Based on ethnographic and policy research in the Somali Region of Ethiopia, this article examines how contemporary trends in the humanitarian relief industry to mandate continual data collection, "accountability," and the "localization" of aid have increased demands for participatory and intensive research methodologies in crisis-affected communities. International humanitarian relief agencies hustle to hire local staffs and recruit enough participants for their repeated research projects, while at the same time, the so-called beneficiaries of aid also hustle to participate in data collection as paid informants and temporary employees...
September 2018: Medical Anthropology Quarterly
Ann M Cheney, Steve Sullivan, Kathleen Grubbs
Scholars have traced the processes through which moral subjectivities are constituted in culturally meaningful ways through eating disorders and recovery practices, demonstrating how subjective meanings of eating disorders and recovery from them are imbued with moral undertones and become meaningful ways of existing within specific historical and cultural contexts. Drawing on ethnographic insights and interviews with young women with disordered eating histories in southern Italy, we show how suffering from eating disorders and recovery from them enables women to retool their identities and craft moral selves...
September 2018: Medical Anthropology Quarterly
Gabriela Elisa Morales
This article examines how efforts to "culturally adapt" birthing spaces in a rural Bolivian hospital are generating debates among doctors about what constitutes proper obstetric care. Working at the intersection of national and transnational projects, NGOs in Bolivia have remade the birthing rooms of some public health institutions to look more like a home, with the goal of making indigenous women feel more comfortable and encouraging them to come to the clinic to give birth. Yet narratives of transformation also obscure ongoing conditions of racial and gendered inequality in health services...
September 2018: Medical Anthropology Quarterly
Ugo Felicia Edu
Drawing on ethnographic fieldwork among black women, medical personnel, and activists in Brazil, this article highlights the implications of hierarchical medicalization. I show that the prioritization of particular forms of medicalized contraception for women located differentially in society enables different relations, political positions, and mobility. Denial of a tubal ligation in favor of modern reversible contraceptives, in a context of inequitable distribution, can perpetuate social stratification. This work contributes to literature exploring the complexity of medicalization and its relationship with society via reproduction...
August 20, 2018: Medical Anthropology Quarterly
Edna Bosire, Emily Mendenhall, Gregory Barnabas Omondi, David Ndetei
This article investigates how international donor policies cultivate a form of biological sub-citizenship for those with diabetes in Kenya. We interviewed 100 patients at a public hospital clinic in Nairobi, half with a diabetes diagnosis. We focus on three vignettes that illustrate how our study participants differentially perceived and experienced living with and seeking treatment and care for diabetes compared to other conditions, with a special focus on HIV. We argue that biological sub-citizenship, where those with HIV have consistent and comprehensive free medical care and those with diabetes must pay out-of-pocket for testing and treatment, impedes diabetes testing and treatment...
August 16, 2018: Medical Anthropology Quarterly
China Scherz
While vernacular therapeutics had long been a topic of interest to many writing about medicine and healing in Africa, with a few exceptions most recent anthropological writings on medicine in Africa are focused on biomedicine. In this article, I trace this shift back to the turn of the millennium and the convergence of three events: the emergence of global health, the accession of the occult economies paradigm, and critiques of culturalism in medical anthropology. I argue that these three shifts led to research projects and priorities that looked different from those defined and undertaken as late as the late 1990s...
July 17, 2018: Medical Anthropology Quarterly
Mara Buchbinder
This article draws on ethnographic research on the implementation of Vermont's 2013 medical aid-in-dying (AID) law to explore a fundamental paradox: While public discourse characterizes AID as a mechanism for achieving an individually controlled autonomous death, the medico-legal framework that organizes it enlists social support and cultivates dependencies. Therefore, while patients pursuing AID may avoid certain types of dependency-such as those involved in bodily care-the process requires them to affirm and strengthen other bureaucratic, material, and affective forms...
July 16, 2018: Medical Anthropology Quarterly
Jamie Lorimer
Historians of science have identified an ecological turn underway in immunology, driven by the mapping of the human microbiome and wider environmentalist anxieties. A figure is emerging of the human as a holobiont, composed of microbes and threatened by both microbial excess and microbial absence. Antimicrobial approaches to germ warfare are being supplemented by probiotic approaches to restoring microbial life. This article examines the political ecology of this probiotic turn in Western health care. It focuses on Necator americanus-a species of human hookworm-and its relations with immunologists...
July 13, 2018: Medical Anthropology Quarterly
Clare Herrick, Andrew Brooks
Global health partnerships (GHPs) are the conceptual cousin of partnerships in the development sphere. Since their emergence in the 1990s, the GHP mode of working and funding has mainly been applied to single-disease, vertical interventions. However, GHPs are increasingly being used to enact Health Systems Strengthening and to address the global health worker shortage. In contrast to other critical explorations of GHPs, we explore in this article how the fact, act, and aspiration of binding different actors together around the ideology and modes of partnership working produces the perpetual state of being in a bind...
July 3, 2018: Medical Anthropology Quarterly
Emma Louise Backe
This article explores the politics and contingencies of care provided to survivors of sexual assault on a rape crisis hotline in the U.S.'s mid-Atlantic region. The support provided to survivors on the hotline represents a crisis of care, one fomented by the victim services sector's failure to address the limitations of a crisis-oriented paradigm or survivors' chronic trauma. The tension between the survivor-centered model of the hotline and the mental health needs of clients represents a friction of utility-a misalignment between the care hotline advocates provide and the support survivors seek...
July 2, 2018: Medical Anthropology Quarterly
Natalie Hannah Porter
Social science concepts of well-being are largely premised on notions of a common humanity with shared physical needs and broadly legible experiences of the world. While medical anthropologists have interrogated ideas of universal bodily subjectivities, articulations of well-being across species boundaries remain underexplored. This article offers a conceptualization of well-being that attends to species difference. Drawing on ethnographic research with an animal rescue organization, I argue that in the context of partially connected bodily experiences, rescue workers navigate distinctions between dogs' internal feelings and external actions, and they train their bodies alongside dogs' bodies to cultivate canine well-being...
June 21, 2018: Medical Anthropology Quarterly
Tsipy Ivry, Elly Teman
This article explores the way that surrogacy and normal pregnancy share cultural assumptions about pregnancy. Through a juxtaposition of our ethnographic studies of two groups of Jewish-Israeli women-women who have undergone "normal," low-risk pregnancies and women who have given birth as gestational surrogates-we argue that surrogacy and pregnancy emerge as potent metaphors for one another. Both pregnant women and surrogates divided their bodies into two separate realms: fetus and maternal pregnant body...
June 2018: Medical Anthropology Quarterly
Richard D Chenhall, Kate Senior
This article provides a critical discussion of the social determinants of health framework and compares it with theoretical perspectives, such as that offered by assemblage theory, offering an alternative view of the complex interplay between human relationships and the structures around us. We offer an ethnographic perspective, discussing the lived experiences of the social determinants in an Indigenous community in a remote part of northern Australia.
June 2018: Medical Anthropology Quarterly
Peter C Little
This article critically examines the corporate production, archival politics, and socio-legal dimensions of corporate mortality files (CMFs), the largest corporate archive developed by IBM to systematically document industrial exposures and occupational health outcomes for electronics workers. I first provide a history of IBM's CMF project, which amounts to a comprehensive mortality record for IBM employees over the past 40 years. Next, I explore a recent case in Endicott, New York, birthplace of IBM, where the U...
June 2018: Medical Anthropology Quarterly
Margaret Pollak
American Indians have some of the highest rates of diabetes worldwide, and they are disproportionately affected by the secondary complications of the disease. While most research on Native populations focuses on reservations, this study investigates diabetes care in Chicago's Native community. People living with diabetes manage blood sugar levels to prevent the development of secondary complications. As with many diabetics, the majority of their health care work is completed outside of the biomedical setting...
June 2018: Medical Anthropology Quarterly
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